Dr. Lauren Kelly - Chew ; Levels: Democratizing Metabolic Health

Hey everybody, welcome to the Future of Fitness, a top-rated fitness industry podcast for over three years and running. I am your host, Eric Malzone, and I have the absolute pleasure of talking to entrepreneurs, innovators, and cutting-edge technology experts within the extremely fast-paced industries of fitness, wellness, and health sciences. Please stop by futurefitness.co to subscribe and learn more. To live your healthiest, longest life possible, you need to understand what's going on inside your body. People age at different speeds, and generic annual blood work doesn't properly evaluate your biological age, but Insight Tracker does. Insight Tracker is a truly personalized nutrition and performance system designed to extend your health span and slow down the aging process. Created by leading scientists in aging, genetics, and biometrics, Insight Tracker analyzes your blood, DNA, and fitness tracking data to identify where you're optimized and where you're not. You'll get a daily action plan with personalized guidance on the right exercise, nutrition, and supplementation for your body. Add InterAge 2.0 to any plan to calculate your true biological age and see how you're aging from the inside out. For a limited time, get 20% off the entire Insight Tracker store. Just go to insight tracker.com forward slash future. That's insight tracker.com forward slash future. We are live. Lauren Kelly Chu. Welcome to the future of fitness.

Very excited to be here.

I am very excited to talk about this. Uh this is the first time I've got into what, you know, obviously what levels is in CGM. I take that back. Uh a couple episodes talked to uh Nicole Acoin, um, who's a you know a nutrition coach and coaches other nutrition coaches. She started talking about her utilization of CGM and uh what that means for the industry overall. So it's it's a really cool topic. I'm excited to learn from you about this because I've, you know, probably don't know as much as I should, given what I do for a living. So it's gonna be valuable. Uh let's start with this, Lauren. Uh, give us a little bit of your background and we'll go from there.

Sounds great. I'm I'm really excited to talk about this topic because, like you said, I think it's starting to come into the conversation, but it's still at the beginning phases. So, so this will be fun to talk about. In terms of my background, I've been in the healthcare industry for quite a while now, but coming at it from different perspectives. So I actually started my career as a healthcare private equity investor and really got a sense of how healthcare works from that perspective. From the business side, when you're looking at companies as an investor, what makes tech companies in general and healthcare, health tech companies specifically, um have a shot at actually lasting long enough to impact the field? Um, I then knew that I wanted to build my clinical knowledge and really understand how healthcare is practiced on a deep level. So I did my clinical training, got my MD. Um, and that was really where my eyes were open to one, how medicine is actually practiced in the world today, and also all of the big, big systemic issues that are occurring in the healthcare system that really need to be solved before we can expect the overall health of the country and more broadly, I think, of the world to move forward in a significant way. That inspired me to go into health tech and try to build products and work on companies that had a chance to really change the way that healthcare is practiced. So from there, I co-founded a digital therapeutic startup focused on chronic digestive disease. That brought me back out to the West Coast, um, joined Y Combinator and worked on that for several years. And from there, um shifted over to Verily, uh Google's healthcare and health sciences arm, and worked on all kinds of things, focused on emerging products, biomarkers, um, biosensors, all of those things. Um, and and from there made my way to levels where I've been for about a year now and have just had so much fun getting to work on a mission that is both personal to me and also really brings together all of these other experiences I've had to try to make a difference in how people approach their health.

Yeah, great. And I I want to dive into a couple things there, but you're I want to clarify this. Your title is the head of clinical product at levels. What does that mean exactly for those of us who don't know, like myself?

It's a good question. Levels is still a growing company. So I think at any startup, everyone is kind of doing everything and certainly focused on whatever is most important in that moment. But broadly speaking, my role is focused on how we take levels and start to apply it to specific clinical conditions. So, for example, um, insulin resistance is the underlying mechanism for so many different conditions. For example, the leading cause of infertility, polycystic ovarian syndrome, which is at its heart a metabolic, a complex metabolic disorder that involves hormonal imbalance and a variety of other things. But the question is, how can we take this core product that we're building at levels and apply it to groups of people, for example, with things like PCOS, to really start to drive change in specific areas. Now, I think the reality is that the vision of levels is that ultimately, if you improve your metabolic health, then all these downstream conditions are improved as well. And so ultimately, my my vision is that I won't be necessarily focused on specifically one condition or another, but rather just on the underlying cause. But in today's world, both patients and clinicians and just the healthcare world in general, we think in terms of specifically defined conditions. So that's still the language of communication, and that's where we want to make sure that we're part of the dialogue.

Yeah, great. I like the way you frame that. So let's let's kind of we're gonna zoom out a little bit and we talked about the challenges with our healthcare system. And then we'll kind of use that as an angle to kind of focus in specifically on the problem that you guys are are addressing. So, you know, when you've done all this research and you've you've studied globally, I would imagine, in multiple different healthcare systems across the world, right? What specifically uh do you point out as the issues and challenges that we face here uh in the United States and I don't know, maybe North America, you you choose?

