How to see inside your body using CGMs with Maz Brumand from Levels

Until recently, getting a blood glucose measurement required a finger stick. The whole process was so painful and annoying that only diabetics taking insulin bothered to do it regularly. But there’s a new class of devices called continuous glucose monitors, or CGMs, that make getting a glucose reading as easy as glancing at your smartwatch to see your heart rate. A CGM is a patch with a tiny electrode that goes into your skin to measure glucose levels in the interstitial fluid, plus a radio that sends the measurement to an external device like your phone. The devices are pain-free to use, and they’re rapidly coming down in price. Harry‘s guest today, Maz Brumand, is head of business at Levels, a startup that wants to use CGMs to help everyone understand how their choices about food and lifestyle affect their health.

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Transcript

Harry Glorikian: Hello. I’m Harry Glorikian. Welcome to The Harry Glorikian Show, the interview podcast that explores how technology is changing everything we know about healthcare.

Artificial intelligence. Big data. Predictive analytics. In fields like these, breakthroughs are happening way faster than most people realize.

If you want to be proactive about your own health and the health of your loved ones, you’ll need to learn everything you can about how medicine is changing and how you can take advantage of all the new options.

Explaining this approaching world is the mission of my new book, The Future You. And it’s also our theme here on the show, where we bring you conversations with the innovators, caregivers, and patient advocates who are transforming the healthcare system and working to push it in positive directions.

People used to go through their lives not knowing very much about what they were eating or what was going on inside their bodies.

If you time-traveled back to the year 1900 and you stopped a person on the street to ask how much they weigh, they probably wouldn’t be able to tell you—because the bathroom scale didn’t become a common consumer item until the 1920s.

If you visited the 1960s and walked into a grocery store, you wouldn’t be able to figure out the calorie, protein, and carbohydrate content of anything—because nutrition labels weren’t a thing until the 1970s.

And until very recently, the only way to figure out your blood pressure was to visit a doctor’s office or find someone who’d been trained to use a blood pressure cuff. Now you can buy an automated home blood pressure monitor for under fifty dollars.

And of course, if you have a wearable device like an Apple Watch, a quick glance at your wrist can show your heart rate or even an EEG readout.

So, what’s the next health-related measurement that’s about to go from obscure to commonplace?

It might just be your glucose level.

Until recently, getting a blood glucose measurement required a finger stick. The whole process was so painful and annoying that only diabetics taking insulin bothered to do it regularly, to avoid episodes of hyper- or hypoglycemia.

But there’s a new class of devices called continuous glucose monitors, or CGMs. They’re pain-free, and they’re rapidly coming down in price.

A CGM sticks to your arm and it has a tiny electrode that goes into your skin to measure glucose levels in the interstitial fluid. There’s also a radio that sends the measurement to an external device like your phone.

I wear a CGM myself. Over time it’s teaching me which foods cause my glucose to spike the fastest, and which ones can help me keep it more even over time.

My guest today, Maz Brumand, works for a company called Levels that wants to use CGMs to help everyone understand how their choices about food and lifestyle affect their health.

Maz left a pretty high-level position at Apple last fall to join Levels.

And my first couple of questions for him were about what attracted him to the company, and why he would leave a company like Apple, with more than a billion users worldwide, for a health-tech startup that isn’t even out of beta.

So here’s my conversation with Maz Brumand.

Harry Glorikian: Maz, welcome to the show.

Maz Brumand: Thanks, Harry. Thanks for having me.

Harry Glorikian: So I want to start by maybe, [going over] the story behind Levels. I mean, you’ve got five great founders with, you know, stellar Silicon Valley credentials from companies like Google, SpaceX. And, you know, pretty much why they started the company, you know, and I’d love to understand sort of the special sauce and unique insight that you guys felt that you could bring to the market for mobile health monitoring.

