Startup Spotlight: Kalibra

Startup Spotlight is an interview series where we ask health, fitness, and wellness startups that use Terra to share their wisdom from their journey to success and also where they see fitness data going in the future.

For this week's spotlight, we connected with Ivan Vatchkov, founder and CEO of Kalibra, the platform that turns health data into action.

Kalibra is a platform that turns health data into action.

Kalibra is a platform that turns health data into action. We feel that there's a market for this service as data is currently exploding in the general market. Of course, advanced dashboarding help, but human beings are meant to be serial, not parallel processors. So our job is to organize all the data about somebody's online and offline data.

So wearables could be other forms of assessment in addition to personal assessments by doctors and personal trainers and various optical integrations that we have with third parties. We organize all of this through an intuitive health operating system that basically separates all the data into six pillars of health: how we rest, how we move, how we nourish, how we connect, how we reflect, and how we grow. Essentially we have mental, physical, and social health on one unified platform. And then every day our intelligence interface looks through that data and finds people's personal 80/20. This is the highest leverage action you can take today and that's very well. Our bodies work the same way, but we all need different things at different times in different sorts of sizes.

So for you, today's suggestion might be to go to bed 20 minutes earlier. For me, the suggestion might be to complete a quad stretch, whereas for somebody else, it could be to call your mom, and for somebody else, it might be - "hey, it's been three months since you've checked your vitamin D. Let's take a look at whether that's an important metric for you." That biomarker could be trending back because you've been taking a supplement. At Kalibra, we try to really reduce health to a conversation where everybody knows exactly where they are in the health journey and what the next step they have to take is and hide all of the complexity of the data and the processing and the hierarchical ordering of that exploding data set into something very intuitive. That's the gap we fill, and we do that for practitioners and consumers.

What got you into this space, and how did you start as a founder?

Personal passion. My family has a history of health challenges; let's put it this way. Myself included - I come from an industry with incredibly high stress. My prior identity was in the hedge fund industry, which is pretty much a 24/7 job for example, if you're sitting in Asia the US market won't close until three or four in the morning. Essentially, I knew that I was making a health trade-off and feared that I was gonna follow in the footsteps of my dad, who is a type two diabetic. I left, and I decided actually to figure out how to best extend my health span. And that's sort of the number of years I am both healthy and free of disease, but I can do everything I want. That's basically what got me started as a personal passion, and just by serendipity, I met my co-founder, who shared a similar passion. We decided to try to reduce health to a maths problem, which I guess is what you guys are doing in a manner of speaking as well. The origin story is that we actually built it for ourselves, and it looks like it's resonating with people, so we took it from there. That was a couple of years ago.

As a company, what was the first step you took?

The first step was rapid prototyping and validation. We built a user journey around what we think is probably one of the most important steps of the health journey for all of us, which is getting a little bit of a sense of where we are, right?

Every journey has a starting point in terms of a destination, and that starting point is often overlooked. Most of us know more about what's going on in Beirut, in Beijing, and even in our BMW than we know about what's going on in our own body. Wearables, of course, fill a big chunk of that gap, but if you look at the overall health picture, wearables are not the dominant part of it. So we thought, what's the easiest way without tedious questionnaires and a lot of lab tests and all that, to get a quick read and quick reckoning of where we are with our health journey. We partnered up with a health practitioner and created something called the 10-minute health assessment, where you can go in and get a blood test. We also do a metabolic assessment by looking at your body composition, and we do a very basic stress assessment, strength assessment, and grip test. It all takes 10 minutes, and you're out. From these tests, we can triangulate quite a lot about your early onset of metabolic disease and how you are in terms of strength and losing muscle, which is sarcopenia.

Moreover, if you're ageing, what's your hydration status? For example, is there a big imbalance in your body with respect to vitamins or minerals? This is to ensure we find where you need a tuneup through our premises to keep you healthy rather than waiting for some sort of symptom to show up. At that point, you're the domain of the medical system, and there are fewer good decisions to be made.