Oh, there are so many. I'll focus on the US healthcare system just because I think the healthcare systems really vary by country, and I'm most familiar with our healthcare system. Great. One of the main themes that is a big problem is that incentives are misaligned. So I'll give a specific example here. If you're a patient in a doctor's office and you've gone to see your primary care physician, um, you finished the visit, you leave the office, maybe you paid a small copay, maybe you didn't if it's a primary care visit. This is assuming that you're insured. When you leave, that physician then communicates to the insurance company that they did these five services for you and that they need to be paid. So, what this means is that really the customer of the physician, the primary customer, is the insurance company, not the patient. So when we go into a doctor's office, I think a lot of people think, well, I'm the I'm the physician's customer. You're not really. Actually, if we view this from a product lens, you're the physician's user, right? Like you are using their services. The people paying for their services are the insurance company. So physicians, no matter how well-intentioned they are, they're incentivized to please the insurance company and to be rewarded by the insurance company. Um, and so right off the bat, in this just kind of bread and butter situation of how healthcare is practiced here, you have a situation where the physician's primary focus is not necessarily on the patient getting better. Um, and like I said, I have so many physician colleagues who I have so much respect for, um, and I think that they do an amazing job. But in general, when they care about the patient getting better, it's altruism. It's out of their own commitment to their profession to help that patient get better. It's not monetary. And if anything, if we look traditionally at fee-for-service systems, which is to say, healthcare systems where physicians are paid based on the amount of services they provide, there's actually an incentive not to make the patient better because a patient who is sick will keep coming back for more services. Um, there are changes happening right now in terms of how the system has evolved. There's integrated healthcare systems which have different incentives. There's all kinds of newer, more innovative models that are out there. So there's definitely recognition that this is a problem. But I use this basically as a just very clear example of how poorly aligned these things are. And if you apply it to health tech and startups, so many startups in today's world are still essentially working within that system where they're trying to have a product that a physician will prescribe and an insurance company will pay for. If you are dependent on insurance paying for your product and physicians prescribing it, you are fundamentally making the success of your business contingent on a system that's full of misaligned incentives. So that's a that's a broad overview. I mean, we could talk about this forever, but I just think the number of issues are are just so numerous and very, very deeply ingrained.

I think it's uh it's important to get into the the details of this. And I guess the next question is how how did we get here? How do how do we get to this misalignment? What happened?

That is a really complicated question that I'm probably not the right person to answer. I mean, I will say that I think you can trace the evolution of the payment systems of healthcare over time. And many practicing physicians who are later in their careers will remember the time when insurance companies started to play a much more active role. There was a time when if you were in private practice, that was almost like having a small business and patients were actually paying you out of pocket. That is a much more aligned system, right? Because then the physician is incentivized to have you feel like you're getting value out of the care that they're providing. Um, because one, that means you'll come back. And two, it means you'll spread the word and other people will go to that practice. Um, but there was a transition point where insurance became much more of a stronger player. Those incentives started to get misaligned. And at the same time, large employers started to move to a self-insurance model where for most large employers in today's world, your employer is essentially also your insurance company, which is to say that most large companies take on the risk of the health of their employees. And what this means is that now you've added another layer as the system evolves, where you now have gatekeepers to the care that you can access. And that's not just what it used to be, which was what will the physician prescribe you or not. That's one gatekeeper. Now there's gatekeepers of also what will the insurance company cover, and specifically what will your employer cover, and what will your employer offer as your benefits. Um, so there have been multiple stages of added complication and increasing misalignment that have happened over the last decades. Interestingly, I think we're at a point now where it's so broken that everybody recognizes it. There's a lot of innovation in the space trying to fix this. And I think, and I say this coming from a health tech company where I believe change is possible, but there's a lot of debate as to whether the solution will come out of tech or other kind of evolving industries, or whether the solution is a government solution, that eventually healthcare will take up such a large percent of GDP, our health outcomes will be so poor that the government will have to change something and that that will be the impetus for creating a new system. At this point, I don't think anyone knows what the solution is. And um, in the meantime, those of us who are working in health tech are trying to change it through empowering consumers to be in charge of their own health.

Yeah. It is. I mean, Bernie, right? He's the one who kind of brought healthcare reform to most people's, you know, top of mind. And that was, gosh, eight, nine years ago. And it seems like nothing's happened. Nothing's happened, you know. So it's hard, it's hard to have faith in the legislative side of things, like, okay, are we actually gonna get it done at a government level? Uh, because I don't know, you just don't see any movement in it. And it's interesting too, because anecdotally, Lauren, like my dad, where I was talking, uh, I I grew up in the the Bay Area, and uh, my dad was a dentist, and he started his practice, he went, you know, immigrated from Italy and started his practice and you know, ran asking. And I thought at one point, I'm like, you know, I'll just probably take over my dad's practice. And he wasn't, you know, a pure medical doctor. I mean, he was a dentist, there's obviously a difference there, but you know, I think the similarities in the insurance, I asked him, remember when I was young, I'm like, hey, you know, what do you think about me going to dental school? And uh he's like, you know, I I just can't recommend it. You know, healthcare is insurance has changed the way I do business and he hated it. You know, he went from this very like cash-only business where people came in and you know, like you said, there was that old, you know, interaction between the patient and the doctor that was great, but that middle person coming in that at entity really sucked the joy out of it for him in so many ways. And it was kind of hard to watch. And he told me he's not like, Don't do it, you know, just go do something else, get into business, right? So it's it's interesting.

