112. Josh Clemente: Why Energy Crashes Keep Happening and How to Stop Them

What if the future of medicine isn't about diagnosing disease, but preventing it entirely? For decades, our healthcare system has only reacted once things go wrong. We measure when there are symptoms. We intervene when there is a crisis. But what if we could see the shift before it becomes an illness? In this episode of EXTEND, I'm joined by Josh Clemente, founder of Levels and former SpaceX engineer, to explore how continuous health monitoring is about to change human health at scale. Josh shares how engineering principles—not traditional medicine—first revealed the hidden metabolic patterns that were draining his energy, affecting his cognition, and pushing him toward disease long before any lab test reflected it. We discuss why continuous glucose monitoring is only the first step in this revolution, how data empowers individuals instead of the healthcare system, and why the next era of health will be defined by observability—real-time insight that lets you adjust, course-correct, and optimize your biology every single day. Josh Clemente is the co-founder of Levels, a metabolic health platform bringing continuous glucose monitoring and real-time lifestyle coaching to the mainstream. Previously, he led life support systems engineering at SpaceX, where he developed safety technology for astronauts aboard the Crew Dragon spacecraft. What's Discussed: (00:00) Why You Should Own Your Health Data — Not Your Doctor (05:50) The Tech That's About to Replace Annual Checkups (17:47) The Medical System Won't Fix Chronic Disease — You Will (26:02) AI + Biology: The Turning Point We've Been Waiting For (35:15) Learning to "Read" Your Body in Real Time (45:54) How Small Daily Inputs Create (or Reverse) Disease (57:05) What's Coming Next in Wearable Health Tech (01:06:57) Continuous Monitoring: The Future of Metabolic Health (01:13:57) Metabolic Health = Energy. And Energy = Life. (01:27:11) Final Takeaways: Empowerment, Data, and Ownership Thank You for Our Sponsors: NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/https://www.next-health.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram:@darshanshahmd https://www.instagram.com/darshanshahmd/ Learn more about Josh Clemente: Instagram: @levels https://www.instagram.com/levels Instagram: @josh.f.clemente https://www.instagram.com/josh.f.clemente Website: https://www.levels.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  You know, we measure many things that matter. We're measuring our steps, maybe our calories, maybe even our screen time. But there's one piece of data that can actually change how long and how well you're living today. The human body is one of the most complex systems we know, but yet, we're barely scratching the surface of how we're measuring it. Today, I'm going to be joined by an expert who lives in this world, Josh Clemente. He's the founder of Levels Health, one of my favorite companies. But he's a former SpaceX engineer, and that's important because he's applying engineering to biology, and he's making the future of health measurable. We're going to dig into concepts like biological observability,

• 1:31Dr. Darshan Shah?

  how real-time data can expose silent risks like metabolic dysfunction, and why consistent measurement, not guessing, is the key to health optimization. Josh also shares the exact framework he used to drop his APOB from 98 to 73 in just six weeks using a simple tool, Measure Change Measure. We're going to talk to you about that protocol. And we're also going to discuss how applying engineering precision to human biology can redefine what prevention and performance look like in the next decade. Josh, a former SpaceX engineer and the founder of Levels Health, a company pioneering in real-time Metabolic Measuring for Everyday Health Optimization is my guest today.

• 2:14Dr. Darshan Shah?

  He's going to talk about how integrating continuous glucose data with life cell analytics. He's going to talk about how his team is redefining how we understand energy, nutrition and performance, and bridging the gap between engineering precision and human biology. Welcome to my show, Josh Clemente.

• 2:34Dr. Darshan Shah?

  Josh, welcome to the podcast Extend. It's such an incredible pleasure having you here. Long time coming. I've been using the Levels device that you created for, it was basically my first CGM that I used. Yeah, my first continuous glucose monitor. And when it first came out, I was talking to your team members and your app was just being launched. And I was so excited to see this come to fruition. And you know, I think for my patients, it's been an absolute game changer. So it's an honor to welcome you to the show.

• 3:04Speaker 01

  Well, thank you so much for having me here. I could not be more excited to have the conversation I've been following next for, for a long time. And, and what you're doing with, with all of your businesses is just, it's really pushing the industry forward and in ways that I couldn't be more grateful for. So, so thank you and thanks for hosting me.

• 3:18Dr. Darshan Shah?

  Yeah, it's, it's a pretty incredible what we, what we're doing, I think, and how the industry is changing. Don't you think like, I think people are finally taking control of their own health and understanding what their own data means to their health, right? And giving them access to it, the way you did with the Levels app that allows you to see what your glucose level is every five minutes, is that correct?

• 3:41Speaker 01

  Yeah, roughly five minutes, depending on the device you're using. Yeah, it's a total paradigm shift. And you know, I think it's still only the first infant step towards where we need to move, which is an abundance environment for, for health information. You know, the, when I first tried to get a CGM myself, and this was now almost 10 years ago, I was really disheartened by the interaction I had with this physician. You know, I was able to go down to a pharmacy and grab a finger prick device to measure blood sugar one time, and my fingernails were black and blue from, from sticking the needles in. And I was just asking, you know, can I get this tool to kind of understand what's going on a little bit better? Something's off. And I was basically shamed out of his office.

• 4:23Speaker 01

  You know, he was, he was frustrated and upset that I would ask for that device. And I think we've seen, you know, if you now fast forward to where we are today, I don't think that pushback exists anymore. And that's really exciting. And yet we have so much more to do.

• 4:36Dr. Darshan Shah?

  When was that that you went looking for a continuous glucose monitor?

• 4:39Speaker 01

  That was in 2016.

• 4:41Dr. Darshan Shah?

  2016. So, I mean, it's only less than 10 years how the perception has totally shifted. For the most part, I still think there's some doctors that, I mean, I read this in medical journals, that continuous glucose monitors have no data to show that they change the trajectory of anyone's health outcomes. I'm like, so we're going to wait till people die to find out if this thing works or not?

• 5:00Speaker 01

  Yeah, I really, I really just have to laugh at it. As an engineer, you know, it's, it is such a, it's a bit of a Luddite sort of philosophy that, you know, we have to wait before adopting new technology until there is the most etched in stone evidence available. And, and deaths are happening every day.

• 5:18Dr. Darshan Shah?

  Yeah.

• 5:18Speaker 01

  At the expense of this simple information, the people, by the way, that defines the health of the individual. So, going back to that first interaction, asking for a CGM, the doctor's position was that I had to be severely sick, not just diabetic, but uncontrolled diabetic, to have this tool. And as an engineer, what we were doing every single day was using data to measure the health state of our machines that we were building, so that we knew as soon as we subtly shifted off of that healthy trajectory. And that's what I wanted for myself. And when my doctor said, no, you can't have that information, I responded, this is my body. Why am I even asking you? Shouldn't you be asking me?

• 5:55Dr. Darshan Shah?

  Right.

• 5:55Speaker 01

  For this information? And, and that sort of triggered this, this thought, like, imagine going to a financial advisor, and my financial advisor says, you don't need access to your bank account information. Let me handle that.

• 6:06Dr. Darshan Shah?

  Mind blowing, right?

• 6:07Speaker 01

  I mean, I'd fire that person immediately.

• 6:09Dr. Darshan Shah?

  Exactly.

• 6:09Speaker 01

  And so, you know, where, where have we gone wrong that we even have this philosophy that, that anyone other than ourselves should own and control our health data and, and use it to our advantage, which includes, by the way, working with experts we trust to take that information and help us make the most of it. But that's the direction we're going in, and, and levels exist to break down the barriers to this technology, not just CGMs, but. All of the technology we need to measure and understand health state. And eventually, we'll be able to take that and really see some amazing human flourishing as a result.

• 6:38Dr. Darshan Shah?

  Absolutely. Jess, what made you go into the doctor's office to, you know, seek out a continuous glucose monitor? Were you not feeling well? What was going on?

• 6:47Speaker 01

  Yeah, it's a good question. So at the time, I was working at SpaceX. It was a really, really intense environment. I'd been there for over five years at this point, and I was leading a team. We were developing life support systems for astronauts. And so the goal was to keep people alive in space. SpaceX had never done this before. It was incredibly honored. I felt very honored by the challenge, and also, it was incredibly difficult, you know, emotionally and stressful. And I was experiencing a lot of symptoms, physical symptoms. And, you know, in retrospect, these things were all connected, but I had no idea what was going on under the hood. I would, every day, I would have these strange episodes of like frailty. It's hard to describe. Such low energy that I had to take a seat. I was like kind of cold, sweat and shaky.

• 7:29Speaker 01

  I'd have this pit in my stomach and, you know, it's 11:30 a.m. What's going on? I was 26 years old at the time. And so, you know, I was just very confused. And I actually would tell my mom, you know, I think, I think I might have a terminal illness. And she would say, you really need to go get checked, like go, go figure out what's going on. So I got all the blood work. My doctor basically said, oh, your vitamin D is a little bit low. You know, maybe take a supplement and you're super healthy. And it just was not a satisfying answer because there was every day, my, my experience of my life was very affected by this. And even though I was relatively fit looking on the outside, I worked out really hard. I was a CrossFit trainer at the time as well. These episodes of low energy and fatigue and shakiness and flushing, skin flushing and rapid heart rate were so pronounced

• 8:12Speaker 01

  that eventually I just started to take things in my own hands and say, I'm going to do this myself. I'm going to figure out how to measure my body in a way that is satisfying.

• 8:21Dr. Darshan Shah?

  And there you ended up in the doctor's office and he was like, no, you can't have this data.

• 8:25Speaker 01

  Right.

• 8:26Dr. Darshan Shah?

  But back then, you know, continuous glucose monitors were being used for like type one diabetics for the most part. When did they start getting used for type two diabetics? Was like, I know Levels is the forefront, but was there any history behind that?

• 8:39Speaker 01

  Well, the devices have have matured somewhat rapidly. They could have moved more more quickly if we had more of a more of a kind of private industry free market. Right now, the healthcare system really breaks the incentives. So the technology would be far ahead of where it is today if we if we made it more accessible. But yeah, they certainly started with the intention of just helping people with type one diabetes who have an immediate concern around their blood sugar, right? They have to manage it or it's life or death, to give them that real time data. And the the type two use case kind of came about through the Freestyle Libre device first. Dexcom was kind of one of the first to bring about a type one device. And then Dexcom, you know, kind of led that space. And then Abbott came in with the second technology, which was the Freestyle Libre.

• 9:23Speaker 01

  And they got an indication for use for type two diabetes. And, you know, that's kind of where things were around the time that I I wanted to get a CGM. I had heard about the Freestyle Libre getting approved. It it was really funny. It didn't even connect to your phone at the time. Again, this is this is 2016. Bluetooth existed, but we, you know, you had to use this like little pager device you carried around.

• 9:44Dr. Darshan Shah?

  I had that.