The idea is to give people a starting point, a very intuitive assessment, and then say, okay, look, if I was you, these are the top two or three things I would tackle. And then we actually give them a playbook. We did this completely offline with a medical practitioner on Excel spreadsheets and paper, and when elements of this started resonating, we began digitizing every step of it.

We also knew that we needed an operating system, but we needed to figure out what's the most important data set and what's the easiest way to extract this data and how to combine it. That turns out to be wearables measuring blood work and some elements of body composition - and that's where we started.

We're obsessed with validation, and interestingly we are a startup that necessitates slower growth.

The whole idea of blitzscaling that everybody talks about wouldn't necessarily work in a journey like ours because we're not interested in getting big data at this stage. We're interested in getting thick data.

I want to know everything about a single consumer because the connected consumer is all about uber personalization. There's an expectation that if I'm providing any advice or service to you, I will reflect all the data available about you in customizing that service seamlessly. And to align this, it is necessary to have a slow journey because it's about thirty or forty human phenotypes that you need to work out in terms of motivation and starting point, and so on. That's where we're a little bit different.

You launched two weeks ago - as a user, what do I get today, and how do I use it?

If you're a user today, we have both a consumer and a professional platform. The consumer pro platform is already in beta. You would get a very simple and intuitive app today, only in iOS, soon in Android, which contains sort of three really good ways of interacting with it. Number one is we have a conversational assistant, like Alexa, that has a very short and friendly interaction with you every day for about 30 seconds. It gives you an interesting insight about you. Asks you a question about whether it's a habit or something about your health, and then it will assign you an action. A typical conversation might be "Hey, good morning [User Name], I noticed that your deep sleep score was only 39 minutes yesterday. I think we need to improve on this - here's why: it affects deep sleep, brain function, restfulness, ageing for whatever reason, and metabolic health. Tonight I'd like you to go to bed at 9:37 rather than 10:15, and three hours before bed time, I'd like you to not eat anything and one hour before bed, no screens. Let's try this tonight and see if we can improve on that metric." The KPI we've set for ourselves is a very small increment on your deep sleep. And the next day, in addition to the first conversation the message might be: "Hey, did you improve on that metric?" If the user did, we've created the very first small incremental step towards a healthier habit, and we've created awareness and we repeat this journey over and over again in all sorts of domains. For example, it could be related to mindfulness or it could be something philosophical like "do you ever think about your why? your purpose?", or it could be something as simple as "Hey, I see you've been running quite a lot in the last seven days. There are some risks related to your shin splints if you run a lot, as it's quite inflammatory." Or the question could be "Did you know that when you run and sweat, you lose quite a lot of salt. Do you ever take salt tablets after you run?" These little conversations feel very intimate and personal because they're not a standard user journey. They are based on your own data and that's sort of the interaction.

The second level involves if we can pick up some of this data from wearables and that's where Terra comes in, which is really helpful.

The third level is actually acquiring the data that would ordinarily be stripped off. That could be asking a personal trainer to do a basic strength assessment. It could be asking a medical practitioner to upload some vitals. It could also be uploading your entire blood test, which is probably our key differentiator because all these little markers are falling into place to paint a more complete picture of who [User Name] is. It's sort of a way to use model language, a 3D digital copy of you that we then use to figure out where the biggest white spaces are, what we need to learn more about, and where we think the highest leverage action is. For that, we use fairly complex scoring, which we show to the user through a message: "Hey, your rest is 80 out of 100, that's fantastic, but your nourishment is only 30 because you consumed too many carbohydrates, or you're not hydrated enough."

By using Terra's API, we can pick up a user's hydration status from a Garmin watch or track a user's carbohydrate intake from Cronometer.