Maz Brumand: Yeah, that was a good question. You know, we have found five founders, as you mentioned, and they’re just fantastic group of people. They’re they’re very passionate about this area in health. And I think all of it started from Josh, one of the founders where he quickly understood that there is power in CGMs and that he has been in his account living a healthy life. But when he actually started measuring his glucose, he realized that a lot of the things common knowledge or advice around food was wrong. And there is great stories on that on our podcast. For example, drinking juice. And all of us think that drinking juice is the healthiest thing you could do. And so I think one of the investor meetings, he took a juice that was, you know, presumably very healthy, a green juice, and drank it and shot his saw his glucose spike sky high. And so that was kind of an indication that there is something here. But you know, the thesis behind the company is that we don’t know what’s going on in our bodies. And if we could create a dynamic where we have bio observability and by that, I mean, we can actually see what’s going on inside our body based on our behavior and actions. For example, in the case of CGM, if you eat a hamburger, the CGM will tell you how your body’s going to react to that in real time. Or if you eat a doughnut. It will tell you so. There is no two questions about it. It’s very specific to you and it will show you in real time how your behavior is going to impact your health. And that’s very powerful. And so the thesis of Levels is starting with CGM, can we create that feedback? Can we close it in real time? Can we show you how food and your lifestyle affects your health and create this path towards healthier lifestyle and healthier decisions?

Harry Glorikian: Yeah. You know, we’re going to jump into all of that, but I want to step back for just a second. You spent nine years at Apple. You were head of business and strategic development for the Health Strategic Initiatives Division. So just did you? What? What products did you did you work on? Because that’s super exciting.

Maz Brumand: Yeah, the stuff that’s public. We worked on a lot of research efforts to really understand, for example, how human cognition works. One of the projects I led was quantifying cognition to understand how cognition changes based on lifestyle and then also based on decline due to disease. And that’s just an example of one research. We had research around how screening affect early on will change the trajectory, so I spent a lot of time thinking about how does our behavior and how does technology allow us to improve human health.

Harry Glorikian: So I was reading about your background. I mean, you, you seemed like an outdoorsy guy like, former triathlete. If I if I read it correctly, were you always interested in health and wellness technology or did that something was that evolved over time?

Maz Brumand: Yeah, that’s a tricky question. From the wellness perspective, I’ve always been interested. I’ve always been an athlete. I’ve always been active. I always try to manage my food. But if you asked me 10 years ago that I would end up in health, I would have told you, you’re crazy. And the way I thought about health was always like being hospitals and IT systems, and it did not interest me at all. I thought it was slow and and not very interesting. But as Apple entered its health journey, obviously with releasing the Watch and then putting a heart sensor on the Watch, which was actually more elementary, yeah, I’ve got one, too. We quickly realized that there is so much power putting the consumer at the center of their data, and that kind of led to the whole platform that Apple created around HealthKit and ResearchKit and then built the products at the top. That being involved in that and I was part of the New Technologies Group within Apple on the commercial side. So I got introduced to that. And when I saw that, I fell in love with it because I saw that we can really change the discussion about health and put the consumer at the center. And nobody’s better than the consumer to make decisions about their health. They’re the one that probably cares most about their health. And so creating the dynamic where you allow consumers to take control of their health, by providing insights, by providing clarity, by providing services to help them manage that, seemed like a better way than having a disintermediation that we’ve obviously experienced in U.S. health care, and it’s very well documented.

Harry Glorikian: Yeah, I mean, you know, I’m in the venture world, so I mean, I love the the way the technology is changing the entire, you know, center of power or center of gravity that that that’s evolving over time. But I mean, Apple is like, I don’t know, over a billion users in the world, so, you know, you left for a startup. Why?

Maz Brumand: Yeah, that’s a good question. You know, working at Apple, I learned that to really make a difference, it has to be an ecosystem. And each of the players in the ecosystem have a different role. For example, Apple has really played a fantastic role in creating the platform and allowing people to take control of their health data on their phones. And it’s built a platform where other people can now build on top of to help. But Apple plays a unique role in the sense that it is this platform and it is going into verticals and trying to help wherever they can. But there are many more opportunities for startups like Levels to come and build on top. And when I was doing a little bit of soul searching about what would I do, I want to do with my life for the next 10, 20, 30 years, I was thinking about what are the big problems that we need to solve in health, and two areas became pretty apparent to me. One was metabolic health, because it’s the underlying of many of our chronic diseases, which has not only economic implications, but health implications around morbidity and mortality. And it’s a big problem not just in the US, but around the world. And then the second was mental health. And looking at the space, what I thought made sense and looking at the companies, metabolic health is what I really wanted to go tackle. And I got introduced to Levels about a year ago and I’ve been watching them.