• 9:44Speaker 01

  You couldn't zoom in, you couldn't scan. It was just like a trace like from, you know, the Apollo era or something. And and still, it was the most incredible technology I'd ever interacted with. It told me immediately what was happening to my body as I took an action, I saw the reaction. So type two was, you know, sort of the 2016, 2017 timeframe. And since then, it's really been an uphill battle to convince the industries, both the hardware and the medical industry, that we should not be approaching access to technology based on a disease diagnosis, right? It's it's unreasonable for every human being that's walking around. Blood sugar is flowing through your veins. Management of it is fundamental to human life. We should not be sort of gating access based on disease. Certainly, we should prioritize people who have an immediate condition like type one

• 10:29Speaker 01

  diabetes. And every diabetic person should have a CGM. I think it should be borderline mandatory, right?

• 10:34Dr. Darshan Shah?

  Exactly.

• 10:35Speaker 01

  But it's unreasonable to say that you cannot understand your health state if you do not have a diagnosed disease. And in fact, you know, I would argue it's totally backwards.

• 10:43Dr. Darshan Shah?

  I completely agree with you. I mean, like, why do we wait till someone gets into a disease state, a diagnosed disease state, to then finally start using technology to reverse the disease? Not even reverse, manage a disease state. We wait decades too long sometimes, and so it's mind blowing to me, and obviously you and I are on the same page here. That's why we created Next Health, is to, number one, monitor people, so you never get there in the first place. But if you are in a chronic disease state of a type 2 diabetes is one of those, knowing that you can reverse that using tools like this, right?

• 11:15Speaker 01

  Absolutely.

• 11:16Dr. Darshan Shah?

  You probably use the finger stick devices as well to measure your glucose.

• 11:21Speaker 01

  I did.

• 11:21Dr. Darshan Shah?

  And, yeah, those are painful and hard to use long term. I used them when I was on the keto diet also to monitor my ketone levels. And then when the continuous glucose monitor came out with the little filament that goes in your arm and feeds now directly to your phone without even the little interface, you can see your glucose every five minutes. Do you see this technology being also useful for ketones, other measurements that we can use?

• 11:46Speaker 01

  100%. This is the future direction, and the potential for the technology is so profound, it's frustrating that we aren't there yet because the technology exists to make this a reality, to be able to measure human physiology in its completeness.

• 12:01Dr. Darshan Shah?

  Constantly.

• 12:03Speaker 01

  Constantly.

• 12:03Dr. Darshan Shah?

  Right.

• 12:04Speaker 01

  Today, and basically, measurement is the wrong term. It should shift to monitoring, which is a passive observation. Today, we are measuring this tiny little slice of physiology, which is blood sugar. And we did that because there's an acute disorder in diabetes. That's why we ended up there. And that's backwards. And again, so this is going back to the engineering principles. What I think we have to do is we have to merge the practice of medicine with the practice of engineering. And they have different philosophies, and each can learn from the other. But the future of health will be that merger. In engineering... We measure our complicated machines in the healthy state deliberately. In healthcare, we measure and look for disease state. We wait until there's a symptom. You have to have a diagnostic code.

• 12:49Speaker 01

  You have to have some symptom to complain about. And then we go and search forensically what could be wrong already. And if you don't find anything, they say, go away. You don't need any more measurements. We have to flip that paradigm. And to measure in the health state, it is known as health state monitoring. We do this for all of our complex machines. I'll give you an example.

• 13:07Dr. Darshan Shah?

  Yeah.

• 13:08Speaker 01

  An Airbus A350, which is a newer airplane, is collecting two and a half terabytes of information per flight day.

• 13:15Dr. Darshan Shah?

  Incredible.

• 13:15Speaker 01

  It's a thousand, thousand megabytes. And that is from, there are tens of thousands of sensors on every surface of that airplane. And just inside the engines themselves, the parameters of the jet engine are being observed continuously at the millisecond scale on the order of thousands of sensors. Now, does that induce anxiety, all that measurement? Of course not. If you're a pilot with 250 passengers, you're flying across the Atlantic Ocean in a twin-engine airplane. You are not pushed into anxiety by the fact that those engines are being observed in real time. In fact, it's peace of mind.

• 13:46Dr. Darshan Shah?

  Exactly.

• 13:46Speaker 01

  Because you know, as soon as something goes wrong, you're going to be told about it, you're going to be able to take action, preventive action. That's the direction we have to shift. And it's not a subtle distinction. To look for just glucose because there's a disease associated with it is backwards. To look at the healthy state and observe the full spectrum and identify anything that starts to drift in a direction of disorder is fundamentally rethinking why we measure in the first place. One other example, which is kind of mind-blowing. The modern car collects about 25 gigabytes of data per hour. The average person will get 80 megabytes of healthcare data in their lifetime.

• 14:26Dr. Darshan Shah?

  Wow.

• 14:26Speaker 01

  So the car is collecting four times more data per hour than you will get in your entire life from the traditional healthcare system.

• 14:32Dr. Darshan Shah?

  Oh, my gosh.

• 14:33Speaker 01

  And that's just totally broken, totally backwards.

• 14:35Dr. Darshan Shah?

  Completely broken and backwards, right? And to your point, the technology is there. We're just not even developing it because of our healthcare system and the incentives of the way they are. I think, let's be honest, the reason the continuous glucose monitor Was developed was because there was a diabetes type two I C D nine code that you can now bill for and you can have insurance pay for that C G M. Right. And then, once they did that and they started getting payment, there was no other diagnostic codes to go after. So let's just stop developing this device. No more R and D dollars went towards this. But I think you and I both know, like this filament technology can be utilized in, like you said, many other data points. And we need to shift our mindset. We got to get away from this. You know, if it's paid for by insurance, we will do it. Otherwise, it just stops there.

• 15:19Speaker 01

  Totally. I, I, I 100% agree. And you know, there's, when you have a product that you are paying money for, and in exchange, you get some value, that that's a very direct system. And the incentives align really nicely. So you want to build a technology that people find a lot of value in, and they're going to be willing to pay a commensurate amount for it. We don't have that in healthcare, right? You know, it's trying to get that C G M. I would, I was willing to open my wallet and pay whatever it costs to get a C G M. But I was, I was prevented from it. And there's this three party system where payment isn't transacted by the person who produces it. It's totally backwards.

• 15:52Dr. Darshan Shah?

  Totally backwards.

• 15:52Speaker 01

  So this is why what you're doing, and what Levels is doing is so important, is because we're building true transactional relationships with our customers. And our goal is to align incentives and help achieve the best version of health for that person. And to do so, we have to build really valuable technologies that help people to understand and improve health. And, you know, there's, there's a world in the very near future where we're able to better understand human biology than, understand it at least on the same scale as we understand the internal combustion engine, right? You know, right now, we, we measure all of our machines continuously, because it's that continuous nature of the measurement that matters. It's

• 16:34Speaker 01

  how it's responding to the load conditions that it's being exposed to, how that machine is responding to real environments around it. That's what you're looking for. You're not looking for a point in time measurement. Did the engine run properly on the tarmac before takeoff? Nobody cares about that. You care about it when it's over the Atlantic Ocean, you know, in Arctic conditions with a hurricane force wind coming at it and 200 people on board. That's when you care about it. And with the human body, we The most complex machine, we measure fasting glucose, right? The basil rested, most preserved state. And we do that for some reason, because we we kind of think that it's maybe the most consistent measurement. I'm least interested in the most consistent measurement. I want to know what's the most out of bounds measurement? When I'm poorly slept, when my blood pressure's out of control, when I've eaten a piece of birthday cake,

• 17:17Speaker 01

  you know, and my and my blood pressure's high and my heart rate is is up and alcohol's in my system. And I suddenly have to, you know, sprint after my baby who's who's run into the street. You know, is am I going to be able to respond to that circumstance? Do I have the resilience? Is my body going to be able to function? I need to know that before that moment happens. Otherwise, I may not be able to achieve what I need to in the moment. And so so the point is, is that the continuous dynamics of measurement, right? It's that continuous nature that we do not have in our healthcare system today has to become the expectation for everyone. I need to know how my body is performing in all conditions, not in the best case scenario during a, you know, a fasted glucose check.

• 17:55Dr. Darshan Shah?

  Exactly, exactly. And fasting blood glucose, for the listeners, that's something that you measure with a blood test. And how often do people get blood tests? Not often enough, like, you know, even if you get a yearly exam from your doctor, many times they won't even look at the fasting blood glucose on there. If you've even, you know, and a lot of times they don't even tell you to go fasted. You just go and do the blood test and they go, oh, you didn't fast. It's fine. It's probably high because you ate something. And then you never get the benefit of understanding what your glucose is doing until it's way too late, until your fasting blood glucose is like 300. And now, all of a sudden, you're diabetic and an alarm goes off, right? And that's the system that we've lived in since the 80s. And it's time to make a change. And to your analogy, I love your analogy of the airplane, right?

• 18:38Dr. Darshan Shah?

  We measure terabytes of data for every flight. And the monitors in front of us, in front of the pilot, let them know way before something is going to go wrong. That's why the aviation industry is at such a high standard right now, where planes very rarely, rarely crash, you know? And people feel very comfortable getting on an airplane. And if we thought of our health that way, right? Like, every person should think of their health as a dashboard. And they need to understand what are the different dials and what do they mean? And when things are going in the wrong direction? And we should be empowered, not just with the data, but also given the knowledge and be trained in our biology to understand what that dashboard is telling us, right? And so.

• 19:23Dr. Darshan Shah?

  Yeah, my dream is to teach this in high school to every kid in high school, right? Here's what your continuous glucose monitor means. Here's what your heart rate means. Here's what your HRV means. And these are all data points that are available to us. And to your point again is we're just scratching the surface because, you know, it's so frustrating. Like you said, like we have the technology. We've had it for decades now. Why have we not built this out?

• 19:46Speaker 01

  Right.

• 19:47Dr. Darshan Shah?

  Right?

• 19:47Speaker 01

  Yeah, there, you know, I, there was this concept in Star Trek of this device called a tricorder.

• 19:52Dr. Darshan Shah?

  Yes.

• 19:53Speaker 01

  Right? And, you know, maybe, maybe the nerd in me is coming out. But this device seemed, we had, there was like an X Prize challenge around building a tricorder about 15 years ago. And it seemed to me at the time, like surely this technology already exists. All, all it does is it just measures, you know, it observes the, the health state of this, you know, person and it just identifies any, any problems, right? That's, that sounds like something that our technology industry would be able to build.

• 20:18Dr. Darshan Shah?

  Yeah.

• 20:19Speaker 01

  And it turns out like we don't even have the, we don't even have the motivation to build that at the moment. And it's again, it's because we completely miss the purpose. It's not that, you know, every single measurement of that two and a half terabytes that that aircraft is producing is some profound insight. It's exactly the opposite. It's totally boring. It's passive. Nothing's happening. That in and of itself is important. As soon as you see a blip from that passive baseline, something's going wrong or something's trending towards going wrong. That's where the interesting stuff happens. And you want 99.999% of it to be totally uninteresting. That means that's health. That's resilience.

• 20:53Dr. Darshan Shah?

  That's health, right?

