Co-founder and President of Levels: Josh Clemente

Josh, it's a pleasure to see you again. I've been following levels since the early days, and I'm really excited to have this discussion together. How about we start with the pre-history? I believe you have an awesome pre-history with the likes of SpaceX.

Well, Kyriakos, I'm excited to come on the show and definitely have enjoyed being in touch and connecting about the space for a long time.

To go back to the beginning, I never had much of an interest in health beyond physical fitness growing up. So I was always into sports after school, where I played a bunch of club sports in university. I started to do Crossfit and became a Crossfit trainer. Generally, if I could run fast, lift heavy weights, and jump high, I figured that's the picture of health.

And it wasn't until I was deep into my professional career I was working at SpaceX on the astronaut life support program, which was a brand new first for SpaceX. We had been basically an empty box. The spacecraft just carried supplies up to the International Space Station, but it didn't have to sustain life. When we started doing that at SpaceX, we had to make NASA very comfortable to keep humans alive.

That was my first project at SpaceX, where health came into the picture. I started to be involved with the mission doctors and the long-term crew sustainability concepts. I had these moments of realization.

I was working on an extremely stressful project, the most stressful moment of my life, but also the most exhilarating and exciting. I was physically fit. I was working out as frequently as I could, typically every day or every other day.

I had a few weird moments where I realized that although I looked healthy, I did not feel healthy.

I was literally sleeping under my desk in the middle of the day, having to sneak a nap, just wanting to sit down, feeling low energy, feeling shaky. Simultaneously, we were developing these fantastic systems for the spacecraft on the program itself. But there would be these moments where we would have all this data telling us that the vehicle was operating properly. But I would realize, and I'd have this weird sense, that we wouldn't have any data on the astronaut within the vehicle.

So we wouldn't know if they were healthy or what that even means. And so I started combining these two concepts and researching for myself, what would sensor health look like? What would you have to measure in order to know the health state of somebody?

I started to experiment myself and eventually, this led to continuous glucose monitoring. It led to a realization that I have impaired fasting glucose and impaired glucose tolerance myself, despite never having been told that by any doctor. Ultimately that kicked off a realization that CGM is just the first of many future technologies that will give people continuous real-time insight into their health state, and they'll be able to live in the driver's seat instead of having to offshore that to another physician or something.

That's the long story short - levels came out of my own realization from a very stressful period, a very exciting period of my life where I was burning the candle at both ends and was really pushing myself into metabolic dysfunction. I just happened to stumble on it and realized that this is the tool, the beginning of the tool set that will give people control over their health in the future.

Early days at SpaceX, learning from Elon Musk, and building a responsible engineer framework at Levels

I wanted to ask some questions about the early days of SpaceX in terms of the culture. What did you learn from the approach - what did you learn from Elon?

So many things. The things I took away from SpaceX, first of all, is that it's not for everyone, but it is for me, having worked in many different environments since it is the pinnacle of fast-moving technological breakthroughs.

SpaceX is the pinnacle of fast-moving technological breakthroughs.

There are not many places in the world where you can be an engineer to work on hardware problems and get the condensed experience that you get at SpaceX. Things happen literally 10 times faster there.

And the reason for that is I think two things - there are no arbitrary barriers. So even something I think a good exploration of this is something as simple as language. There is no acronyms policy at SpaceX. If you look at any other aerospace program in US history, it is rife with acronyms. You can read an entire page and you will have no idea what that page is describing because everything from the project to the intention to the outcome is condensed into acronyms which you have to have a glossary to understand.

At SpaceX, that's not tolerated. Everyone is expected to communicate. Regardless of how advanced you are in your career and how specialized you are, you're expected to communicate in a way that anyone at the table, regardless of their background, can understand and contribute to.

That's key because it avoids the sense that you are too ill-informed or uneducated to contribute to a conversation or you don't have the experience, and it enables everyone literally to stay in the same context. That genuinely means that people who are just interns are walking in the door and within a few weeks they're contributing in a significant way to major initiatives that have been going on for a long time. Something as simple as language, and it'll be funny because you would sit at a conference room table at SpaceX and it will sound like people are explaining things to children.