Right. No, and that's an experience that I think is shared by so many clinicians across all aspects of healthcare. Because what you bring up is what used to be the patient-physician relationship. There was an opportunity for that to really be created. And I think there's there's a lot of satisfaction that happens on both sides of that. And also care is better. You think about the simple thing of I think one of the most powerful things a clinician can do is be a good listener. But when you're time constrained to a visit that's 17 minutes for the whole year, it's almost impossible to listen because you also have to document and you also have to make a plan for the patient. And and there's just, it's it's very, very hard to create a true relationship in that kind of setting. And then you begin to lose trust, right? Like there's all these things that happen when that relationship is not made possible.

Yeah, and it's tough because it it ultimately falls upon the physician, right? Like I'm upset with my physician because I only got 17 minutes for every year to talk about you know my health. I the best experience I've had is when I was living back in Santa Barbara and I had a cash, you know, doctor. I paid him cash every time I went and visited. So, you know, our our annuals were an hour and a half, like in and one hour of that was talking. We sat down, he you know, went over again my family history. Hey, what's going on here? You know, how what's going on with your mother and her issue, like all these different things. And like, I this is gonna sound cliche, but I felt heard, right, by my doctor. And, you know, I feel like now the physicians are so entrapped into this system that they end up looking like the bad guy or bad person when they're not. They're all great people. They got in it to help people, right? But they get stuck in this really difficult situation. It's not fair to them, it's not fair to the patients. And um, anyway, so we got this big problem, right? Um, and we don't know how it's gonna be solved. Is it gonna be solved through tech? Is it gonna be solved through government? Uh, you know, in the short term, I think the best thing that people can do is become an advocate for their own health, right? You know, take responsibility, like you said, for their own health. And that's that's something I you know beat the drum on constantly is like any tools that we can provide to consumers to give them more insights, to get them more interested and get them more empowered is really great. So uh now taking one step closer on the problem, what specifically is the problem that you and the levels team are looking to solve?

We're focused on metabolic health. And I think the place to start is what is good metabolic health? So, what do we even mean when we say metabolic health? The the body is made up of about 37 trillion human cells, and every cell needs energy in order to perform its function. So, metabolism really is just the biochemical complex processes that convert the food we eat into energy so that the cells can do their function. When all of that's running smoothly, we call that good metabolic health. Unfortunately, due to primarily lifestyle factors, for example, eating highly refined carbohydrates or high sugar foods, we are actively disrupting that system, overwhelming this natural, beautiful process and creating a lot of dysfunction. So that's what we would call dysfunctional metabolic health or metabolic dysfunction. So that's the problem that levels is focused on. And within there, we can get much more deep into what is insulin resistance, what's the role that's being played there, why is blood sugar spiking? But essentially, we are trying to bring the body back to that smooth and efficient process of converting the food we eat into energy for our lives. Um, and I think many people are aware of blood sugar from the perspective of prediabetes or diabetes. But the reality is that likely nine out of 10 Americans has at least one marker of metabolic dysfunction. So this is happening to all of us, just about. It certainly was happening to me. I was diagnosed with pre-diabetes in my 20s, despite being a runner, had been lean my whole life, thought I was eating really healthily. And there's some family, I mean, we have a strong family history of diabetes, so maybe there's some genetics there, but the overall point is no one is exempt from this. It doesn't matter what you look like, it doesn't matter what you think. I was in medical school when I was diagnosed. So that's that's a a long way of saying our focus is on metabolic health, and it's the entire spectrum. People who think that they're healthy, but maybe have something else going on, all the way through to people who really have known metabolic dysfunction because they've received some kind of diagnosis.

Yeah, I mean, that's surprising to me, and people can't see you because you know this is audio only, but you do not look like someone who would have, you know, be pre-diabetic at all, right? Uh so that's that's shocking. And so when you talk about metabolic health, I mean, for the majority of people, um, where are some of the more common ways that metabolic health shows up? You know, we talked about diabetes and prediabetes and insulin, but what what what are some of the more common things that people see?

In the short term, when blood sugar spikes are happening, you can experience everything from brain fog to mood swings, acne, hormonal imbalance, disruption in your sleep, even things like wrinkles. Actually, when blood sugar is really high, not only does it create an inflammatory cascade, but it can actually disrupt the healthy function of collagen. So you see these impacts throughout the entire body. And again, these are things that happen even in the short term. In the long term, metabolic uh dysfunction is linked with everything from Alzheimer's disease, cardiovascular disease. Basically, nine out of 10 of the leading causes of death in the United States have metabolic dysfunction as a primary driving factor. So this really is just all-encompassing. And um, I think many people are experiencing their day-to-day life experiencing these things. Like, for example, feeling these crashes in energy, but not knowing that the underlying cause is probably blood sugar.

Yeah, I I've I've constantly have like the two or three o'clock slump, you know? Um, and I've never tracked my glucose in any certain way. But I presume, I mean, that's something that's extremely common, right? And if people don't have the two or three, you know, o'clock slump in their days, then they're probably very lucky. So what, like, okay, let's use that example. What's going on there? Why why am I slumping in the afternoon?