• 20:54Speaker 01

  Right? And that is what we're missing in healthcare is we are looking, we are forensic pathologists. We're looking for what's broken. We need to be looking at what's healthy so that we can know when something starts to break and exactly the cause and effect of it. This concept is super well understood again in, in engineering and the sciences. It's called observability. If you have a complicated system and you can measure enough of the outputs of the system, right? You can measure enough of the parameters that you know its state, then like you can actually model it, right? And then you can identify cause and effect. So an input changes and suddenly the outputs change. Now the state is different. That if you can model. All that you have what's known as observability and this is a little bit like maybe it's a little bit in the weeds.

• 21:36Speaker 01

  But it's a really important concept because when you have cause and effect, you have control. Now you can modulate the inputs to affect a certain output. And when we think about health, I mean, it's so, it's so interesting. We have blue zones where we go and we, we interview people like you, you won the lottery, you won to, you lived to a hundred years. Tell us how you did it. What combination of, you know, you had one whiskey a night, you had a cigar on your 21st birthday. Are these things, what, what caused you live to a hundred? You know, we're sort of looking at people like in this almost superstitious way. Well, that's because we don't have observability. We don't know how they got there and any conclusions we draw are wrong, entirely wrong. And so, once we get to the point where we are understanding, we have to be able to observe this complicated system. Sufficiently high resolution that we can model it, which is not easy, but we'll get there.

• 22:20Speaker 01

  Then and only then can we take the targeted actions to control our health at the individual level. And this is, this is why I have such a controversial take, but right now, nine of the 10 leading causes of death in the United States are directly chronic illnesses or caused by them.

• 22:33Dr. Darshan Shah?

  Exactly.

• 22:34Speaker 01

  And yet, I do not believe that doctors should be treating or preventing chronic illness.

• 22:39Dr. Darshan Shah?

  I agree.

• 22:39Speaker 01

  I firmly believe this.

• 22:41Dr. Darshan Shah?

  I see this on my podcast all the time. You know, the Western medical system was never built to deal with chronic disease. It's built for disasters. It's built for if you get hit by a bus, if you, you know, get diagnosed with stage four cancer and need surgery and chemotherapy. That's what it's built for, heart attacks, right? But everything leading up to that, that's not what the system was built for in the first place, right? So, sorry, sorry to interrupt you, but I just want to emphasize, you know, people listen to this podcast and they hear me say the same things over and over again. It's great to hear someone else say it in a different way.

• 23:11Speaker 01

  I feel it so strongly and I know that, I know you align with this and, and it's like, we need to put our foot down. And, and I think doctors need to, they, you know, right now I feel for the system. I feel for these people who, who want to help. But they're totally ill-equipped. They don't have the technology to under, to really understand somebody's chronic illness or why it's developing. But even more importantly, they can't affect the change anyway. It's, it's us. It's the, so we make these subtle decisions on a daily basis. Those decisions compound on each other.

• 23:38Dr. Darshan Shah?

  Yeah, the inputs.

• 23:39Speaker 01

  Exactly. Those are the inputs. It's what we're eating, our exposure to sunlight, our environment, the toxins, our sleep quality, our exercise. All of this stuff, these are, these are small in, in a vacuum, but they compound on each other. So each one affects the next and on and on and on. And over years and decades, this, this manifests as chronic illness and lifespan. And it's not the physician who has the ability to change these inputs. It's me. I have to be able to connect the dots between a cause and an effect, an action reaction. That's the beautiful thing about a continuous glucose monitor is that you eat something, within 10 minutes, you can see how your blood sugar is changing. You can take action, you can take a walk, you can do some squats. You know, or you just see, oh, wow, that's actually going much better than I thought. Like, there is no blood sugar elevation. Interesting. Maybe it's because I'm sensitized. My muscles are sensitized because I just worked out.

• 24:22Speaker 01

  You learn things immediately and the behavior change, again, compounds on itself into a different outcome. That is the paradigm we have to replicate to alleviate the system. Physicians should no longer have to worry about chronic illness because we have completely alleviated it. We've shifted it through technology so the individual can understand their health state, the cause and effect, not just blood sugar, across hormones, inflammatory environment. You know, blood sugar, lactate, fats, proteins, understand our bodies, the cause and effect, so that we can control them and we can alleviate the system to do what it does incredibly well, which is to affect traumatic, you know, contagious disease, the types of things that the medical system like originally was developed for before this chronic illness epidemic.

• 25:00Dr. Darshan Shah?

  Yeah. The combination of those two, a Western medical system that deals with disasters and then the other, I think that should be 5% of the system. The other 95% is basically individuals taking control of their own biology and having the tools to do so will completely break this trend towards more and more chronic disease, in my opinion. I think we have the power within a generation to completely reverse this and it only happens with tools like the continuous glucose monitor as one of those tools that everyone makes a part of their life, right? And then understanding that there's other tools. And then, you know, Jason Huang, I think his last name is, the founder of Nvidia, I just told you this story.

• 25:41Dr. Darshan Shah?

  He was just asked a few months ago at, in Berkeley, when he did an interview or onstage interview presentation for the students at Berkeley. One of the students asked him, what is the most exciting thing that you are looking forward to with this technological revolution that you're building at Nvidia? And he said, without a, you know, you can look up the YouTube video, he said, without a shade of a doubt, the one thing he's most excited about is finally biology is going to become an engineering problem. And when biology Both of us get chills when we hear this, right? I mean, you gotta watch this video. It'll give you chills. But you know, the smartest man in the world telling us we're almost there where biology becomes an engineering problem. And then everything that you said becomes true. You can control the inputs. You can reliably predict the outputs.

• 26:25Dr. Darshan Shah?

  You can make minute by minute, second by second changes in your behaviors and your habits. And you could completely reverse and avoid chronic disease. Then nine of the top 10 causes of death go away. Guess what? The other 10th one is probably gonna go away too, using artificial intelligence driving our vehicles, right?

• 26:43Speaker 01

  Totally.

• 26:44Dr. Darshan Shah?

  And we get to a point where people just finally die of an old age with their health, right?

• 26:50Speaker 01

  It really is a vision of the future that I'm excited by. It's aspirational thinking around health. And you know, what Jensen's getting at there is is something that I, every single day I wake up excited for, which is that we are finally at the point with our technology that we can crack biology. It's the most complicated and mysterious of all of the, of all of the, you know, you call it systems or concepts. Like biology is, it's physics and chemistry. It's so complex. It is us. It's our experience. And we, you know, it doesn't necessarily mean that we'll understand consciousness or some of the metaphysical elements. But understanding how the human body is functioning, that is a solvable problem. And what Jensen's getting at is turning that into an engineering problem.

• 27:34Speaker 01

  It's exactly what I was trying to say with the merger of medicine, practice of medicine and the practice of engineering. We have to be able to measure and then intervene and be able to construct health from the raw inputs. And I'm so excited by not just the technologies we've had, like since the iPhone, right? There's been this amazing revolution in microelectronics and small batteries and like the stuff that you need to make sensors. So now we have that. And then with this AI revolution, it's like, I was telling you, it's, it feels like it's meant to be. Suddenly we have the ability to generate so much data that, yeah, it can be complicated. Like, how do you, how do we possibly use this in an efficient way? And then all of a sudden, AI breaks through. And now you have this like amazingly simple interface to complexity. And you know, you can sort of talk to your own biological information.

• 28:18Speaker 01

  Like whoever thought that that would be possible. I mean, even in the wildest science fiction, I don't think we imagined that what we're seeing right now with the AI revolution would be possible, especially on the time scale. So, you know, this is why I'm so excited that, you know, with the, with a simple interstitial filament, a little, a little filament like a CGM, like what I'm wearing below the skin, there are thousands and thousands of molecules circulating in that interstitial space. All of those molecules is in and of itself an input. It's a measurement, right? Some are more valuable than others. But the fascinating thing is as you measure more than just one molecule, you get, so let's say you measured two molecules. Well, you actually get a third. So let's say we're measuring glucose and insulin. So those are two fascinating, really important molecules. Insulin is the hormone that helps glucose come into the cells for energy.

• 29:03Speaker 01

  But you're getting a third marker, which is the glucose insulin index. It's how they move relative to each other. And that means because for every two measurements, you get a third, that means there's an exponential value here. The formula grows massively with few increases in the inputs. And, and that's the, so the information unlock with just a few additional markers being measurable is exponential. It's incredible. And that's what AI is built for.

• 29:30Dr. Darshan Shah?

  I never thought of it that way. That is so true. AI is built to manage that data and the interactions between different data points. So, and then that's just two. Then you throw a third one in there, it accelerates even more rapidly because now you have the interactions between those interactions as well, right?

• 29:45Speaker 01

  Exactly. Yeah. So the, so the complexity and the value, it makes me smile because it's like the complexity. It's just a few. This is, this goes to your point. You always, you always raise the 2080 paradigm. Like that, that like, you know, 20% of the information gives you 80% of the value. 100% agree. And this is that example. Maybe 20% of the markers that are circulating are going to give us the vast majority of information about our health. And AI will help us target those. And so, you know, in the example of glucose and insulin, you know, insulin's a hard molecule to measure. But if you have that glucose insulin index, You suddenly can understand your insulin sensitivity and your insulin resistance. And there's this fascinating concept that we do not at all use in medicine. I've read maybe three papers that mention it in scientific journals.

• 30:30Speaker 01

  And they're typically from PhDs who are not necessarily, they're like in biological research. We don't use it in medicine at all. But it's so fundamental. So our bodies are these kind of wet chemistry sets, right? Things are, we're introducing chemicals through our food and through our environment, our sunlight, into our bodies, and then new chemicals are being synthesized all the time, breaking those things down and turning them into energy, et cetera. It's a chemistry problem, very complicated. There's a concept called hysteresis, and it's, I'm trying to make it complicated. It's very simple. It just means that the state of a system is affected not just by the current moment, but by its history. That's what it boils down to. Think about a thermostat. So in your house, let's say, you know, your thermostat is set to 70 degrees.

• 31:13Speaker 01

  Well, if the temperature in your house increases to 71 degrees, the thermostat typically doesn't turn on, right? It's only once it reaches, say, 72, then it turns on, and it doesn't turn off the instant it hits 70. It actually will cool to about 68, and then it will turn off. And then it will start to rise back, and it'll hit 70, but it won't turn on, even though the setting is at 70. And what's interesting is, at any moment, if your house is 70 degrees, do you know if your thermostat is on or off?

• 31:38Dr. Darshan Shah?

  Right, you don't know.

• 31:39Speaker 01

  You don't know. Because it depends on whether the temperature is increasing or decreasing. Think of this like insulin and blood sugar. If your blood sugar is rising rapidly, and it hits 100 milligrams per deciliter, your body is producing a lot of insulin to address that glucose. But what if it's crashing, right? It's coming down from 200 to 100. Now your body's not producing insulin. It's actually trying to figure out how to prevent it from going even lower. Maybe it's producing glucagon or something else. So at 100 milligrams per deciliter, your body, you cannot tell, if you just have a single data point, whether your body is producing insulin or not, how it's responding to that. That's hysteresis. It means that you have to know the history of the system to know what any one measurement means.