Then we create a journey around this that makes the user the CEO of their own health. Every day the user will see what the metric is. They decide, do they engage, or do they not? And if they do engage, their score goes up. So there's an element of gamification, but we break it up into very, very small bite-sized conversations that ideally, you would interact with every day. In sum, those are the three user journeys, and if you're a professional, we consolidate all the various data bits. Let's say you are a functional medicine practitioner, or longevity doctor, or personal trainer; we create a real-time measurement of your client's health, what we call their Kalibra score, and know how to personalize for them. For example, one use case might be - you rock up to the gym, but you went to bed at 3:00 AM last night. Your coach should know not to give you heavy deadlifts or sprints. It should be a more gentle mobility session. Or if your doctor sees that you're not sleeping well and your blood sugar is picking up and your resting heart rate is picking up. Then they might ask you "Hey, are you under a lot of stress? Is there something we can do?" That would be the type of preventative, personalized care - we call it continuous care - as we not only dashboard the data, but we provide the interpretation and the Kalibra score so that the practitioner doesn't see hundreds of data points beautifully organized, but we can direct their attention to specific ones. For instance, for User A the specific metric is Vitamin D and for User B it's her deep sleep and for User C it's the fact that he's only walking 300 steps a day and is very inactive.

Who are the initial users that you will be targeting first?

They ask themselves, "am I on the right track with my health journey and how would I know?" These are the people who are already motivated. You would recognize them by the fact that they probably invested in an expensive wearable, they're paying for personal trainers, they do their own blood work, or potentially, they take supplements.

A number of flags show us that there is not only a willingness and a demonstrated motivation but a propensity to spend on health. Human beings are quite strange, we'll spend a lot on sort of high-value consumer goods to demonstrate status, but to me, the ultimate flex is being very healthy and most of us don't spend enough on it.

The ultimate flex is being very healthy and most of us don't spend enough on it.

We're trying to find those that are on their way and give them the tools to own more of the journey. We would find that person that is very active from a sports perspective, or a biohacker that's really interested in fully downloading a digital copy of themselves, or somebody who's visiting a functional medicine doctor and looking to make a lifestyle change. You typically find those people in three types of locations; 1) in gyms and personal training centres, 2) in longevity and integrated health clinics, or 3) in nutritionist or wellness spa hotels. These are people that are saying - "I'm making a very conscious choice to be intentional about my health." That's not a huge cohort of people at the moment, but it's an incredibly cohesive one and very powerful. That's the market we're looking to serve first, because they're the most discerning customers.

We can always simplify the product from there, but the goal is to satisfy this group that we call an active advanced cohort that really resonates with the demographics of where people are going. For example, younger people don't drink as much and they're very conscious about their consumption and about what they eat. That's kind of who we target initially, which is why we have the B2B angle. Those people are already working with some practitioner somewhere. That's essentially our starting point and eventually as we grow and we improve engagement and we validate, we'll broaden this out to a direct consumer business.

However, for now we've got a very, very good engagement on the practitioner's side globally. People looking for a way to homogenise all the data that they have and actually turn it into engagement, which is a problem everywhere in the chain. People come in, they behave in a certain way when they're at the office, doctor's office or gym, but you don't know what happens to them in the other 165 hours a week that you don't see them. This is the gap we look to fill.

What can we expect from Kalibra in the next year and in the coming five years?

In terms of a one year view our ambition is to find the best practitioners and geographies to serve. Elements of Asia, elements of the US, elements of Europe, and help them leverage what makes them unique. For example a fantastic personal trainer, a fantastic doctor, a fantastic nutritionist, an exceptional wellness and spa hotel that really provides a very good integrated health service. Our job is to scale those guys and get their brand out there along with our brand and get them associated with excellence.

That'll take us probably close to a year. Hopefully, in that same period our product suite will be more or less complete. The consumer app is there, the professional app probably needs another few weeks of work. From then it's validation and incremental improvement. On a five-year view, we'd actually like to turn health around. I don't like to use the word disruption, but rather re-imagining big parts of the healthcare system to give people the tools to have a better control of their health and how they spend it, and how they engage with their health journey. And specifically give them the parameter of health span and longevity. Help them understand the things that age them faster, the things that wear them out faster, and help them imagine a life of continued health into their 60s, 70s, and 80s. The decisions to make that a reality for each of us start today in your thirties and forties, not when we're 60. So I would say the specific KPIs for that would be, How are clients engaging with the actions that we prescribe? Are we actually rewiring people's habits or not? Rewiring habits is a very tough job, right? So if we can move the debate on this a little bit, I think that'll be fantastic.

Our strategy is to give everybody the highest leverage action to improve health span in real time.