Right. So there's there's a few possible explanations, and I'll I'll link them all to blood sugar.

Okay.

The first is that when you have routinely elevated high blood sugar, and depending on when you're eating your dinner, it's very possible that your sleep is being disrupted. So you're already starting that day with not a full, restful night of sleep. And that has a lot of consequences. Not only, again, does it lead to inflammation and as we've all experienced, mood swings, cravings, that kind of thing, but it also increases the drive for carby and sugary foods. Also, we know that interrupted sleep reduces your insulin sensitivity. And it's probably worth chatting about insulin a little bit more in a minute to put all this into context. But what this means is that by the time you hit lunchtime, you've probably already spiked and come down from breakfast. Now you're feeling like you're really hungry, you need to eat lunch. If you're eating a typical American diet or even one of the quote, healthy diets, like a plant-based diet or vegan or any of these things, they're often very high in carbs. You're then getting a massive blood sugar spike. Um, and then as your blood sugar comes down, you're starting to feel that crash come down. Um, and it's really that change in high blood sugar to what oftentimes becomes low blood sugar because your body overcompensates for the meal that you ate, you feel this massive change in energy. Um, it's very marked. And like you said, I think a lot of people think of this as normal. But when you stabilize your blood sugar and you have good sleep, that is not normal. That doesn't need to be the way that it is day to day.

Yeah. And so let's get into insulin. What do people need to know about insulin?

Insulin is the body's hormonal signal that tells the body to take sugar out of the blood and move it into the cells, the muscles, the liver, and eventually the fat. It's really a beautiful protective mechanism because the body can't function optimally when blood sugar is out of a safe and healthy range. So as soon as it goes out of that range, the body produces insulin to bring it back into the safe range. If you're occasionally having high blood sugar, this is a beautiful system. You you eat, you have high blood sugar, the pancreas produces insulin, it's released, your blood sugar is brought back down to a normal level, and you resume your normal life.

People age at different speeds, and the date on your license may not represent your inner biological age at all. If you're looking for ways to extend your health span and slow down the aging, Process, the keys to health and longevity run in your blood. That's why Insight Tracker provides you with a personalized plan to boost your metabolism, reduce stress, improve sleep, and optimize your health for the long haul. Created by leading scientists in aging, genetics, and biometrics, Insight Tracker analyzes your blood, DNA, and fitness tracking data to identify where you're optimized, and more importantly, where you're not. You'll get a daily action plan with personalized guidance on the right exercise, nutrition, and supplementation for your body. Add inner age 2.0 to any plan for a definitive calculation of your true biological age to see how you're aging from the inside out. I was proud to find out I'm a few years younger than I thought I was. For a limited time, you can get 20% off the entire Inside Tracker store. Just go to insight tracker.com forward slash future to check it out, learn more, and get your own. It's inside tracker.com forward slash future. On to the show.

However, most Americans, and actually this is true outside of the US too, but we'll just talk about Americans. Most Americans are having elevated blood sugars on and off throughout the entire day. To give you an idea, if you wake up in the morning and you eat, let's say, for most people, you eat a boat um a bowl of oatmeal, you will spike up high and you will probably stay high for a couple hours. So that's just one example of a meal that would bring you up there. Now, when you're spiking all the time, then your body has to constantly be producing insulin to counter those spikes. The analogy I like to use is parenting. If you're a parent who rarely yells at your kids, then when you do yell, the kids are right there. They're very attentive and responsive. That's how the body is when you rarely have high blood sugar. As soon as you release that insulin, instant response. But if you're a parent who is always yelling at your children, they will come to learn that that is just your normal form of communication and they are much less likely to respond to that yelling volume. Likewise, in the body, if you're constantly spiking your blood sugar and therefore you're constantly having elevated levels of insulin, the cells in your body stop being very responsive to that signal. That's insulin resistance. So then if the parent needs a response out of their child, they have to scream, right? Like they have to really do something that shocks that child into listening. Likewise in the body, if you always have elevated insulin, pretty soon to get your cells to bring glucose back into the body, you have to produce so much insulin that it's like a parent screaming. And eventually the pancreas cannot keep up with that, and the cells just become relatively unresponsive to insulin at all. That's when you finally see blood sugar unable to be controlled by insulin and you get into a prediabetic diagnosis. So the moral of the story is insulin resistance is happening often for over a decade before you'd have any sign from conventional lab testing that you have any problem with your blood sugar.

I I really like the way you explain that. I've heard insulin resistance explained in so many different ways, but that was really that was really good. And the moral of the story is if you keep screaming, you're gonna lose your voice, right?

Exactly. And that's why you see the pancreas become damaged and become unable to keep up with the body's demands.

Yeah, fantastic. So, Lloyd, let's let's get into a little bit of what you guys are doing. Maybe an introduction into continuous glucose monitoring, what that is, how long it's been around, and you know, yeah, start with that, please.