• 32:20Speaker 01

  And when we have continuous data across more than blood sugar, we're going to be able to map the hysteresis loops of our body. And again, the word is a little bit complicated, but the point is just simple. The history of a complicated system affects its current moment.

• 32:34Dr. Darshan Shah?

  Yeah.

• 32:34Speaker 01

  We can't do that in medicine. It has to change.

• 32:36Dr. Darshan Shah?

  Yeah, and continuous data monitoring will enable that for sure. There's one difference to kind of highlight in this analogy that we have is that each one of our individual bodies are an N of one, right? Like, we're not talking about an assembly line of airplanes here. We're talking about your biology being different than my biology being different than, you know, another person on the streets biology, obviously, right? And so we have to develop these systems for each individual. And I think that's also something to highlight because AI will also be able to do that on an N of one basis for us, right? So the continuous glucose monitor is a perfect example of this. This is why I give, I really encourage all of our patients to wear it because I can't

• 33:17Dr. Darshan Shah?

  tell you that a particular fruit is going to raise your blood glucose or not. I just don't know. There's so many other factors that affect it differently in your biology versus mine. Number one is what's the status of my pancreas, right? Number two is what's the status of my liver? Three is what did I, did I work out or not? What is my gut microbiome doing? And so all of these different inputs are different into the system from one person to another. And so it's, I think, more complicated than your typical engineering problem with machines, but also it's not something that can't be overcome.

• 33:52Speaker 01

  Of course, yeah.

• 33:53Dr. Darshan Shah?

  Yeah.

• 33:53Speaker 01

  Absolutely. You know, what, what's always been a little bit frustrating is when you look at the state of current, like, you know, epidemiology or nutritional science or, or even even more targeted trials, like randomized controlled trials, we, we sort of average out all of the variation, right? And so it's, it's the N of many.

• 34:12Dr. Darshan Shah?

  Yeah.

• 34:12Speaker 01

  But few data points paradigm. We measure lots of people a few times.

• 34:16Dr. Darshan Shah?

  Right.

• 34:17Speaker 01

  And so you'll look at these plots of the effect size, right? For any, let's say, you know, for anything, right? A certain food or a certain exercise routine or a certain medication even. And you'll see that there's this distribution, right? It's like a bell curve.

• 34:30Dr. Darshan Shah?

  Bell shaped curve, yeah.

• 34:31Speaker 01

  And there are data points all the way across the bell curve. Most of the people are kind of in the middle, but then there's people on this side and there's people on that side. And those are real people.

• 34:38Dr. Darshan Shah?

  Yeah.

• 34:39Speaker 01

  This person had a totally different response than that person.

• 34:41Dr. Darshan Shah?

  Exactly.

• 34:42Speaker 01

  If I'm this person, I want to know, am I this person or am I that person? And so we, we kind of, we deliberately average that out. We say, oh, it doesn't work or it does work. But actually. We know that it works for some people and it doesn't work for others. This has always, always, always been in the data.

• 34:55Dr. Darshan Shah?

  Yeah.

• 34:55Speaker 01

  And we try to completely suppress it and a lot of scientists don't like this when you cherry pick, they call it. But if it's real, right? If it's me on that bell curve on the left side versus the right side, that's not cherry picking for me.

• 35:09Dr. Darshan Shah?

  Yeah.

• 35:09Speaker 01

  It's cherry picking for the conclusion for the population. Fine. That's not what I care about. The future is going to be N of 1 with many data points. So not N of many, few data points, N of 1 with many data points. You will be doing randomized controlled trials on yourself. The equivalent, you know, the gold standard will be introduce a change, measure the impact with very high resolution on your health, introduce a different change, observe the effect. And we will be able to do real, high quality science. In fact, I think we're going to look back and kind of laugh at the old school paradigm we were in, where we had to measure other people that were nothing like us to try to predict what we should do. Yeah, I think there's a really funny analogy here as well. Again, to kind of make it machines again.

• 35:48Dr. Darshan Shah?

  I love it.

• 35:48Speaker 01

  I do this, but imagine your car, for those of us that don't drive EVs, imagine your car didn't have an oil pressure gauge. And when you were trying to figure out when to check or measure your oil, you had to consult a journal where some researchers went and they sampled randomly cars in a different part of the world and measured the oil quality. And then they published that in the journal and you had to pay money to see the journal and then figure out, okay, based on these diesel trucks, you know, in Nebraska, should I change the oil in my Honda Civic in New York? It'd be absurd.

• 36:19Dr. Darshan Shah?

  Absurd, right.

• 36:19Speaker 01

  But that's what we do with medicine. We're like sampling randomly people who aren't us and trying to predict, how does this affect me? How should my choices change? What should I eat for lunch?

• 36:27Dr. Darshan Shah?

  Exactly. This is mind blowing, yeah. But you know, that's all we had for many years and that's what created this incredible system that we have. But it is time for a change. And you know, I don't think this is in the future like 100 years. This is now. People can do this currently with a technology right now. And so if you're not doing this now and you're going to wait. Because maybe you have data overwhelm. I hear this a lot. Like, I don't want to know the data. It stresses me out. Or maybe you think that, um, you know, the doctor telling you that you don't need that unless you're type two diabetic. You're gonna miss out on just, first of all, the health benefits you can have now, but also getting into the mindset as things advance, right? Because as things advance, if you don't know how to use like an iPhone five,

• 37:12Dr. Darshan Shah?

  using a new iPhone like an iPhone seventeen is very difficult, right? There's so many more options, so much more you can do with it. So I think it's important to start now with this mindset. Do you agree with that?

• 37:23Speaker 01

  A hundred percent. You know, there's this concept of like data native or like internet native, right? It basically just means that you you've kind of like, you know, grown up with the ecosystem and you understand it. And there's absolutely a disparity between people who can, you know, use computers and can't today in our modern world where everything is powered by these things. And there's going to be a similarity with with our healthcare system, or, you know, the future, like healthcare three point O system, where it's powered by this continuous accessible data. And people who have gotten an early jump on this, who wear wearables, they measure their heart rate, they measure their HRV, they measure their blood sugar. They have an incredible advantage already, right? I mean, you see this, one of the things that's manifesting is kind of this like reduction in alcohol.

• 38:05Speaker 01

  And I'm one of those people, you know, I wore a Garmin watch and saw how just kind of crushed my my heart rate would be. It would be like twenty percent higher overnight and I would wake up poorly recovered. And, um, you know, it was just so stark and you just take the alcohol away, even even just a glass of wine at dinner was doing this to me. And these things compound, again, like over over a long time period, the inflammation, the quality of my rest, the recovery, how I can sort of heal from infections, that sort of thing is being affected by those those poor sleeps. And so, you know, that's that's just a, you know, simple example, but but that kind of like ecosystem familiarity is going to be really important. Now, tools, again, like AI is going to make this so much more accessible. And it sounds, you know, to kind of address the point around.

• 38:49Speaker 01

  The overwhelm and the anxiety, like firstly, in the world that we're talking about, this is not combing through reams and reams of spider web data.

• 38:58Dr. Darshan Shah?

  Right.

• 38:58Speaker 01

  Right?

• 38:59Dr. Darshan Shah?

  Exactly.

• 38:59Speaker 01

  This is a simple interface. Most likely, it's actually just passive. It's probably just an AI assistant saying, you should pick this item on the menu, not that one. And that's like already interpreting your cortisol state, your blood sugar, your lipids history, your family history. All that stuff is packaged into that one recommendation. It's like, oh, easy. You know? But more importantly, I think that the anxiety point, the reason we're in this world where a healthcare measurement feels like a scary thing

• 39:24Dr. Darshan Shah?

  Yeah.

• 39:24Speaker 01

  is because we've been in a scarcity environment for so long.

• 39:28Dr. Darshan Shah?

  I agree.

• 39:29Speaker 01

  Let's take the imaging example. So MRI is this incredible technology, right? Magnetic resonance imaging. It uses magnetic fields to be able to measure all the soft tissues and like create a map of the human body. Really profound, there's no radiation involved. And so you can do it without like X-ray exposure and such. I personally believe that every person should be getting a full body MRI every year and it should cost like 50 bucks.

• 39:52Dr. Darshan Shah?

  Yeah.

• 39:53Speaker 01

  Unfortunately, today, it's about a six month waitlist. You have to have a soft tissue damage in order to even like kind of get a recommendation for an MRI. And it costs on the order of like $2,500 on average. So in a world where an MRI is expensive, it's artificially scarce, and you have one image, you have to take action on any result that you get. So there's this fear, what's going to be in the image? Like, I'm terrified of that measurement because what if it should show something that's that's off or that's scary? You know, a surgeon might have to cut me open and try to like extract it or something. Well, that's only in the world where MRIs are scarce. In a world where everyone has an MRI on a continuous basis and they're affordable and accessible, you can just take another scan, right?

• 40:38Speaker 01

  Just see, is it still there? Is the artifact still there? Maybe wait three months. Has that abnormality changed, developed in some way? If so, then you can take action. So we only have this scary world when data is scarce and when we have to take an action based on it, which could be a bad action. In a world where it's abundant and you have it continuously, you become familiar with the trends and patterns and you can take action only in targeted ways when you're really well informed. And it's frankly a travesty. There's a lot of unfortunate situations where physicians are exposed to unnecessary risk because people are trying to take action on too few measurements.

• 41:13Dr. Darshan Shah?

  Yeah, I totally agree with you. You know, we're doing a lot of analogies here, so I love this, but. The way I like to think of that data overwhelm problem, I talk to my patients about that. I'm very empathetic towards them, you know, I understand, right? Because you feel disempowered because you, no one's ever given you the data before. And then you also don't really know what to do with it either, once you have it. And so I think education preceding the data is really important. Because then you feel more empowered to make actions. So, I'll use sleep as an example. A lot of times I'm convincing my patients to get like an Oura ring or some sort of sleep tracking device, like a Whoop band or whatever have you. And a lot of times people are like, I just don't want to know because I don't know what I'm going to do about it. So then I educate them, like, here are the things you can do in your sleep environment.

• 41:57Dr. Darshan Shah?

  Here are the things you can do in your sleep routine. Here are some of the other, you know, nutrients that you can take to help your sleep better. And then once you have that knowledge, then the data can be affected by your knowledge, right? And so I think if you, if you approach it in that way, it can be really powerful. And I also tell them, like, look, obviously, when you learn to drive a car, when, if you go back to, you know, high school and you were taking driving lessons, you had a lot of anxiety because you were going to get all this data for the first time into your brain, right? But what happens after even just a few months of driving that car? It's like you can do it, you know, without even thinking about it. People end up from home at work without even thinking about it, right? And so you're, for me, tracking my own data is, now, I don't even think about it.

• 42:39Dr. Darshan Shah?

  It just, it just happens in the background and my brain has developed habit loops around what to do and how to look at it, et cetera, et cetera, and it just works.

