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Josh Clemente05 April 2021

Special: "Why Now" for Digital Health (with Levels founder Josh Clemente)

3Frameworks
11Insights

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Frameworks in this episode

Self-Mastery6 steps

Baseline–Explore–Optimize Metabolic Awareness Loop

Observe normal behavior, test interventions, then combine what works

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Entrepreneurship6 steps

Premium-First Healthcare Market Expansion

Win discerning consumers first, then use evidence and scale to expand access

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Leadership5 steps

Responsible Engineering End-to-End Ownership

Assign one owner who carries a critical system from design through delivery

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Insights & moments

The myth-busts, hot takes, explainers, and tools worth keeping.

Myth Buster· 1

Myth Buster

Why a “Heart Healthy” Bowl of Oatmeal May Spike Glucose

The hosts and Clemente describe unexpectedly large glucose responses to oatmeal despite its healthy reputation. Clemente says Levels data showed substantial responses among many users and questions blanket health labels that ignore individual glucose variability.

  • Ben observed a large response to whole-oat oatmeal
  • Oatmeal routinely appears in healthiest-breakfast recommendations
  • Clemente said it ranked among the worst foods in the Levels dataset
  • Individual reactions can diverge from generalized nutrition labels
  • Glucose variability is associated with adverse cardiovascular outcomes

“So you Google healthiest breakfast and it's like top three, no matter what is oatmeal.”

Josh Clemente

“Well, last time I checked, and it has been a few months, but one of the worst foods in the data set was oatmeal.”

Josh Clemente
#oatmeal#glucose#nutrition#personalization

Hot Take· 2

Hot Take

Diagnostic Codes Turn Individual Health Into Rigid Buckets

Clemente argues that requiring a diagnostic code before treatment shifted healthcare away from individual nuance. Combined with reimbursement incentives and limited consumer choice, the system encourages standardized products and discourages using personal health data for everyday decisions.

  • Diagnostic codes determine whether treatment can proceed
  • People outside a recognized bucket receive little targeted help
  • Reimbursement can reward conformity over a better experience
  • Consumers rarely use annual health measurements to guide daily choices
  • Cash-pay alternatives can reintroduce selection and competition

“It went from the nuance of an individual to if you don't fit this bucket, I can't do anything for you.”

Josh Clemente

“Like once you're in the captured audience like you have a payer who's going to reimburse you have a doctor who is going to draw…”

Josh Clemente
#healthcare#incentives#insurance#personal-data
Hot Take

There Is No Average Person to Optimize Nutrition For

Clemente argues that broad population guidance fails because individual health responses are highly multivariate. Large anonymized datasets and continuous personal feedback could shift action to the individual, allowing many people to solve locally for themselves rather than relying exclusively on centralized dietary policy.

  • Wearables historically focused on superficial metrics such as pulse and steps
  • Genetic information alone cannot determine the right daily choices
  • Individual responses require real-time feedback
  • Large datasets can sharpen personalized recommendations
  • Decentralized individual action could compound into population-scale improvement

“It's to try and solve for the average person. And uh there is no such thing as the average person. There, there is the individual.”

Josh Clemente

“So rather than trying to solve nutrition, you know, with legislation or policy, you can instead have each person solve for themselves, multiply that by…”

Josh Clemente
#personalization#nutrition#wearables#public-health

Explainer· 4

Explainer

Why SpaceX Could Take Risks Old Aerospace Would Not

Clemente argues that early SpaceX operated from a position of having little to preserve: either it succeeded or it ran out of money. Incumbent aerospace organizations, by contrast, had programs, careers, and political capital to lose, making visible failure much harder to tolerate.

  • Scarcity can make organizations defensive once they possess something valuable
  • Early SpaceX remained one launch failure away from collapse
  • Old aerospace failures could end engineering and political careers
  • SpaceX treated failure as an option and publicly streamed explosions

“And and so SpaceX was in a we have nothing to lose mentality for the entirety of its kind of early days.”

Josh Clemente

“No other program does that because it's like airing your dirty laundry.”

Josh Clemente
#spacex#risk#culture#innovation
Explainer

How Telehealth Unlocked Consumer-Friendly Prescription Products

Companies such as Hims, Roman, and Curology combined physician review, asynchronous communication, and mail-order fulfillment into an experience resembling online checkout. The medical decision remained with a licensed practitioner, while technology removed travel, stigma, and unnecessary workflow friction.

  • Prescription review still occurs through a licensed physician
  • Asynchronous communication can replace an office visit in permitted cases
  • Mail-order fulfillment completes the consumer experience
  • Privacy and convenience can increase willingness to seek help
  • COVID-era changes broadened acceptable telehealth tools and practices

“Companies like HIMS and Roman and and others were demonstrating a new model where you combine telehealth capability with um low-risk products, medical products, into…”

Josh Clemente

“It feels very much like ordering something online, which is really convenient.”

Josh Clemente
#telehealth#digital-health#regulation#consumer-health
Explainer

Why Better Biosensors Are Useless Without an Insights Layer

A CGM can display a glucose value and trend arrow, but those numbers do not explain what caused a response or what the user should do next. Clemente positions software-generated context, scores, and recommendations as the bridge between inexpensive sensing hardware and durable behavior change.