Maz Brumand: And the fact that they’re building in public and being so transparent really helped me get to know them over the years. And I think the metabolic health space or in some of these things that are still in early innings, you need a startup to take the first step and accelerate and take risk to make this into something that consumers will accept. And there is a lot of things that needs to be done and put in place for this mission to be accomplished. But I felt that I could do that inside a startup faster. And then obviously, companies like Apple and others can help scale this and make it available to many, many, many more people, not just here in the U.S., but globally. But I think there’s just a different role to be played by startups and Apple, and I felt like getting to know Levels, I felt like they’ve got the DNA that’s not too different than Apple. High integrity, focus on customer trust. Just like Apple, focused on privacy and trust and the way they’re building the company focusing on culture is also something that’s quite differentiated. So even though there’s different places in their evolution, I felt like it was similar DNA between Levels and Apple. And it’s just that in metabolic health today, I think a startup like levels can move a lot faster and create that change.

Harry Glorikian: Yeah, I mean, I’ve looked at a lot of these different, you know, technologies people say, Well, you know, you’re wearing an Apple Watch. What does that do? What does this do? And I always tell them, I’m like, I think of the Apple Watch as sort of a aggregator or data repository, and things that sit on top of it are the monitoring or applications that would then do something with the data that that then is useful to me. But I mean, I’ve I’ve worn a CGM, you know, I can tell you that Korean bibimbap like spikes the hell out of me and it stays up there for much longer. But but you know, I just I was talking to somebody the other day and they’re like, OK, why would you wear a CGM? And and you know, how do I use it and so forth? And I was trying to walk them through the other things. But you get to now tell our listeners: So why do healthy people need this data? Why is this CGM data useful for people who are not diabetic or pre-diabetic, right?

Maz Brumand: Yeah, yeah, that’s a really good question. Look, you can look at everything from a disease perspective and look at, so now I’ve got a disease, how do I treat it or treat the symptoms? Or you could think of a foundation. And so what is actually leading to these things that are now disease and or symptoms of disease? It’s kind of like saying, I’m overweight, so I should go get a scale versus having a scale to measure yourself to make sure you don’t become overweight, but then saying, I only sell you a scale if you’re already overweight. So if I show up and I’m skinny, I cannot buy a scale. It’s kind of a crazy thought experiment, right? And then the CGM is based, I think, you know, we should think about like, what are the underlying things that are leading to these diseases? And it is metabolic dysfunction, which is how your cell produces and uses energy. And this is a long journey. It doesn’t happen overnight. So it may take 10 years for somebody to develop diabetes and you really want to measure their behavior today that’s going to lead to that metabolic dysfunction and intervene today. So what CGMs do and other technologies like that, is they provide real time feedback at the molecular level, which is what called bio-observability, to help you change that. So if I don’t know something is not working for me metabolically, how can I change that behavior? For example, I used to eat oats in the morning.

Maz Brumand: And I think many people do. I always thought that’s the healthiest thing I could do, I sometimes would even skip the milk and just be literally oats, which is crazy, right? And I thought I was the healthiest person in the world until I put on a CGM or saw other people put on a CGM, that that oats are really bad for you, especially right smack in the middle of your morning, when you’re actually trying to have sustained energy over the day. So CGM enable you to see that. Because first of all, I don’t think science and knowledge around some of these things is is is well understood because it’s so hard to do a clinical research to study food. There are just so many barriers. I think CMG for the first time at a personal level was telling me, like, what do I need to do today that would help me have a better outcome years from now? And also—that’s the disease perspective, so you asked about disease—and then from a wellness perspective, there’s a lot of benefits. Like the fact that I have higher energy. The fact that I am probably healthier, metabolically healthier. So I’m more resistant to disease. Obviously COVID being a big issue. So I think there’s a lot of benefits in thinking, both from how can I address the underlying factors that lead to disease and then also on a day to day basis, how does that make me feel better?

Harry Glorikian: Yeah, so so for those you know, people listening, what’s the benefit of keeping your glucose level flat and steady? I mean, I do my best to do that, but you know, I’m not sure that everybody fully appreciates what that does.

Maz Brumand: Yeah, I’ll talk about it from the wellness perspective. When you have a glucose spike, your body produces insulin and it crashes that back down. And when you get back down, that’s the afternoon lull where you feel low energy. That’s our lethargic brain fog. So just from a wellness perspective, just from, you know, how do I want to live my life perspective, managing these spikes allows you to feel better during the day, and that’s a pretty easily, like, you’ll feel that. That’s from the energy level, also from brain fog. You know how in the afternoon, you might feel like your brain is not working?