• 42:46Speaker 01

  Totally. Yeah, I think it's, you know, it's really common. There's maybe, there's maybe like an initial learning curve and then, then you kind of get familiar with it. And some of the, like, you've sort of explored the boundary box and like, yeah, you've had those bad nights of sleep. You've also had great nights of sleep and you can start to connect those dots. But what we found at Levels is that, like, over the past, we've kind of had three phases of Levels. Phase one was just break down barriers, get the technology out, get it to people. Phase two was start to develop insights, help people create some action ability, like identify these causes and effects where we could. Phase three is really a maturity. It's kind of to your point, like, having that information and being informed or educated. Right now, we're incorporating coaching.

• 43:29Speaker 01

  And additional information in the form of blood work alongside CGM. We've been doing blood work since 2020, but it's giving a more comprehensive view. And it's coaching people in the progression from measurement to improvement to measurement again. And that has really been a breakthrough for people. You know, we've recently seen that for people that are going through this blood work plus CGM plus our coaching. On average, 80% are improving out of range biomarkers. And they're doing it with, this is all lifestyle first, right? We're not doing medications for this. And so it's entirely just recognizing that you are fully empowered. Like you have this information, we're telling you how to connect action to reaction, what's driving it. And then you just go do it and then measure again and you see, wow, that worked. It wasn't just, it's not out of my control.

• 44:13Speaker 01

  And that's where the magic moment happens where it's like, none of this stuff is woo woo. It's like, oh yeah, my food affects my, my health, my sleep affects my health, exercise affects it. This is like, it's, it's in my control.

• 44:24Dr. Darshan Shah?

  Yeah. And there's another powerful aspect to having the data as well is that it's incredibly motivating to see the change actually happen. Right?

• 44:32Speaker 01

  Totally.

• 44:32Dr. Darshan Shah?

  And so when I started wearing the continuous glucose monitor, my hemoglobin A1C was like 5.6. I didn't like where I was at. I wanted it to be better. Obviously it wasn't in any sort of diabetic range, but I don't want to wait that long. Right? So using the CGM, I was able to get it down to 5.4 and then 5.3. And now I'm aiming for 5.2. And it's that continuous feedback of the data that's so motivating. It's almost like gamifying it to myself, how I can make that better and better and better.

• 45:04Dr. Darshan Shah?

  This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting edge technology. I actually founded Next Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Next Health using hyperbaric Oxygen, sauna, cryotherapy and LED light is a game changer. In addition, the doctors at Nex Health measure thousands of biomarkers and put into place

• 45:48Dr. Darshan Shah?

  a longevity optimization plan using advanced tools like ozone, plasma exchange and peptides. Go to www.nex.health to check it out.

• 46:02Dr. Darshan Shah?

  Can I ask you about the blood testing? I know you guys have been doing it for a while. I would love to hear any insights that you've gathered from now five years of doing blood tests and tying it in with the CGM data.

• 46:14Speaker 01

  Yeah, it's really fascinating. Again, right now, I think blood work is a necessary bridge technology to where we're going, which is going to be continuous measurement. Right? And so it's a little bit unfortunate because you only have a few data points, but you can do a lot with them. Right? And A1C is a really good example. It's showing you kind of the culmination of your blood sugar over time. The things that we are able to do is supplement beyond just blood sugar. We're able to look at your lipids, right? You know, your apolipoprotein B, your LP little A, your triglycerides. We're able to look at your protein metabolism, your kidney health, able to look at liver health. All of that stuff supports an understanding of what the CGM is telling us. And so I think the most fascinating thing is, so a personal example, I recently ran

• 46:57Speaker 01

  through our, our heart health program at Levels, which takes blood work and CGM data. It sets program goals around protein, net carbohydrates and fiber. And in five weeks from start to finish, my APOB came down from 98 to 73 and with no medication. And this was just following fiber. I targeted 40 grams of fiber a day. I targeted one gram per pound of protein per day. And I targeted net carbohydrates at 40% of my intake. And what I saw was I didn't just see apolipoprotein B improve. My blood sugar improved. So I've always had, since, since using CGM, my, my sort of resting glucose has been elevated, my fasting glucose, and I have sort of impaired glucose tolerance. Blood sugar goes super high for carbohydrates. So that improved.

• 47:42Speaker 01

  My triglycerides came crashing down into the 40s and my APOB came down. And what's amazing is The leverage that we have on these markers, ApoB being a prime example, or LDL, cholesterol is kind of what most people probably have measured, we're kind of told that these things don't change, not quickly, that's for sure. And, you know, sort of any rapid change is probably going to require medication, especially to get down into the regions that I'm in. Well, it turns out that when you use a closed-loop feedback like a CGM, that immediately informs the quality of my nutrition decisions. That's keeping me on the daily accountability path. I'm like closing the loop through that CGM feedback. And then the longer feedback loops being blood work, you're able to like stay focused

• 48:26Speaker 01

  and then lock in the measurement with these North Star metrics. And it's just incredibly, I feel like I can change any marker on my blood panel through lifestyle only with CGM as a partner in it. And a lot of, you know, it's not just me, again, like I said, 80% of people who start with elevated fasting insulin, right, over 18, 80% of them improve it by more than 30 points, just in a few weeks using levels. Triglycerides, another one, A1C, another one, people just improve just through observation with their CGM data. It's a profound, like, it's a manifestation of the Hawthorne effect, which, you know, it's this effect that was, it was from a, I think there was an electrical plant in Illinois called the Hawthorne Electrical Plant or something. And they basically announced to the employees that they were studying productivity.

• 49:09Speaker 01

  And they actually never got the study off the ground, really, but productivity went through the roof. And they were like, hold on a second. It was actually just the fact that people thought their productivity was being measured caused them to improve their productivity. And so if you think that you're, if you know that you're measuring your health, you will pay more attention to it. And that will cause you, just through osmosis, to improve. And I think that, you know, that is what Levels is building on, is it's the cause and effect relationship with the CGM. And the big picture is measured with blood work. And we're able to build this really beautiful feedback cycle with measurements every quarter for blood work and CGM keeping you going daily.

• 49:41Dr. Darshan Shah?

  I love that. And, you know, to this point of this feedback loop that you're developing, it seems like it should be relatively easy then to also tie in other pieces of data from wearable devices. And so is there a world where you're tying in HRV, you know, resting heart rate, et cetera, and bringing that also into kind of that data mix?

• 50:04Speaker 01

  Totally. Right now, we do pull in lifestyle markers from other wearables.

• 50:09Dr. Darshan Shah?

  Oh, okay.

• 50:10Speaker 01

  So, sleep data, heart rate, heart rate variability are all brought into the backend for our system. We're finding ways to, anything we expose on the user interface, we want to be like super actionable.

• 50:21Dr. Darshan Shah?

  Right.

• 50:21Speaker 01

  And so, we kind of like abstract it a little bit. We don't necessarily have like a lot of information about HRV. We're using it to understand recovery quality and sleep quality. And that's super important. So, you know, poor sleep, which I essentially, you know, if there's one thing I would recommend people do, if you're trying to understand sleep, get a heart rate tracker, doesn't matter what device, I use a Garmin watch.

• 50:39Dr. Darshan Shah?

  Yep.

• 50:39Speaker 01

  Measure your resting heart rate overnight. That is beyond anything else, even HRV, that is the best indicator of the quality of my sleep, how low did my heart get overnight? And so, we do pull that information in and use it to assess quality, which then affects today. You know, we kind of had this idea maybe, or like, I think as individuals, we kind of think like, well, yesterday was different from today, you know, fresh start today. And I wish that were true. Unfortunately, yesterday and all the decisions, again, this history, this concept, all the decisions we made yesterday, the quality of our sleep, you know, what we did, what we ate, that actually is going to affect today.

• 51:10Dr. Darshan Shah?

  Absolutely.

• 51:11Speaker 01

  And we need to know that context. And so, Levels really focuses on helping you identify each morning, like, here's where you're starting, and here's how that should affect today.

• 51:19Dr. Darshan Shah?

  Yeah.

• 51:19Speaker 01

  And we'll only get better at this as we add more and deeper information into the mix.

• 51:25Dr. Darshan Shah?

  Yeah, so true. You know, one of the things I noticed with wearing the CGM was how it affected my resting heart rate at night and my sleep, was that the closer I ate anything in my mouth, whether it was anything except water, to my sleep time, it affected my overnight resting heart rate. And so, I kept just turning it back a little bit, time-wise, to where I would only eat, my dinner now is at 5:30 PM, and that seems to be the magic time where I get the best sleep at night. And also, you know, using the CGM, that has to be a meal that is started with fiber, has a big dose of protein in it, and some carbs as well, right?

• 52:08Dr. Darshan Shah?

  And so, you find that magic combination for you, tying in all these data points over time as well.

• 52:13Speaker 01

  Absolutely. You've got better discipline than I do. For a while there, I was able to get my last meal earlier in the day. But lately, it's been drifting. But it's so true. There's this digestion and distributing those molecules. And then the ATB generation and all that stuff. It puts you in a higher energy state, it seems like, to have food processing in your system. And I think Brian Johnson is one of the most extreme examples. I'm pretty sure his last meal is at 11:30 a.m. right now, which is pretty wild. It's certainly not for everyone. But I think the point is, if you look at his sleep streak, I think he had a year of 100% recovery on Whoop. And that's insane.

• 52:51Dr. Darshan Shah?

  Insane.

• 52:52Speaker 01

  Even just the error on that device itself should show some fluctuation. But he's just nailing the recovery so consistently. And that's obviously part of it. And he will say, I've chatted with him a few times, and he'll always say, "The last meal has got to be four hours before sleep." Or, "You're doing yourself a disservice." And so I think that these are those simple or subtle optimizations that, when you can get a receipt, you do that, and then you see the difference between yesterday's sleep quality and today's. And you're like, "Oh, wow. That actually did move the needle on this measurable thing." It's a really strong reinforcement. It's not just like when you read about something on the internet, and then you just wonder, "Well, did it work? Did it matter?"

• 53:34Speaker 01

  You're just very likely going to lose interest in that shortly thereafter. But again, getting that receipt on it helps you commit and stay focused. And that becomes a behavior change, a habit.

• 53:45Dr. Darshan Shah?

  Yeah, absolutely. I love talking to you because you're an engineer, and you have this engineering mindset, and you have this kind of relationship to data that is so innate in your brain. Like, here's how you think about the data. There's nothing magical. There's nothing scary about it. It's just data. And presenting that to people, I think it's difficult right now because, number one, people aren't used to living with data the way you are. And people are not used to having any insight into their biology the way physicians have, going through medical school, and being in front of patients and understanding that insight into biology that we have. And so I think, unfortunately, a lot of people are not comfortable with the data

• 54:29Dr. Darshan Shah?

  and then what to do about it from a physiological standpoint.

• 54:33Dr. Darshan Shah?

  And I'm asking you this question because I fight this battle every day with my patients, you know, and when we first started Next Health, it was 10 years ago, around the same time that you were looking into making the continuous glucose monitor available beyond prescription, right? And it's been a really hard climb to get people used to both of these, right? And so I would just love to hear, how do you talk to people or get them, get their heads wrapped around even just going in this way, right? And so it's kind of like a marketing question. How are you tackling this kind of blue ocean territory, right? Because still, I mean, like probably less than 1% of people wear a continuous glucose monitor, right? There's a massive blue ocean out there. How are you thinking about reeducating people's perception around this?