After that the idea is to make people intentional about their health in a measurable way. What percentage of our clients is improving their Kalibra score? Is it because they're sleeping better? Is it because their mindfulness is improving? Are we managing to hydrate our clients better? All of that data is naturally stored as part of our user journey.

I would be able to answer in a year's time with numbers, but hopefully in five years time I'll be able to answer with cohorts, hacks, and small pivotal journeys of what are the things that really matter to the health journey of the bigger population. That's what the strategy is in one sentence, to give everybody the highest leverage action to improve health span in real time.

What are the three biggest mistakes you see today, and what are the three best changes people can make to improve their longevity?

It's a great question. I'm going to generalise, but we've worked with enough people now to have a good idea.

Number one is that most people are either dehydrated or deficient in a key mineral and they don't know it. Interestingly, both of these things will not give you any tangible signs. You have to be very careful in getting quite technical by tracking the colour of your pee or the dryness of your mouth, or do a blood test every so often.

I was looking at some statistics where 80% or 90% of Americans are deficient in both B and D-vitamins. Those are absolutely critical, not only for physiological functioning, but for our mental health. Thus, I would say number one, most people are dehydrated because you need to drink lots of water at the right time and also take enough hydration minerals to retain that hydration.

Most people are either dehydrated or deficient in a key mineral and don't know it.

Strike number two for most people is they think that time in bed equals quality. Let's say you went to bed at 10:00 last night, and I browsed Instagram until 10:45. Well, you've already missed a critical sleep cycle. The fact that you exposed yourself to blue light means that you shifted your entire circadian rhythm by an hour or two later, which means that you didn't complete the necessary four or five sleep cycles, which means your deep sleep and REM sleep are out of order. Sleep hygiene is very important, and wearables that track your deep sleep are very helpful. As a side note to that, I think most people still don't fully understand the effect of alcohol on quality sleep. They confuse sedatives with something that actually makes you sleep well.

There are three pillars of longevity - hydration, sleep, and movement.

There are three pillars of longevity - hydration, sleep, and movement. We found a really interesting u-shaped curve of the utility of moving. If you don't move at all, that's really bad. If you over-exercise by for example, excess cardio, then that's also really bad. Most of our clients are obviously very active people. We don't have many couch potatoes reaching out for Kalibra and wondering how to go on their journey. Still, we attract type A personalities that tend to be overexerting on the cardio. Overexerting has all sorts of implications for their hydration because they have to take some sort of hydration salt to ensure they hydrate appropriately after a lot of exercises.

Excess cardio can mean a lot of excess inflammation and a lot of people equate fitness with cardio. While movement and exercise is probably the key longevity drug, it's important to balance cardio with strength and mobility and flexibility, and most people over index on the thing that they're good at. It could be running, cycling, or another activity, because they think excess exertion is what keeps us fit. Although elements of that are very true, such as training with increased heart rate once or twice a week, an exponential mistake we see as people age is to be way under the curve from where you should be in terms of strength. Having strong muscles equals strong bones, and as we age, that's the most important thing. That's how you avoid osteoporosis and that's how you avoid bad falls. Strength and mobility will be sort of the third element that I think a lot of people really misunderstand.

Awesome. Is there anything we didn't touch on that you want to discuss?

Your questions are quite sharp. We're excited to partner up. We look forward to bringing our methodology to more people, and I would urge everybody to get a wearable and start the journey. I think fitness and health is a journey we should all start, and none of us should ever finish.

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What activities do you do?

I used to play basketball when I was younger, which cost me both of my knee ligaments, so sadly, that's no longer possible. My preferred method of cardio is cycling or swimming. I find cycling to be a very good balance between cardio and strength without too much impact on the bones. I've tried calisthenics, weights, and a little bit of gymnastics. I find gymnastics to be the purest form of fitness, but it gets harder as you age.

Essentially, my fitness regimen is around cardio in the form of cycling, mostly a little bit of running and swimming, and then really emphasizing lean muscle mass because naturally, as we age, we're gonna start losing it no matter what. I'm just trying to get as high as I can initially so that I've got something to lean on once it gets me.