Harry Glorikian: Yes, I remember how it used to be.

Maz Brumand: Me too, I used to think that afternoon like dosing or feeling tired was normal. Until now, it’s like now, why do people take naps in the afternoon? I don’t even get it anymore. But you know, joking aside, I think there is a huge impact on energy levels and your mental fog. And then obviously long term leads to insulin insensitivity, which leads to all sorts of problems, chronic problems.

Harry Glorikian: Yeah. So. On the website, you know, you guys talk about hardware, software and then this very interesting word called insight. So I want to sort of focus on the insights part of it. What kinds of analysis or advice do you offer members about eating or exercise? And if you can describe the scoring system in the in the app, the I think it’s called the zone score and the day score, right? So just if you could help me understand that, that would be good.

Maz Brumand: Yeah. Well, you know, one of the things one of the early decisions we made was really focus on creating content and education. So we publish hundreds of articles a year about metabolic health and how different things affect you, and some of them are really deep and well researched. And it’s scientifically based. So we put a lot of energy into creating content that will help explain the science and explain the physiology. So there’s a lot of content that is available on our blog that’s available in our app. And so that’s a primary focus for us. One of our objective is actually to make metabolic health into the zeitgeist. And if you go on Google, search that you’ll find Levels is one of the top hits as explaining what all that is. So there’s a huge philosophy within our company that we want to be science based. We want to help people understand what metabolic health is and how they can affect it. So that’s the core philosophy. The second question you asked is around what is Insight. So you want to know, for example, if your glucose spiked right and you haven’t logged anything, we ask the user, Hey, did something happen? And that’s a teaching moment where they go on and put in, “I ate oats for breakfast,” Or something like that’s a teaching moment.

Harry Glorikian: And then having content that explains that is when you have that aha moment. Or let’s say you ate something one day that affected you. Nothing. Fine. And then the next day, it’s a crazy response. We give the ability for people to compare. So imagine one of the things is the order in which you eat your food actually matters, which is actually really mind blowing concept, meaning I can enjoy the same thing. I just have to change the order. For example, if you eat naked carbs at the beginning of your meal versus if you’re having protein, fats and fiber and then eating the carbs later, glucose response will be different. So helping people compare different instances or behaviors is another insight. And for example, you could also do, easier, you could say, like I ate dinner, sat on the couch, watch TV, or I ate dinner and took my dog for a walk for 10 minutes. Not even something strenuous. And you’ll see the response. So these are moments that it creates these aha moments or insights that will help you change your behavior.

Harry Glorikian: Does the app actually, you know, other than showing the spike, does it sort of make it digestible for someone? I’ve not played with it, so that’s why I’m asking. Does it put it into, you know, human speak or some way to communicate with someone to let them know that these are things they they should be paying attention to?

Maz Brumand: Yeah, I think the short answer is yes and no. Yes, in the sense that we do it today and we’re planning to make it better. No. Are we reached the end goal to make the perfect app? Not yet. We’re in that journey and we’re constantly innovating and creating new experiences and new ways to help people understand their behavior. But I’ll give you an example. If you, for example, see a spike after a workout…What happens when you do strenuous workout, your body produces glucose to power you, and so you’ll see a spike, but that spike is not the same as if you ate a donut. And so we will show content to people that say, Hey, did you know that this is a spike and we’re not going to hold this against you? For example. We’ll take it out of your score because it’s generated based on good behavior, which is exercise, versus not so good behavior which is eating a donut.

Harry Glorikian: Right, right, right. And there’s a difference between a spike that comes up and down, which is normal versus one that stays up for a long period of time.

Maz Brumand: Yeah. The area under the curve is important now. I think another angle we haven’t talked about yet is research. I think we know a lot, but real time CGM in health and wellness, at least in the wellness side, is relatively young. So there is a lot of work to be done to actually understand at a deep level all these questions that we have and you have on the customer will have. So there’s a lot to do there, which we could talk about separately.

Harry Glorikian: Yeah, I mean, I actually, I mean, I think about all the different companies in this space and I think like you guys are running probably one of the largest, sort of, I don’t want to call it a clinical trial, but for a better word, right, on actually a healthy population looking at this space. So the data is going to be hugely valuable to drive, you know, next level of how to communicate and what to communicate to each person.