• 55:19Speaker 01

  I think the vast majority of it is approaching from an aspirational lens that this is empowering. The technology is empowering. And if we become, you know, in any case, if we become at the mercy of our technology, we can subject to it doom scrolling and social media and all these things, they can have these consequences that are negative. But in all the circumstances where our technology is a tool that we use to our advantage, we've seen massive improvements in productivity, quality of life, human flourishing. And it's super, super important to approach this not from fear mongering. You know, I think there's a lot of unfortunate messaging around fear and disease and like you have to measure this because it's probably, you know, sneaking up on you. And if you don't, something bad

• 56:03Speaker 01

  will happen. And inevitably, I think that just reinforces the stigma around this sort of thing. For me, it's, again, it's exactly the opposite. It's that as early and as consistently as possible, we should be measuring the healthy state so that we really understand the connection that we have to the healthy behaviors that we are, you know, doing every day and to understand where it's drifting. And so at any point, it's better to start now than than to not. To get a feel for how your body's functioning, to start to develop interoception, the ability to like connect the data to how I feel. And the beauty of it is that regardless of where you are on the spectrum of health, right? We all have the same processes running in our bodies. And to identify those is not ever scary. It's

• 56:48Speaker 01

  just, all it is, is the current circumstances that already exist, just better defined so that you can understand them. And understanding is always better than not understanding, always. So that aspirational element of like, once you have it, then you can start to improve every day. And every day can be a little bit better than yesterday. And it just flips the paradigm from avoid disease. I mean, it's like saying, you know, avoid bankruptcy is not a retirement plan, right? Right? Avoid disease. Is that really the best we can do in our healthcare system? No, it's, it's achieve your peak.

• 57:20Dr. Darshan Shah?

  Right.

• 57:20Speaker 01

  Live as the best version of yourself. That's the type of messaging that I want to use. And that's the type of thing that gets people interested in trying it. It's like, this isn't going to bludgeon you with, with fearful and disciplinary actions. Telling you, oh, everything you're doing is wrong. And even if it, if it does say everything you're doing could be improved. That's the framing.

• 57:36Dr. Darshan Shah?

  Yeah.

• 57:37Speaker 01

  And here's how you can do it. And so, you know, it's a little bit, it's different for every person, right? Everybody's got to, got to kind of come around on their own, on their own terms. But the more people adopt it and the less stigma that we put on these, on these technologies and the data that it's generating, the better. And I'm, I'm like very happy to say, or I'm willing, very willing to say, I've been pre-diabetic according to, you know, this continuous glucose data for six years. And I struggled to keep myself in a good blood sugar zone. My fasting glucose, I would bet right now, just, you know, mild, the mild stress of, of, you know, being on a podcast, for example, my blood sugar is for sure over 115 right now. And I can tell that intosception, again, my face is a little flushed, my heart rate's a little elevated. I know these things because I've been measuring.

• 58:18Dr. Darshan Shah?

  Right.

• 58:19Speaker 01

  And it's not fearful, it's not fearing inducing. I know what I'm going to do about it. And that's a good thing. It's like, I have a plan.

• 58:26Dr. Darshan Shah?

  Yeah, yeah, it's, it's biofeedback. And then you could tell just by how you're feeling, what's probably happening to your blood glucose. I love that. So I, you know, I'm, I'm so excited about this technology and we've made, I don't know if you even know this or not, but Levels Health is going to be our continuous glucose monitor partner.

• 58:44Speaker 01

  Oh, I know. Quite exciting.

• 58:46Dr. Darshan Shah?

  Yeah. And we're going to highly encourage all of our members, you know, benefit from this data. What are some of the things that you're excited about in the future? Whatever you can tell me that we can see coming from Levels Health. You're already tying in wearable data. You're tying in blood biomarker data. What other data points potentially could be tied into this? And where do you even see the sensor technology going?

• 59:11Speaker 01

  So I can talk about a lot of stuff, but you know, the, the, the direction that Levels is going is biological observability. Right. So we are, we are forging the path for new technologies to be accessible to people. And that those technologies will, will always be useful to measure the human health state better. So right now, yeah, it's the, it's the, the blood sugar, the continuous glucose data, it's labs. But we're building a really powerful health record that you own, an empowering health record that you can completely control. And I'm very excited about this. It, it sounds subtle, but actually it's like, it is the ecosystem. You can put all data that you've ever collected for your health into this ecosystem. And it breaks it out into, into health chapters. And so it kind of gives the progression of you. And right now I'm a new father, my son's six months old.

• 59:55Speaker 01

  And my sleep isn't great, right? One of the consequences of fatherhood. A lot of other things are great. I remember that time. Yeah. And so I'm in a different era. My body is being affected. My health state is different in this current moment. And you know, when I emerge from that, I'm going to have some different goals to, to kind of get back on track. And so the health record that I have tells that story back to me. It explains where I am right now, what's driving my current health state. And so Levels is building these tools that people can really own. They can interpret and interact with your data in a completely empowering, easily exported to interact with physicians, other experts sort of way. Where the technology is going, where the, where the measurements are going is very exciting. The, the ecosystem is changing rapidly. We've got over the counter CGMs now for the first time.

• 1:00:39Speaker 01

  So Freestyle Libre has now transitioned to Lingo for the over the counter. And Dexcom introduced Stello. And there is a recent FDA approval for Biolink, which is a, you know, really the third CGM to get approved in the United States. So the Biolink's new, new product is called Shine. And it's, it's not over the counter, but it is a, it's an entirely new paradigm. It does not have an interstitial filament. It's, it's these sort of microneedle patch. So there's no, it's not as deep. It's worn on a different part. It's worn on the forearm. And it has some really cool new features and the platform that Biolink is building on seems extensible. I know there are lots of teams working on the next phase, which is going from glucose, which has a really

• 1:01:21Speaker 01

  Wrong, obviously diabetes market, but deliberately following levels, right? And we're saying measurement for wellness cases is in and of itself the largest application for monitoring.

• 1:01:33Dr. Darshan Shah?

  Absolutely.

• 1:01:34Speaker 01

  And people, there are many teams that are working on this. I can personally say that I know that there are cortisol, continuous cortisol centers out, there are sensors out there, continuous lactate sensors, continuous ketone sensors. I can't say exactly who's working on all those things, but those all exist right now, today. They have incredibly high value and really, really high quality data. And so that gives you kind of like a sense for the next wave. We're going to move from glucose to multimolecule and it's going to be really a game changer. And then from there, the kind of like 10 years out, I would, I would argue that we will be able to measure a pretty comprehensive view of hormones, inflammatory state, all the metabolites, proteins and potentially even toxins and maybe even like antibodies, viral load. You're, you're going to have a real incredible view of real time health for yourself.

• 1:02:18Speaker 01

  And so I, I just like, I'm beaming it to you every day. I'm so excited to get to work on this stuff and the technology, like literally, we've only taken the first step.

• 1:02:26Dr. Darshan Shah?

  That's incredible. I mean, just every single thing you said there, you know, like to be able to measure cortisol in real time and to know, an alert go off on your phone, your cortisol level has been high for too long, kind of a thing. And let's get out of this, do some breath work.

• 1:02:39Speaker 01

  Totally.

• 1:02:40Dr. Darshan Shah?

  It could be a game changer. One of the interviews I had on this podcast was with Dr. Jay Shaw. And he, no relation to me, but he's working really hard on a continuous blood pressure monitor that just got FDA approval here in the United States called Hilo. And.

• 1:02:56Speaker 01

  That was Actia before?

• 1:02:57Dr. Darshan Shah?

  Yeah, Actia, right.

• 1:02:58Speaker 01

  Yeah, yeah, I've been tracking, I did not realize they just got approved.

• 1:03:00Dr. Darshan Shah?

  Yeah, yeah. And so it'll be distributed here soon. Game changer. I mean, just like glucose, like right now, people measure their blood pressure one time if they're lucky, a year, right? And if you have a blood pressure cuff at home, maybe you'll do it a couple of times a year. Understanding that it's not just that one point in time measurement that matters. It's what's happening throughout the day. What are the situations that raise your blood pressure to unhealthy levels? When do you know in real time? How can you bring your blood pressure down? But also what is that area under the curve? Which is important with glucose measurements too, right? Not only how high is it spiking, but how long is it staying in that state as well? All of those are measurements that we have no idea right now and those compound over time into poor health.

• 1:03:43Dr. Darshan Shah?

  And so, you know, I think even just a combination of continuous glucose monitoring plus continuous blood pressure monitoring. Game changer, right there for people's sake.

• 1:03:52Speaker 01

  That's amazing. I'm really excited to hear that they got US approval. Yeah, I mean, I'm somebody who has also struggled with hypertension. I was first told, I was in ROTC in college, and at 19, I was told that I was hypertensive and I would not be allowed to fly, or in this case, I wanted to fly helicopters. I decided not to commission because of that. No one ever connected that to my lifestyle. I mean, I was sleeping two, three hours a night in certain cases. I had jobs. I was working 21 credits of education stuff. It was just crazy. And of course, my blood pressure was elevated. Now, now I'm able to like, connect those. I have a blood pressure cuff at home. I measure as consistently, as consistently as possible. But, you know, I'm really interested in, the way I measure it is the way that you're supposed to, which is like, you sit at rest for 10 minutes, you know, don't, don't have to go to the bathroom, like, make sure you're like, totally ready, then take one measurement. And that's the best case scenario.

• 1:04:36Speaker 01

  And it's just like, I know that that is not my real circumstance. I'm running a business. I'm trying to exercise. I'm drinking a bunch of coffee. What is the actual area of the curve? And so, these tools, I mean, again, the revolution that's coming is going to be incredible.

• 1:04:49Dr. Darshan Shah?

  Yeah. And I think, you know, luckily, hopefully, everyone listening to this podcast can take advantage of these tools right now. And like you said, start getting some data literacy, right? Start getting used to the data, understanding what affects it. It's so powerful. And you're going to be a major step ahead of most people out there. And the side effect of just avoiding chronic disease, I always say, is you feel great. Like, you feel so much better every day, right?

• 1:05:15Speaker 01

  That's a great way to put it. Yeah, exactly. That's the upside.

• 1:05:17Dr. Darshan Shah?

  Yeah, exactly. Like, you're not just avoiding disease. Like you said, not just avoiding bankruptcy, you're super profitable, right?

• 1:05:24Speaker 01

  Totally.

• 1:05:24Dr. Darshan Shah?

  That's the side effect of knowing what your data is.