  • Raw readings require substantial domain knowledge to interpret
  • An insights layer links nutrition, exercise, sleep, and stress to outcomes
  • Composite metrics can summarize curve height, speed, and duration
  • Low-overhead logging improves adherence
  • The primary value lies in actionability rather than measurement alone

“So it seemed like the huge value proposition was building an insights layer on top of this raw data.”

Josh Clemente

“So the metrics that we're producing, which are uh composites of a number of clinical, well, clinically relevant data points about a blood sugar curve,…”

Josh Clemente
#biosensors#data-science#behavior-change#software
Explainer

Why Non-Invasive Apple Watch Glucose Sensing Is So Difficult

Clemente describes Apple's challenge as detecting a small, colorless, water-soluble molecule without breaking the skin. The system would need sufficient accuracy and resolution for the narrower glucose fluctuations of people without diabetes, potentially using Raman spectroscopy.

  • Existing CGMs directly interact with glucose beneath the skin
  • Apple's product design strongly disfavors breaking the skin
  • Glucose must be detected within a fluid composed primarily of water
  • Non-diabetic use demands sensitivity to relatively small fluctuations
  • Successful sensing could open opportunities for additional analytes

“Apple needs to solve what I consider a mechanical miracle, which is non-invasive measurement of a colorless, small water soluble molecule in a fluid which…”

Josh Clemente

“I'm hopeful it's called ramen spectroscopy, is what I think the the technique they're working on is, and it's a light scattering technique.”

Josh Clemente
#apple-watch#glucose#raman-spectroscopy#biosensors

Story· 3

Story

How SpaceX Saved a Falcon 9 Launch With a Pair of Shears

An air-conditioning purge caused the Falcon 9 second-stage vacuum nozzle skirt to flutter and tear shortly before launch. Rather than disassemble the vehicle, SpaceX flew technician Kelly to Cape Canaveral, where he climbed inside the stacked rocket, trimmed away the damaged section, and enabled a successful launch.

  • The vacuum nozzle skirt was thin enough to tear with fingers
  • Traditional aerospace would have delayed and disassembled the vehicle
  • SpaceX accepted a calculated loss of engine efficiency
  • The improvised repair preserved the launch schedule
  • The rocket successfully reached orbit

“The SpaceX approach was Elon calls up one of the lead technicians in the entire company.”

Josh Clemente

“But you know, basically Kelly hand trimmed this thing in the inner stage, walking around on the on the dome of the the first stage…”

Josh Clemente
#spacex#falcon-9#engineering#aerospace
Story

The SpaceX Burnout That Started Clemente's Health Search

Years of intense work, four-to-five-hour nights, unmanaged stress, and punishing workouts left Clemente exhausted, irritable, and frightened that he had a serious illness. Standard blood panels found nothing, despite recurring episodes of shakiness, cold sweat, tingling, and severe fatigue.

  • Clemente routinely slept only four to five hours
  • He relied on hard CrossFit training as his wellness strategy
  • His mood and personal relationships deteriorated
  • Standard clinical tests did not explain his symptoms
  • The experience exposed a gap between looking fit and feeling healthy

“I had gotten to the point where I woke I woke up one day and was just like, I think I have a terminal illness.”

Josh Clemente

“I've got a decent amount of muscle, I can run fast, but I don't feel healthy.”

Josh Clemente
#burnout#sleep#stress#metabolic-health
Story

The Ketogenic Rat Study That Broke the Calorie-Is-a-Calorie Model

While researching oxygen toxicity for spacecraft life support, Clemente encountered Dominic DiAgostino's work on rodents in high-pressure, high-oxygen environments. Ketogenic interventions reportedly allowed the animals to remain seizure-free far longer, prompting Clemente to reconsider his belief that food choices were interchangeable if total calories matched.

  • The research connected Clemente's aerospace work with metabolism
  • Ketones can provide an alternative energy source for the brain
  • The rodents reportedly survived up to five times longer without seizure
  • The result challenged Clemente's calorie-is-a-calorie absolutism
  • It motivated him to seek objective dietary feedback

“And the result was that these rats could live up to five times longer without seizure just because of the ketogenic state they were in.”

Josh Clemente

“And that completely blew my mind because up until this point, I was a calorie is a calorie absolutist.”

Josh Clemente
#ketosis#nutrition#oxygen-toxicity#metabolism

Takeaway· 1

Takeaway

A Stressful Meeting Can Raise Glucose Without Any Calories

Clemente says CGM data made the physiological cost of stress visible by showing his glucose rise during a difficult meeting despite no food intake. David describes similarly unstable glucose during the Texas power outages, connecting stressful conditions with both poor mood and measurable metabolic changes.

  • Stress can affect glucose independently of food intake
  • Clemente observed glucose exceeding 145 during a stressful meeting
  • David saw larger spikes and crashes during the Texas outages
  • Immediate personal data made generic stress advice more compelling

“sitting through a stressful meeting with a CGM on and seeing without calories my blood sugar exceed 145 milligrams per deciliter”

Josh Clemente

“It was just unreal to see the data of like I knew I was feeling bad.”

David Rosenthal
#stress#cortisol#glucose#biometrics