Maz Brumand: Yeah. And also, you know, we take actually research pretty seriously and science pretty seriously. If you look at the list of our advisors, we have some of the most thoughtful people in the world being on this journey with us. People like Dr. Lustig wrote the book Metabolical. Or Dr. Ben Bikman that wrote Why We Get Sick. Or Dr. David Sinclair, that wrote Lifespan. So we have a lot of serious people that are involved with us trying to further science, and we also have a lot of research projects going on with some of these folks plus other folks to answer some of these questions.

[musical interlude]

Harry Glorikian: Let’s pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that’s leave a rating and a review for the show on Apple Podcasts.

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It’ll only take a minute, but you’ll be doing a lot to help other listeners discover the show.

And one more thing. If you like the interviews we do here on the show I know you’ll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.

It’s a friendly and accessible tour of all the ways today’s information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.

The book is now available in print and ebook formats. Just go to Amazon or Barnes & Noble and search for The Future You by Harry Glorikian.

And now, back to the show.

[musical interlude]

Maz Brumand: How do you guys—there’s a few different companies out there that are doing this. How do you guys differentiate yourselves from these different players that are out there?

Maz Brumand: Yeah, it’s a good question. There is a couple of things. I think the consumer angle of this space metabolic health has, for the most part for a long time been ignored. A lot of people are creating products for payers, and kind of disease. And so we put on the hat and say, Look, who’s the best person to manage or care about their health and take actions that improve their health? It’s the consumer. So our whole approach is consumer-centric, including the consumer in the middle and creating value for them, building trust for them and helping them in their metabolic health journey. So I think that’s differentiated in the sense that all of our decisions are ultimately driven by that mission. I think the second thing is that we are very much science based and research based. So if you look at how we think about these things and read our content, it’s very much ground level up thinking about at the cell level what’s happening. And we also haven’t narrowed it to a specific disease, right? We don’t call it diabetes management program, which we can’t anyways because we’re in the wellness space. But even if it could, we wouldn’t. And so because we’re looking at a much more broad metabolic health. How can we make sure that your cells are healthy and using energy and producing energy in a way that will prevent both the disease states, hopefully, one day, but also the wellness space. So really marrying this short term like I want to feel better, I want to look better. I want to have more energy. I will spend more time with my kids. I want to have high fertility. Whatever it is like that is just as important than trying to tackle disease through payers. So I think going from this broader angle is also something that’s unique.

Harry Glorikian: Yeah, I mean, I’m a firm believer that everything is moving towards keeping people healthier as opposed to just treating them when they’re sick, it’s going to be much more profitable. But which brings me sort of: the website talks about customers as members, right, so I’m assuming the business model is around subscription. So can you explain sort of how that works, that subscription program and what features are included?

Maz Brumand: Yeah. So we think of it as a membership. To us membership means something different. We see as the health journey as a long term thing, like managing your health and improving your health is not a one time transaction. It’s also a two way conversation between us and our members, meaning we want to engage with our members. We want to hear from them. We want to them to help us improve the product, but also create a community. So it’s much more than just transactional. I’m selling you a single product and or a subscription. It’s more about like, how can we create this long term relationship that’s based on value creation for the member and building trust for the member for the long term so we can continuously drive value for them? And that continuous value creation trust and two way relationship is the basis of why we call it a membership because it will help inform our business vision and product decisions design decisions in a different way. When you think about this as a two way relationship over the long term.

Harry Glorikian: So just talking about business models, I mean, you know, people always ask me, you know, Harry, all these technologies are great, but they’re usually pretty expensive, right? Depending on where they start. And then, you know, obviously, you know, these things come down over time is, you know, how do you see this? I know, you know, the group is starting with, which is usually the higher price. And how do you see this coming down for a much broader audience over time?

Maz Brumand: Yeah, it’s a good question. I think the technology, obviously in the wellness space is relatively new, right? And so any new technology is going to be higher priced. So I think, as CGM and sort of all the technologies become more mainstream, the concept of not just CGMs but bio-observability, becomes more mainstream and it becomes a consumer thing, it will help drive down costs. And ultimately, I think there’s two questions to be asked. One is, is the product and service providing more value than it’s taking in in terms of cost and price? That’s question number one that we have to answer regardless of what the price is. When Tesla came out for a subset of their customers, it was a $120,000 car but it created more value in their eyes than the price tag. So I think that has to be important and true. And so that’s question number one. The second question is affordability, right? No matter how much value creating, if it costs $10,000 to get this membership per month, know nobody’s going to be able to afford it, except a few. So you have to solve both problems, the value problem and the cost problem. And the cost problem is getting more efficient in terms of creating products and services, using technologies that become more mature and consumer friendly so their prices go down.