• 1:05:26Speaker 01

  Yeah. Yeah, it's, it's, you know, it's really interesting to imagine a world where we, we don't just like, plan financially for retirement. We, we know that we're going to be healthy enough to enjoy it, right? I mean, that's the world we all want. And that means like, yeah, that does mean getting better every day. And, and that's something I can say, I have such a better quality of life as a result of the micro optimizations. And some things, you know, I still have work to do. But the, the difference between where I am now and where I was in my twenties, when I was having all those episodes, inexplicable episodes of just fatigue, and, and just like, honestly, a cognitive cloud that would hang over me, and I would struggle with memory issues and all this stuff. The difference there is night and day. And I'm, I'm so grateful that this technology was available. And, you know, there's so many people that still don't know about it. And we, like, this is why this

• 1:06:09Speaker 01

  podcast is so important, to help people spread the word. Like, this, this technology right now is available today. It can change your life.

• 1:06:15Dr. Darshan Shah?

  Yep, exactly. Um, you know, there's some people that might be new to this world of CGM, and you and I live in it, so we, we, we talk about it kind of freely. But I think it's important for people to understand that, um, the way this works. So the CGM device is made by companies like Dexcom, right? And Dexcom and, um,

• 1:06:34Speaker 01

  Abbott.

• 1:06:35Dr. Darshan Shah?

  Abbott, right, Abbott and Dexcom. And they make basically a patch that goes into your arm that previously you had to get a prescription to get it. Now there are, um, lower costs, maybe a little bit less accurate over the counter versions. Would you say that's true?

• 1:06:47Speaker 01

  Some of the, the data is still coming in. They're supposed to be the same platforms, but, but yeah, they're, they operate a little bit differently.

• 1:06:53Dr. Darshan Shah?

  They do operate a little bit differently, okay. But that's just the hardware part of it. And then you need an app or something to interpret the data that's being fed from that device to your phone by Bluetooth, right? And so that app is the software part of it. And that's where Level Health comes in, is developing software that is easy to digest. The data that is coming from this device, that piece of hardware that you put in your arm. And then what you've done with that data that's coming into the Levels app is you're plotting their glucose over time. But more than that, what you're seeing is what are the moments in time that are causing unhealthy levels of blood glucose, right? And you're empowering people with that knowledge. And it could be food, it could be sleep, it could be exercise.

• 1:07:36Dr. Darshan Shah?

  It could, and what can you do to make those unhealthy levels of glucose better? Take a walk after a meal, start your meal with fiber, um, avoid certain foods. All of that is given to you in this app. And then lastly, what's really beautiful about the app is now you can take a picture of your food and AI will very accurately, actually, I've done this so many times now, tell you the macros in it, what it's going to potentially do to your blood glucose level. All of that, it, it, within seconds, it will tell you that meal, even like a complicated meal, like you mix up a salad, it recognizes what's in there. And the portion size is mind blowing.

• 1:08:12Speaker 01

  Yeah, yeah, well, you did a better job than I would explaining what we do. Yeah, we kind of, we set up the, the node that pulls all the different data in, including from these continuous devices, which, you know, the manufacturers, they do a great job building the hard technology, but then actually translating that into what does it mean? What, what actions can I take? That's what we hear from members who use CGM is I just need somebody to tell me what to do. And what Levels does, and increasingly through the, the application of AI more now on the front end, you're always on the back end, you know, interpreting the data and helping to kind of translate the action to the reaction, how a specific decision, meal, exercise, sleep, affected your blood sugar curve. We've always been using AI on the backend to just help us interpret and surface really good insights.

• 1:08:54Speaker 01

  And now on the front end with, with the, the user interface, you know, being able to effortlessly log your food and break that down. And we have some really exciting things coming soon with, again, better application, the ability to sort of talk and interact with the data in a really powerful way, be able to query into, you know, your health history, the connections between different data streams. And it's just getting better and better. The sandbox that I get to experience on the, you know, on the inside is, is, is really, really exciting. And again, with, with blood work there, all, every step of the way, we, we constantly have that kind of North Star metric of health, the, the stuff that the healthcare system really trusts. And that's, that's given us the ability and for patients to be able to really understand the connections to these, these numbers, but also advocate for themselves.

• 1:09:38Speaker 01

  You know, when you, when you just have a CGM on and, you know, it's showing some traces, a lot of physicians, they don't know what to do with that, right? But when you're able to bring that data along with evidence from your blood work that your A1C improved from, you know, 5.7 or 6.5, you know, for a lot of people, down to 5.2, that's something that gets physicians' attention. You can really talk to the, the healthcare system kind of through. So that's why we're building that health record, like the ability to, to bring all that data into a very concise form that you can interact with physician with, you can export, you can really take control of your health data, not just for your own actions, but to also work with experts. And so that's, that's what Levels is, is access, actionability and empowerment over your health data.

• 1:10:20Dr. Darshan Shah?

  Yeah, and for the practitioners out there, you guys have now also a practitioner dashboard where you can access the data of your patients, correct? So that makes it really fantastic for our practitioners that, you know, a lot of people, to speak to data overwhelm, when we're kind of get people to start using continuous glucose monitors, one piece of data, for example, one of the ways that I kind of mentally get their heads around is say, look, don't even look at the data, just wear it for a little while. And when you come back in to see me in about a month, we'll go pull up your dashboard together and I'll tell you what I'm seeing. And that way, I think they're stepping into this new world. They're first getting the data, not even looking at it, then I'm looking at it

• 1:11:01Dr. Darshan Shah?

  with them, then I'm giving them some tools and like, not just tools, but also like habits, really, to affect the data. And then they'll look at it just selectively. And then they just start getting more and more used to this. And so that's kind of, I would say, the trick I use with some patients that are a little resistant to the data.

• 1:11:18Speaker 01

  Sure. Yeah. That the we've, we've, we intend to facilitate the, you know, physician, the expert practitioner, patient relationship and make these tools, again, these tools can be overwhelming, not just for the individual, but also for the expert. When you've got, I can only imagine, when you've got reams and reams of data coming in from all these different patients who want that, that insight. Right now, it's a little disorganized. And so what we're doing with Levels is helping to organize and make it really simple to access that through our dashboard. And we'll have AI insights as well at the practitioner level. So you, you know, when your patient shares your data with you, you're able to get the, the real quick highlights and the takeaways and, and see that information, be able to work with the, with the patient on improvement. And, and so I think, you know, again, the future is one where the patient is really in control. They're able to make a lot of the right decisions.

• 1:12:01Speaker 01

  Every once in a while, they get tweaks from their, their practitioner and you're really able to be that backstop in case something really goes wrong unexpectedly. And yeah, I think Levels will be that ecosystem. As the technology matures, we're going to translate that into the world.

• 1:12:15Dr. Darshan Shah?

  Yeah, this is fantastic. So, you know, we have a few more minutes and I want to just kind of dive into metabolic health with you real quick. And so, you know, I think many people are now operating from a state of fear because there's a lot of publicity around this data point that 90% of Americans on average have some level of poor metabolic health, right? And so. I have a lot of patients coming to me and they're asking me like, do I have poor metabolic health? And so we go down some of the blood biomarkers of poor metabolic health, like hemoglobin A1C, fasting insulin level. We also have a liver scanner here where we can scan people's liver with ultrasound and see if they have fatty liver disease or fibrosis in their liver.

• 1:12:56Dr. Darshan Shah?

  We also obviously put them on a scale that uses bioimpotence to measure their visceral fat and their total body fat. And all of these are different data points for metabolic disease, right? And people can get a lot of these data points for free at home as well. They can measure, for example, their waist to hip ratio. But it's important to understand whether or not you're headed towards diabetes, but also headed or also like in a state right now of metabolic disease. And so I think for the listeners of this podcast, I would love for you to just kind of give a big picture explanation of what metabolic disease is, and why do you need to know if you have metabolic disease or not?

• 1:13:37Speaker 01

  Yeah, it's, so I try not to just oversimplify, but the, you know, what I really believe is that we think about physical health and mental health. Both of these sit on a foundation, which is metabolic health. Basically, how your cells take in the environment nutrients, et cetera, that we provide and turn it into energy. That's metabolism. And if your cells, so every cell in the body needs to have energy production available to it. And if the cells in certain compartments of the body, certain systems are unable to produce energy in a clean and efficient way, it starts to produce byproducts that are damaging not just to that cell, not just to that system, but also cascade into the wider system and

• 1:14:19Speaker 01

  create inflammation, oxidative stress, and long-term breakdown. And so metabolism, it is life. It is the production of energy, has to be efficient, it has to be in the right proportion. And when that is possible, physical health, mental health are possible. When that starts to deteriorate, neither mental health nor physical health can long-term be possible because metabolic health is not there. So why is it important to know?

• 1:14:42Dr. Darshan Shah?

  Great explanation, by the way.

• 1:14:43Speaker 01

  That's the reason.

• 1:14:44Dr. Darshan Shah?

  You know, I think, I love it because I give one explanation. I had Casey Means on here that gave her explanation that people loved. It became like a viral. Clip on Instagram and then now, you know, and obviously like there's a lot of people talking about metabolic health and to hear your explanation from your vantage point, it's it's another way to think about it. And I think the more ways people think about their metabolic health in different, hearing it from different people, the more they understand the seriousness of it because it is the foundation of health. It is, energy is life. And when you cannot make energy efficiently, or the system is thrown off, which is basically saying that your metabolism is off, you cannot live life to the fullest. And it leads to

• 1:15:25Dr. Darshan Shah?

  every kind of chronic disease, whether it be cancer, or heart disease, or diabetes, Alzheimer's, or even thousands of other diseases out there, autoimmune diseases, all of them have a foundation in metabolic health, right? And so it is the one data point, in my opinion, that makes the most difference, right? And so that's why the continuous glucose monitor is so important, because it is a direct way to influence that foundational level of your health, which then influences everything else after it, right? If you want to avoid disease, just get your blood glucose levels right. I think that's super critical.

• 1:16:00Speaker 01

  Yeah, yeah, it's, I mean, it can't be, it can't be overstated how important it is. Again, like our cells producing the energy that we use to be alive, right? It's the experience, the experience of life is the production and use of energy. And so your brain cells require energy production locally, your muscles, your heart, every, every aspect of the body is continuously generating and using, utilizing energy. And the reason blood glucose is so powerful is that the, the modern human runs primarily on sugar. And so that energy production is coming directly from glucose in most cases, the vast majority of it. And so it's right over the target. When you're measuring glucose, you're right over the target of energy production.

• 1:16:42Speaker 01

  And glucose has such a long lever, as you might say, like it's got a lot of leverage on the, the sort of wider environment in the body. Glucose is a really powerful molecule because you can generate energy really efficiently with it. But also, because it is such an energy productive molecule, it can kind of go haywire. And so when it's elevated above a certain level, you start to cause collateral damage, right? It starts to stick to things. It starts to glycate. You know, you can see glycation. Actually, glycation is the glucose sticking to and adhering to proteins. You can physically see this in the sort of the spottiness of skin, like people's skin will get these like local spots that are, you know, AGEs, advanced glycation end products. And that can happen internally as well. It's literally the kind of stiffening and almost

• 1:17:27Speaker 01

  the cooking, you might say, like the my artifact, when you brown proteins, you get that in a pan, you get that with glucose in the artery walls and throughout the body. And so there are there are serious consequences when glucose is elevated for too long. But the same sort of effect that we have with overproduction of glucose can also happen with fats, right? And other metabolites. So if you have too much circulating triglycerides, right? We don't, we aren't able to currently measure that continuously. But, you know, we also produce energy from fat continuously. And so, and in fact, it's like it's even more energy efficient molecule in a lot of ways. You can get nine calories of energy out of a gram of fat, and you can only get four calories of energy out of a gram of carbohydrate.