Great. So uh levels is a product that helps you see how food affects your health. Um, and we do that through real-time feedback, through biosensing, and specifically through continuous glucose monitoring. So a continuous glucose monitor is a sensor that you typically wear on your arm. It has a very thin filament that's about the width of a strand of hair that sits under your skin and it constantly monitors what your blood sugar is. Um and what this means is that every time you eat, every time you exercise, when you wake up in the morning, you can see what your blood sugar is in that moment. It's hugely powerful because it creates a closed loop system where you're eating a food and then you're immediately seeing what the response on your body is. I think this is the missing link for so much of kind of the desired behavior change out there, right? Is that someone says, well, if you do these things, you'll live longer. Everyone wants to live longer, of course. But in the absence of seeing the day-to-day, the moment-to-moment impact, it becomes very hard, at least for me, to really integrate the potential impact of my changes into my mindset. So, really the idea of levels is to create that feedback system where you can really make that link. And ultimately, the real goal is to use that as a way to understand your own body, to be able to feel within your own body when you're having a blood sugar spike. So, for example, for you, what you're describing, let's say you start using levels and you're tracking the blood sugar and you're like, wow, when I eat my normal lunch, I have a really high spike, and then I come down, and when it's coming down, I feel that crashing feeling. Ultimately, the goal is that you're so trained by that that you can take the continuous glucose monitor off some of the time, and you can feel in your body when that crash is happening and you know it's blood sugar, and you can learn from that to modify what you're eating. That's the overall um kind of overview of what we're trying to do.

Yeah, it's very cool. How long how long has CGM been around? What's the history of it?

I'm not an expert on the history of CGM, but it's a um regulated device that's been used for diabetics for many years. So there's a very um high and robust safety um evidence and safety track record for it. So it's really, it's been um very active in clinical care for diabetics, and in my opinion, not as active as it should be. And there's a variety of things linked to that. Um, but it certainly is a very well-established technology that that is now being applied more to consumer populations and to people who don't have a diagnosis of diabetes or even pre-diabetes.

And what's what do you think is feeding the shift to, you know, from you know, um people who have diagnosed medical issues to just the general consumer? Is it the uh, you know, is the technology getting more accessible, less expensive? Like what do you think is is driving that?

I think one of the main things is consumer awareness. I think it's exactly what you just said, which is you are recognizing that you're having crashes every afternoon. And maybe I don't want to speak for you, but maybe you don't want to experience that anymore. No, I know. Right. And so, right, and and people are having their own versions of that. And some of them are more um kind of dramatic than others. But for example, to go back to the example I used earlier of the link between high blood sugar and infertility, if you're someone who is struggling with polycystic ovarian syndrome, and that particular condition oftentimes uh comes along with, for example, acne, hair growth, weight gain, um, in addition to infertility, you become very motivated to understand what the underlying cause is and you very quickly learn that the conventional solutions to that through the traditional healthcare system are not really working, right? Like the first-line treatment often for PCOS is to go on birth control. Well, if you're trying to get pregnant, obviously that's not going to work. So, um, and and that's oversimplifying what the treatment protocol is for PCOS, but it's a way of saying that I think there's increased recognition that so many aspects of our life, if not almost all aspects of our life, are influenced by blood sugar. And we're not getting good windows into what's happening there with traditional medicine. All we're all most people get is a hemoglobin A1C lab and a fasting glucose. And maybe not even both, maybe just one. So we don't really have any window. And I think consumers are increasingly looking for that window into their health. Um, and and to your other point, I do think that price will drop over time, though. Again, CGM is something that has historically been part of the kind of payer reimbursement and traditional medical device industry. So there's some challenges there in terms of adapting to a consumer market, but I think the next few years we'll really see a pretty dramatic shift there.

Yeah, that's exciting. So maybe walk me through the the user experience. Like so you have a patch, right? Oh yeah, just what I'm I'm not even gonna just walk me through the whole thing.

Right. So when you start using levels, you have access to our entire platform. We follow a membership model. So you become a member of Levels for the Year, and that gives you access to all of the services and products that we have available. So one of those is our app, um, which is our the software side of our business, where we are really taking the raw blood sugar data and helping to create insights and guidance that you can use to change your life and change your behavior. Um, like you said, the the continuous glucose monitor sensor is also part of it. Um, when when you most people, when they start levels, start with continuous glucose monitoring, though it's not required. Um, and that is, like you said, a sensor that's on the arm and that's directly interacting with the software. We also offer at-home metabolic lab testing. So we offer exactly the labs that we believe are not typically offered at traditional physician offices that we believe give you a lot of information about your metabolic health. The idea through all of this is to help people really personalize their own experience with levels. Maybe you're someone who wears the CGM for a month, and then you want three months to just integrate everything you've learned. Or maybe you're someone who starts with the blood testing, does some make some changes for a month, and then puts the CGM on. We have a lot of options and um, some people wear CGM all the time, right? Some are on and off users. So the goal is really to help you find the rhythm and the information that is most helpful to you. But the glue of the whole thing is the app itself, which integrates all of these different sources of input and gives you guidance on the changes to make for you specifically.

Yeah, that that was my next question, is is the guidance. And that's the uh, you know, a lot of there's a lot of different ways people for I call it the now what. Okay, great. I see this all its data. And as a consumer, you know, um, I would consider myself maybe fractionally more educated than the average consumer, but not by much. And I would probably still sit there and be like, okay, what do I do with it? Right. So what how do you guys solve for that that issue?