Maz Brumand: And one of the things in our membership, actually, I should have probably clarified, is, we will not mark up the hardware and services that we provide from third parties. And so we will try to do it at close as costs as we can. There may be a small difference just because prices go up and down and there may be volatility cost. But our problem is is that we will provide these products and services at cost to our members so that we have no incentive financial incentive to sell you more stuff up, sell you more stuff. Right. When I say you should buy another CGM, we don’t make any money on that. And so therefore, when we say you should get another CGM, you want that to be truly aligned incentive with our members. Or when we say you should go get x y z down the line, that’s all possible cost for us. And really, what we’re focusing on is the membership fee, which is an annual number that’s detached from your level of consumption.

Harry Glorikian: And yeah, and I think just for to so that people understand is, you know, you guys don’t develop the CGM hardware, you know, the part that sticks into your arm, right? My understanding is that you ship, and correct me if I’m wrong, it’s a Freestyle Libra CGM from Abbott, if I’m correct. Okay.

Maz Brumand: Yeah. So exactly. So we use third party products and services like the CGM, because that’s the sensor that’s been developed. Many, many years and a lot of work has gone into it. So we’ll take that technology and then our experience and software and insights and scoring will leverage the hardware to help people make decisions about their behavior by closing them.

Harry Glorikian: Now, at the same time, I think, again correct me if I’m wrong, but I think you guys are still in beta, getting ready to launch. And when do you guys think, I mean, I know like, well, the last thing I got to see on your website was like, you’ve got 85,000 people signed up, right? And, you know, I don’t know if that number has changed. So I don’t know if you have a a newer number for me, but I’m assuming you’re going to try and ship that, get this out sometime this year.

Maz Brumand: Yeah, I think the number is, I think upwards of 150,000. And the answer is yes, we want to ship it. But one of the decisions we made consciously is we want it to ship it in a way that that makes sense. And that needs a number of things. As you know, one of the strengths of start ups is to be able to iterate and learn fast, to be able to talk to their customers and learn from them. Under a beta, I think that enables you, without having huge volumes of people and problems to deal with, to innovate fast. So you can actually, in the end, get to the product that will really help people or create value for people faster. So that’s kind of the thesis of why data. And when we plan to release beta is going to be sometime this year, hopefully sooner than later. Hopefully in Q2, but it all will be predicated on, Do we feel like we’re ready to provide that experience?

Harry Glorikian: Well, yeah. I mean, if you’ve got 150,00o people and I think I read on, you’ve probably have changed this. But again, I want to say it was like, you know, two thousand kits a month. I mean, obviously, the company’s got to ramp itself to be able to meet, you know, get the 150,000 out to people as quickly as it can.

Maz Brumand: Yeah, exactly.

Harry Glorikian: So is there a. I don’t know, longer term play that you’re thinking about, at Levels? I mean, beyond CGM, right? Beyond the, is that just the tip of the spear? Do you want to integrate more types of health data and apps in so that you can give more holistic advice?

Maz Brumand: Well, I think, you know, the North Star is bio observability, right? CGM is just one. But what’s happening in my body based on my behavior? And can I show that to the user in a way that will help them change behavior that ultimately will lead to better outcomes for them and short term make them feel better on a day-to-day basis. So I think that’s the North Star. Obviously, glucose CGMs are available, so we’re using them. But that’s the North Star. And if you think about, if you take that to its conclusion, like every action that we have affects a lot of things in our body, whether it’s generating stress like the cortisol response or generating other reactions in the body. So I think the long term vision is, can we help close this loop based on our behaviors and what’s happening at the molecular level in our body? So that’s kind of like closing the feedback. So getting the assessment to the user and then also helping them now that they’ve got the insight and they see what needs to be done, help them with the products and services that will help them achieve that goal of of improved health.

Maz Brumand: So let me, I’m going to pick on your like, you’ve been at Apple, and now you’re doing levels and you’ve been doing this for a while, like, your personal vision of of possibilities here. Like, can you imagine a time where everybody with a smartphone or a smartwatch is sort of getting daily feedback from their devices on how they can optimize nutrition, exercise, sleep for maximum health?