• 1:18:11Speaker 01

  And so there's this really interesting paradigm there where like fat and glucose are both really important for energy production. Right now, we can measure glucose, which is really powerful. But I think what's necessary to really paint the, you know, the backside of the fence is to be able to also do the same thing with fats and to continuously be measuring triglycerides and the other circulating indicators of fat metabolism. Because if you have spillover, if you have a lot of excess production of glucose, that sticks to things and causes problems. We also see this with the fatty liver you were talking about. If you're locally in your liver producing a lot of extra fat, it will stick to the visceral organs, right? You'll get this like this deposition of a layer of fat triglycerides right there locally. And that starts to have real systemic effects. The liver, you know, one of my, one of my favorite people in the metabolic health space, Rob Lustig, is, he's

• 1:18:56Speaker 01

  really aggressive about this one point. He says, protect the liver, feed the gut. That's your job. Basically, what he means by that is like, make sure your liver is functioning well. And make sure that your microbiome is functioning well. And so like, these are all metabolic concepts. And we're talking about kind of an outcome here, like fatty liver. But what we mean is make sure that the right balance of inputs is present. So that we're not creating a bunch of unnecessary byproducts of our metabolism that start to break down. Yeah, and just to give the listeners kind of a, if there's one single thing I would say. If you, if you don't want to do all the measurement, you don't want to get too deep in the weeds. Okay, I hope, I hope you'll reconsider. But to start off, my recommendation to improve metabolism.

• 1:19:39Speaker 01

  Move a little bit more and then replace the other stuff with protein and fiber. That's what it comes down to.

• 1:19:45Dr. Darshan Shah?

  I love it.

• 1:19:45Speaker 01

  Replace the other stuff with protein and fiber. Basically, that's what, that's what it'll come down to. And you can get like really nice feedback on this and target it and figure out where to get those, those sources from. But if you move a little bit more, and I mean walking, like just literally walk more. Try to get 10, 12,000 steps a day. And, and try to get that protein up to a gram per pound of body fat. And try to get that fiber over 35, 40 grams. You're going to be doing a lot better.

• 1:20:06Dr. Darshan Shah?

  Fantastic. I love it. Yeah, and that's coming not just from your personal experience, but looking at the data of thousands of people that have worn a continuous glucose monitor. And what has affected their blood glucose.

• 1:20:17Speaker 01

  100%. I started doing it because I saw it in everyone else's data. And you know, we look at these population data sets that levels has, you know, we, we really have the largest data set of this kind. On this continuous glucose and nutrition logs in the general population, right? Prior to that, it was only available in the diabetes state. And so we've been able to, through aggregated and obviously anonymized data, really start to understand trends. And this is what stands out is like those who eat higher fiber, higher protein diets. And replace a lot of the other, you know, heavy fats and heavy sugars with them. And who move more, they are having much better results in terms of their metabolic health.

• 1:20:52Dr. Darshan Shah?

  Wow, that's amazing. Yeah, I mean, I just, just realized that, that you have tremendous amounts of data, you know, with. To your point, you know, with really good resolution, what's working? And so to hear you summarize it that way, that's very powerful.

• 1:21:08Speaker 01

  Yeah, and matched with blood work data as well.

• 1:21:10Dr. Darshan Shah?

  Yeah, oh, that's right.

• 1:21:11Speaker 01

  So, you know, we can see what, and it's really interesting. It all kind of falls out of these basics. You, you obviously need to improve the inflammatory environment if you're exposed to toxins, mold, if you're not sleeping well. Those, these are the, the sort of outside kind of conditions. But, but by and large, the simple, it's like major in the majors. And it turns out that the composition of our plate still matters a lot. And we, again, we're taking in energy. We also need to be expending energy to stay in balance. And, and, you know, when we're walking, we're typically not going to be doing it indoors. You know, I would highly recommend if you're going to walk, walk out in the sunlight, not in the, not in the treadmill, even if it's raining, just get outside. All these things compound and Casey would, would certainly have a lot of additional insights to share to, to have like the full spectrum.

• 1:21:54Speaker 01

  But the basics are, are present in every person who's improving their metabolic health. They're getting those basics right.

• 1:22:00Dr. Darshan Shah?

  That's fantastic. Josh, what is the most surprising thing that you've learned personally from looking at your own health data?

• 1:22:08Speaker 01

  Well, I think it, probably the very first thing I learned, which was that I was prediabetic in my mid twenties despite being a CrossFit trainer and taking great pride in my physical fitness. And, and so it really shocked me. No one had ever mentioned blood sugar irregularity or any sort of diabetes, anything with me. And, and yet secretly my body was not managing the foods that I was providing it and my blood sugar was really out of control and it was causing a lot of complications for me. And, and so, um, yeah, it was like sort of day one, putting this thing on. And then over the course of that week, struggling to realize like, wow, this is different than I expected.

• 1:22:42Dr. Darshan Shah?

  Wow. What's the one health trend that sounds data driven, but is really not?

• 1:22:49Speaker 01

  I think probably biological age is, is the answer I'd give there. Yeah, there's a lot of excitement about it because it's an easy way to think about like, oh, I'm, you know, I'm younger than I, younger than my age. But in reality, I think it's just not quite, the science isn't quite there.

• 1:23:05Dr. Darshan Shah?

  From all the data that you've collected, what's the one habit that you see have the most direct impact on people's blood sugar?

• 1:23:12Speaker 01

  Definitely the ultra-processed food content. So this can kind of translate to fiber, how much fiber is in your food. But as we move further and further away from the whole foods, origination of the calories you're eating, you see much, much worse blood sugar control. And, and the spikiness, the variability, the area under the curve, all get far worse. So I kind of think of food as it probably contains water, it probably contains fiber. If it doesn't have either of those things, I'd steer clear.

• 1:23:39Dr. Darshan Shah?

  Yeah, and I think it's important fact to realize that ultra-processed food, the reason it lasts so long on shelves is because of the lack of fiber content, right? And so it's specifically engineered out of the food so the food can last forever in plastic packaging in your pantry. And so if there's one thing, you know, Casey said this on my podcast, if there's one thing that we recommend everyone does is try to swear off ultra-processed food as much as possible. It did not exist 50, 60 years ago, so it does not need to exist in your diet today.

• 1:24:10Speaker 01

  Correct.

• 1:24:12Dr. Darshan Shah?

  I love it. So you're running Levels Health right now, right? What else is going on in your life?

• 1:24:18Speaker 01

  So much. I mean, Levels, Levels has been, you know, we're entering like year seven right now, and it's been just amazing. I'm, I'm enjoying every minute of it. We're expanding again, the, the portfolio of services that we offer, really doubling down into this metabolic coaching and making sure that people have that like next level of, of support that they need to, to be improving. So Levels is measurably improving your health and that, and that we want to make sure that you feel supported in that all the time. And so that's been a big adaptation. I'm, I'm going through it myself constantly. I'm doing all the programs myself. And so I get to like really be the guinea pig and experimentalist. Additionally, you know, I'm living in Austin right now. My, my first child showed up about six and a half months ago.

• 1:24:57Dr. Darshan Shah?

  Congrats.

• 1:24:57Speaker 01

  Yeah, it's been an amazing life change. And, and so I'm just really, really enjoying just being in that sort of family mode when I'm not working and spending time with, with my baby and learning about all the things that he's teaching me already, you know, about, about myself and about what all this is about. And yeah. Really, you know, I would say like the next thing is is really just kind of taking on a I really, I really want to to focus on a spiritual journey over the next few years. Something that I'm, I really care a lot about is that partially because my, my son arrived and it's getting me thinking about the big picture, but also because I think that, you know, complete health is such a complicated thing, you know, right? We talked about physical health and, and mental health and metabolic health and all of these things I think are influenced

• 1:25:42Speaker 01

  again by hope and by like the big picture of fulfillment and purpose. And I think all these are all tied together. So I'm, I'm excited to explore some of the other elements, the metaphysical elements maybe of, of existence and how that plays into physical health.

• 1:25:57Dr. Darshan Shah?

  That's fantastic, man. Yeah, it's a big, big piece of it, I can tell you. And you can't ignore the spiritual side, the, the side that includes having great relationships, right? The side that includes spending some time taking care of yourself as well. Giving your brain time to relax and chill with meditation, breath work. All of it has an outsized effect and it has to all be tied together. But this was such an awesome conversation and I really appreciate you coming on the show. And, you know, I'm really looking forward to working with you guys and doing so much more with you.

• 1:26:28Speaker 01

  Well, I could not be more excited about the partnership and, and thank you for having me on the show. Again, I really look up to what you all are doing here. You've got incredible just infrastructure and everything you do is so just dialed. And again, I said this at the beginning, the kind of bar that you're setting for, for what is ultimately healthcare is, is so important because people want to opt into it. It's aspirational, it's hopeful. And I just, I just hope that you influence more brands and more, more products, more conversations out there because this is the direction we're moving in and I'm, I'm really excited to do it together.

• 1:27:02Dr. Darshan Shah?

  Thank you, thank you. Yeah, we're on a big journey to change the world and we're on it together, so I'm excited.

• 1:27:08Speaker 01

  I love it, yeah.

• 1:27:08Dr. Darshan Shah?

  Where can people find more about Levels Health and you?

• 1:27:11Speaker 01

  So levels.com and I highly recommend starting at the blog.

• 1:27:14Dr. Darshan Shah?

  How much that website cost you, by the way? I saw you just acquired it and I was like, that must have been.

• 1:27:18Speaker 01

  It was actually, my, my co-founder Sam is a, he's a real deal maker. And so we made it happen for relatively, relatively straightforward. But yeah, that was.

• 1:27:27Dr. Darshan Shah?

  Levels.com.

• 1:27:27Speaker 01

  Levels.com and, and highly recommend starting at the blog or on our socials, which are at Levels on.

• 1:27:35Speaker 01

  X on Instagram and TikTok. And then myself, I'm basically typically post on X at Joshua's Forest is my handle. And I also send out a newsletter on our email chain. So if you sign up on the website, you'll get to hear from me just the kind of the things I'm thinking about on a monthly basis, which is really fun.

• 1:27:54Dr. Darshan Shah?

  Yeah, I enjoyed your last one about APoB. It was a really quick, easy, good read. I sent it to a few people.

• 1:28:00Speaker 01

  Very cool. Yeah, it's a lot of fun. I really, really enjoy it. But one of the best parts about this is getting to talk to the people who are using these tools and learning from them and finding better ways to do what we're doing. So always very open to jumping on calls and interacting with folks on email and on social. So please, please take the opportunity, reach out. I'd love to hear from you.

• 1:28:19Dr. Darshan Shah?

  Right, thank you so much.

• 1:28:20Speaker 01

  Thank you.

• 1:28:24Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.