This is something that's actively evolving for us. We we recently um moved out of beta into our more scaled availability. So it's really exciting time for us and it's it's a time of learning. So we're trying all different kinds of things, but among the things that we help our members with is, for example, recommending food swaps that they can make. So if you're someone who's eating oatmeal for breakfast and that is spiking your blood sugar, we can suggest that you might try having eggs the next day instead. Something that we know from our database of glucose logs is promoting glucose stability in the majority of people. So we're able to use this large data set. It's really, we actually have already the largest glucose food log paired data set of this kind that exists. And from that, we're able to make all kinds of suggestions that we believe will work for you. We also do a lot around education and learning about insulin resistance and metabolic health so that you yourself are eventually in a situation where you go to a restaurant and you can actually assess the menu for what is likely to work for you or not to work for you. We we have other things also that are available. For example, you can have a one-on-one consultation with a nutritionist who's an expert in metabolic health. There's all kinds of things that that we've offered to help you on your journey. And like I said, constant, we're constantly uh iterating on this and learning from our from our members and um just trying to trying to find the best ways to help people with behavior change, because behavior change is, in my opinion, one of the world's hardest problems to solve. If if behavior change was as simple as changing your mind, yeah, we wouldn't be seeing all the the challenges that we're seeing and we wouldn't be experiencing them yourselves. I I'm not exempt from it, right? Like there's so many things that I would like to make as permanent changes in my behavior, and um, I make the decision and and it's a process for to really integrate that into my life.

Well, you nailed it. I mean, ultimately in the fitness and health industry, uh, fitness industry specifically, when it all boils down, our job is behavior change, right? It's not program design, it's not movement selection, it's getting people to change their behaviors. And that's hard. You know, there was uh kind of an old joke within the you know, nutrition coaching really is like it's harder to change someone's religion than it is their nutrition. And I I kind of stand by that, you know. I mean nowadays it's a lot easier to change someone's religion, I think, than it was 20 years ago. But uh, you know, it it's true, it's very, very challenging. And I, you know, I see that you guys, you know, this whole market of CGM is is very new in the consumer uh area. So you guys are, you know, probably shifting and pivoting, you know, weekly uh to kind of sort out, take the data, make decisions and and you know, reiterate. Uh when you look at like the the fitness and wellness, like the coaches and the the gym owners and uh the practitioners in those areas, how how is this technology benefit them? And we can I can see the direct benefit of the consumer in educating them and helping them advocate for their own health, but what about the professionals?

Actually, some of the earliest levels users were professional athletes or and or their trainers and coaches. And the reason for that is because really metabolic health is describing the fundamental uh system in the body for the use of energy. And if you're an athlete, that is top of mind. So there's a lot of examples of athletes using levels simply just to see what's happening with their blood sugar as they go through their training, not just day by day, but also in the various cycles of training that they might that that might occur. Um there's so much power in understanding how to time your workouts with your fueling status and also how to fuel for your workouts. So it's really a kind of beautiful system as a way to have a window into how well your nutrition is working. There's athletes who have actually, even endurance athletes who have switched to very low carb diets. And they've done that by creating metabolic flexibility, which is the ability to burn fat and not just glucose and carbs when you're exercising. Um, which, I mean, as you know, is a big departure from the traditional recommendation of carb loading and of, for example, when you're running, eating these high glucose gels and things like that. Um, and that's not to say that those can't also be effective, but being able to see what your blood sugar is doing as you try these different methods of fueling and linking to that to your personal sense of how you feel in your body and linking that to your actual objective performance metrics is a very new way, I think, of thinking about nutrition optimization and exercise and performance optimization.

Yeah. Yeah, optimization is a funny thing in the nutrition world too, because uh you find it very common that in the profession people will argue about the last five percent of optimization when we're missing the fundamentals for the large overwhelming majority of our population, which is you know, the core tenets of of health, right? Sleep, exercise, stress, like nutrition. Like that, that's those four pillars are pr pretty important. Um when you look at like the adoption into the healthcare system for this, and you know, this is something I talk about all the time because I'm really hot on it. And you know, what what a lot of us are working towards is that you know the fitness and wellness professions become part of the healthcare system, right? That you know, instead of a doctor writing a prescription for a pill, you know, they write a fitness regime prescription and they go off and they work with a trainer and someone who's qualified, and you know, the belief is that uh that that is done through a common language between the medical and the fitness profession, that is data, right? Now, how that data comes along um you know is up for grabs at this point, right? But if you kind of put your hat on as far as like how can we help get fitness integrated into the healthcare system, how do you see um levels and your continuous glucose monitoring starting to help with that process?