They'll be using very basic, simple analogies for what they're trying to achieve. Something as simple as we need just to put legs on the rocket, and then the leg should unfold, and then the rocket can land on the pad. That doesn't sound like an advanced aerospace conversation, but that's how it happens in SpaceX. A key part is avoiding limitations on other people being able to contribute. Then the second thing is extreme accountability.

The responsible engineer framework is what it's called at SpaceX, where one single individual is accountable, regardless of what happens, for the outcome of a project.

Bodybuilding and the post-workout glycemic window myth, and why you should not copy elite athletes

In the body-building space, there's a lot of talk about the post-workout glycemic window, is this a myth - what's your view?

It's a great question. I would say this is where I will lean heavily on personal variability. We are not all the same. One of the most amazing things I've learned through levels is just how different we each are in terms of how our bodies respond to the same stimulus, the same inputs. I'm somebody who has very volatile blood sugar. I have high fasting glucose. I have a very aggressive response to simple foods, even black coffee.

If I just drink black coffee, I have a blood sugar spike, sometimes a dramatic one, depending on how poorly I've slept.

Wow, this is surprising.

Yeah, even among people who have been using levels for a long time, I'm one of the few people with that response. Firstly, there isn't a one size fits all answer to this. Secondly, one of the first things I saw when I tried a CGM for the first time was exactly this effect. I was somebody who, like I said, lived in gyms. I was obsessed with musculature and making sure that I was bulking up at the right times and staying lean simultaneously.

It was a lot of carb loading and glycogen replenishing. Loading carbs so you have energy for that workout and then replenishing the glycogen that you depleted from the workout immediately after. I ate many carbohydrates, brown rice, sweet potatoes, and whole-grain pasta. And I found that my blood sugar from those carb loads and glycogen replenishments, regardless of how aggressive my workout is or how long, completely just blew through the roof in terms of blood sugar control. I would have a huge spike.

Let's say I was carbo-loading for a workout. I would have a shake with a lot of carbs, banana, maybe some brand lakes, etc, on my way to the gym, while I have this huge blood sugar spike, I would then be walking up to the bar for the first set, and my blood sugar is now crashing down through the floor and my energy is lost. I used to yawn in the gym at 10 AM because I now realized my blood sugar was crashing through the floor and all that energy was being soaked up. Then for the glycogen replenishment, it just turns out that I was massively overdoing it.

For my body, I just did not need that many carbs. And in fact, I was probably causing myself a lot of trouble with inflammation and just the variation and the crash is just lowering my energy because I was overdoing it so much. That said, I know many people who have a similar build to me who were eating similar nutrition profiles and have completely controlled blood sugar.

My point is that I think you have to dial this stuff in and you need some feedback to know whether or not you're overdoing it. In general, my emphasis is on protein. I eat high protein, moderate fat, low carb diet, and that's where I feel best. That's certainly how I perform best in the gym. I don't have those issues anymore. I would say one last thing on this is that a lot of the gym nutrition culture comes from looking at the elite, looking at the best of the best for athletics, and saying that this is what the best performance looks like so everyone should copy that. At the time that I'm describing, I was certainly spending most of my time at work, working really hard, but it's knowledge work.

I was not physically exerting myself. I would go to the gym and I would work out hard for 60 to 90 minutes. But I'm not somebody who's training for 3, 4, or 5 hours a day. I should not be copying what elite athletes, elite Crossfit athletes, or Tour de France athletes are doing for my carbohydrate intake. We make that mistake all the time.

Everybody looks at what the elite are doing, and there's a difference between elite performance and optimal health.

So what they're doing is pursuing goals in the event that they're competing in. What we're doing is trying to perform well as a team, employees, husbands and wives, and so on and so forth. And so there's a very big difference. I just want to conclude that even if it is important to replenish glycogen and carbo load, let's make sure we're doing it for the lifestyles we actually lead, not the lifestyles that lead athletes lead.