We've made a very intentional decision at levels for this first chapter in the company's life to be a direct-to-consumer company. So we actually, it's not that physicians can't recommend levels, but we purposely are directing all of our engagement towards consumers themselves. And this was for a variety of reasons, but primarily the incentives that I talked about at the beginning in terms of making sure that we're outside of that misalignment, but also from a gatekeeping perspective to empower consumers to learn about their metabolic health, even if their physician might not have prescribed it. A lot of people go to their physician and they have done some reading and they say, I'd like to have a fasting insulin test, or even I'd like to wear a continuous glucose monitor. And on average, the vast majority of physicians will say, No, why would you want to do that? Or that doesn't make sense, or you're not diabetic, so you don't need that, or your insurance will never cover it, so you shouldn't do that. Um, so we we purposely wanted to be just outside of that entire ecosystem to start with. Now, that doesn't mean that we wouldn't eventually go there, um, but I think when we go there, we want it to be very intentional and we want to be very clear that we're not creating some of these dark patterns, if you can call them that, that happen when you when you start in that system. In terms of um, though, facilitating communication with the medical community, which I think is also what you're describing, we're very active and intentional there as well. We have an incredible group of medical advisors who are the leaders in their fields. Uh so, for example, people like Sarah Gottfried, uh, Rob Lustig, these are people who really are leading voices in the metabolic health space related to, for example, women's health and other kind of subspaces with within metabolic health as a whole. And the real goal of that, in addition to our research efforts, and we're engaged in research with our advisors, but we also have a very large research study happening within levels. The idea of all of this is what you said, which is to speak the language of data, to speak the language of clinicians, and to show that we are very, very committed to science as the core of the company. Levels is not a company meant to be a personality or brand that people choose because they want the levels logo on their arm. Although, great if they want that, right? Like that's great. But really, really, we want to be as credible a voice in pushing the science of metabolic health forward as we would be if we were a group of clinicians, right? Like we we do rigorous research, we have a focus on using evidence-based recommendations. And the goal is that even though we're not formally part of the physician kind of ecosystem in terms of clinical practice, we're very much a part of the formal uh research, science, and clinical discussion around these topics. And that's something that's really important to us.

Yeah, well said. Uh globally, like the the CGM market, you know, we talked about this a little pre-recording, but what does it look like? Like, is there um, you know, what what is the appetite for it globally? Do you think so far is this, you know, in the United States, we tend to be very US focused, right? We tend to focus inward many times. But is there other countries who are really turning to take advantage of this? Uh yeah, what does it look like outside of our boundaries?

The still by far, far and away, the most common application of CGM is within diabetic populations. And therefore, again, falling more into the traditional med device industry and often with an interaction with that patient's insurance company. So you see CGM use all over the world from that perspective, um, especially, for example, in Europe. And again, like you said, also in the US. Um, I think in terms of the shift to consumer use of uh continuous glucose monitoring, and especially maybe even without the requirement for prescription, we are in the infancy of that, really, the very, very beginning. Um, there has been a little bit more progress there in Europe than there has been in the US so far. Um, but I think all of these things will begin to shift. Um, and I think this reflects both, like I said, the increasing awareness for the power of CGM, but also the increased recognition from uh the traditional healthcare system, both the med device companies, but also ensures that there is that healthcare is becoming increasingly consumer-centric, that if you are a patient, right, you're becoming more and more empowered, first of all, to have ways to build the knowledge to come in much more educated to that conversation with your physician. But also you have many more options of where you spend your money and what health services you choose to take advantage of. So there's multiple market forces, I think, happening right now that will shift the way that CGM is kind of incorporated into our daily wellness. But again, we're at the very beginning. I think this is one of the reasons that I'm so excited to be at levels because we really get to ride this and to explore it and to put it into use to improve people's lives as it's actively happening.

Yeah, you get to play a part. In shaping it, right? Right. That's a lot of fun. Uh yeah, I this is just a curious question. It's slightly off topic, but you know, when you look at healthcare systems globally, and all the time, dinner table fodder, people are like, ah, the Canadians, their healthcare system's the best. And then you talk to a Canadian and they're like, nah, you get not that great, right? And so when you look uh globally, like, is there any healthcare systems that you think are doing it fairly well that you know can be emulated that we could look at?

This is a very complex and loaded question. I think this could be an entire podcast episode. And in full disclosure, this is not something that I'm nearly as educated about as I as I want to be. Um, I I think, of course, there's there's multiple sides of the debate here in terms of, for example, which basic healthcare practices um should be, should be essentially free and offered to all citizens of a country. This is really a question of government policy. I do think, though, that to the extent that consumers do become more and more at the center of this, and that's not just in terms of where they spend their money, it's also in terms of things like access to their own data. Where, right, like now, if you if you have companies we're getting at-home lab testing and you can see your own data, and even from your physician now, almost all patients have access to their lab data. And you can pair that with information, for example, from content like sources like the Levels blog, and there's lots of other great sources of information out there, that you are actually a forcing function now to potentially change the way that medicine is practiced, regardless of the kind of overall structure of the system. And this trend towards consumerism is happening not just in the US, it's also happening in Europe, and it's also happening in other parts of the world. And so I'm very curious actually to see what the outcome of this is. And I would say my bias is towards healthcare systems that provide basic healthcare services for all people. I think there's a lot of nuance there and a lot of complication, but um, just seeing the suffering in so many communities, I think um having access to conventional medical care, but also having access to content and information and advocacy, that these are all pieces that I would like to see happen more in the US. And certainly I would admire any healthcare system globally that exemplifies those things.

Yeah. Do you have a few examples? I'm not gonna let you off the hook on that one.

In terms of countries that exemplify that? I think some of the countries in Europe do a much better job of this. I mean, there's there's several countries that have much more robust, or even Canada has a much more robust system of ensuring basic medical care for um for all of their citizens. My understanding is that there's still, like I said, quite a bit of nuance there in terms of, for example, long wait lists or lack of access to certain kinds of specialized or high cost care. So I don't think any system is perfect, but as I think everybody knows at this point, when you look at the US and you look at percent of GDP and the amount of money we spend on healthcare and you combine that with our outcomes, we are not doing well. So I think the shift, right? Like when you when you look at other countries, like for example, in Europe or Canada, and you see a much closer linking of healthcare care expenditure to healthcare outcomes, um, I do think that that's meaningful. Um and there's so many other aspects that go into this, right? Because, like, for example, you have countries where there's just not as close tracking of healthcare outcomes. Um, for example, countries that are less developed and where income disparity might be even more pronounced. So I think that there's there's it's such a it's such a layered analysis because also you're dealing with populations that aren't equivalent. For example, some of the countries in Europe, their population is not only smaller than the US, but it's also much less diverse across a variety of metrics. So providing basic healthcare services to that specific population, which might be a lot more uniform in some ways, is very different than trying to provide healthcare for a country where there's vast differences across different communities. So I if we ever chat again, I will come back to you with a much more evidence-based answer to this because I think it's so vital. Um, and it's something I'm really interested in. So this will inspire me to do more learning about this.

Well, you answered right. And it is, it's complex and it's nuanced. And that's that's the world we live in. That's the healthcare system. I mean, it's so individual. And I I just don't think we can go wrong by, you know, I'm just like democratizing health data, right? Which essentially, in essence, is one of the things that you guys are doing. You're democratizing metabolic health so that people can understand the data, take it upon themselves, and be an advocate for their own selves within the healthcare system. I mean, you know, there's we each have two doctors now when we go to the doctor's office, right? We have the doctor we're physically sitting, and then we have Dr. Google, Dr. Data, right? And who do we talk to more often? Probably our wearable or our internet search, far more than our doctor, because we only see them, as you pointed out, 17 minutes once a year. So it's it's uh it's a shift, it's fundamentally changing, and it's gonna be fascinating to see how it all, you know, 10 years from now, uh, what we're talking about and how it looks. And I'm I'm optimistic. I'm eternally optimistic that it's gonna improve. And I'm you know very uh grateful for the type of work that you guys are doing there levels. So uh last question as we kind of wrap it up, uh, you know, what what do you as an organization, as a company, what do you what do you need right now? Um and I asked that in the spirit of collaboration for people who are listening. Uh what what can we help you with?

I think the the most powerful thing right now is just helping to be a voice and spreading knowledge about metabolic health, helping to to share the information that, for example, things like afternoon crashes, they're not normal. You don't have to suffer through that. You can make changes. And whether you do that through levels or you do that through another source, even maybe just reading the levels blog and making some of the changes that are proposed there, that that is a really powerful way that you can change your experience of day-to-day life and you can also change your long-term health risks. Ultimately, the goal of levels is to solve the metabolic health crisis, which is a very ambitious goal. And it means impacting over a billion people. We've actually stated that we want to impact a billion people or more. What this means is that we'll need to impact a lot of people who never necessarily purchase levels. And we understand that and we we are on board with that. That's the goal. The goal is to change metabolic health in as large scale a way as possible. We believe that levels helps people do that, and we invite everyone to try it who's able to. And also we want options available for people who, for whatever reason, are not able to use levels, but can still access all of our content. We we put a lot of content on social media channels. We have a blog that has really high kind of high integrity scientific information. We go on tons of podcasts like this to share the message. So for people listening, I think just getting the word out there that metabolic health is at the core of so many things and that there's easy things you can do to dramatically improve your health.

Awesome. Well said. Well said. Thank you so much, Lauren, for coming on. If people want to get a hold of you or uh, you know, the team at Levels, is there a specific place you want to send them?

Yep, they can they can find us at levels.com and they can access our blog from there. We also have our social channels, which is at levels, and I have my own social channel, which is at Dr. KellyChu, where I will be sharing all kinds of metabolic information and especially with the focus on these small things that you can do, even without much time or money, but that can have a really big impact.

Yeah, right on. Well, thank you so much for taking the time and educating me and giving us insights on where this whole thing can go. It's exciting and it's it's really cool. And uh, I'm hopeful that you guys will continue to do a great job. So, ladies and gentlemen, Dr. Lauren Kelly Chu.

Thank you so much. It was great being here.

Hey, wait, don't leave yet. This is your host, Eric Malzone, and I hope you enjoyed this episode of Future of Minute. If you did, I'm gonna ask you to do three simple things. It takes under five minutes and it goes such a long way. We really appreciate it. Number one, please subscribe to our show wherever you listen to it, iTunes, Spotify, Castbox, whatever it may be. Number two, please leave us a favorable review. Number three, share. Put it on social media, talk about it to your friends, send it in a text message, whatever it may be. Please share this episode because we put a lot of work into it. We want to make sure that as many people are getting value out of it as possible. Lastly, if you'd like to learn more, get in touch with me, simply go to the futurofitness.co. You can subscribe to our newsletter there, or you can simply get in touch with me as I love to hear from our listeners. So thank you so much. This is Eric Malzone, and this is the future of fitness. Have a great day.