Harry Glorikian: Yeah, I think that’s the vision, right? I mean, the consumerization of health. I think the stuff that Apple took to put the data and make their data available to the user and allow people to build on top is, I think, the revolution in personal health. And I think, you know, the market dynamics will drive innovation in many different ways. I mean, Levels is just an example. Levels wouldn’t not have existed if this consumerization foundation wasn’t set up by companies like Apple. At least that’s what I believe. So I think the short answer is yes. I think by putting the tools in place and creating a business environment for people to innovate and provide services to consumers, I think the market will eventually figure out how to help people live healthier lives. Whether it’s in this form or not, meaning whether it’s a watch on your wrist or a CGM in your skin or whatever, it’s hard to say, you know, 20 years from now, but I think the end conclusion is going to be that people are going to know based on their individual physiology, how to optimize their health. And I hope my hope personally is to not focus on just disease, but the wellness leading up to that because. There is a lot to do in that space to make sure people are living their fullest lives and happiest lives.

Harry Glorikian: Yeah, I mean, I find it fascinating, right, that Apple has basically created this ecosystem where they’re not necessarily profiting off of the health and wellness space and the way that you would think, being charged for it, but that they’ve created an ecosystem that everybody says, I have to have these devices and interfaces that that makes them almost core to how this is all rolling out.

Maz Brumand: Now, because I think it’s not a zero sum game, and if you change your mentality from how can I make the most amount of money to consumer-centric? Like, actually help consumers, like what does that look like? It no longer becomes a zero sum game.

Harry Glorikian: Yeah, I mean, but, you know, if you think about it, though, like, you know, I’ve been in the health world for….Everything we make is very purpose built, right? And there’s a reimbursement or something that’s attached to it. Apple is saying, “Listen, I’m going to create an ecosystem, I’m going to create a platform. You can, you know, use an API to get information in and out, right? And I’m going to make it easy for you to sort of do monitoring and apps and everything else. You just need to buy my devices, ad I’m fairly happy. I don’t need to make money on the purpose built product like we do, like we have in health care historically.” So it’s a different way to make money, but in the same ecosystem, which is fascinating.

Maz Brumand: Yeah, yeah, completely. And people that build on top obviously can monetize that in a way. But yeah, I think just idea of being a platform is just a different model. Right. It’s not about creating a purpose built product for revenue. It’s a platform where other people can build on top and make revenue, but also strengthens your own business too. It’s not completely for non profit. There is a business strategy there. But the business strategy is much more aligned with consumer interest and consumer value creation than it is this zero sum game, which unfortunately our health care system has devolved into, with the disintermediation that we’ve seen with the buyer being different than the end consumer. So when you’re actually designing a product, natural incentives will make it so that you’re designing it for the buyer, not the consumer. So you end up creating a product and optimizing features for the buyer that has certain interests. But then you expect the end user, which is a different person, to want to use it, and that’s how you end up with kludgy products that maybe you don’t want to use. Right? So nobody loves using a product that was created for an insurance company as a consumer. So I think this changes that dynamic completely.

Harry Glorikian: Oh yeah, I mean, I think, you know, had you looked pre iPhone in apps and so forth, I mean, this platform to lay all these other things on top of just, you know, again, they were either purpose built or they didn’t exist. So this completely creates a brand new ecosystem for opportunities like Levels and other technologies like that.

Harry Glorikian: Yeah, definitely. And I think, you know, Apple’s done a lot of great things, which I’m really proud to be part of and really have deep respect for for the company and leadership. You know, the work on research is quite groundbreaking, starting the virtual research, for example, at the scale that it did for the Apple Heart study and just just change the thinking about research. And you know, obviously you continue with the Research app and collaborating with researchers and then creating the platform ResearchKit for other people to research. It just completely changed the conversation. And I think, you know, it’s I have tremendous respect for the impact that Apple has had in this space and will continue to.

Harry Glorikian: Yeah, I mean, you know, the conversation I always have with people is, you know, when we were working on a product we already knew like we were going to go for regulatory approval. Everything we were doing, like there was no time to sort of play like you had to have it sort of baked of where you were going to go from day one. Whereas a lot of these companies that are in the wellness space, let’s say Apple, you get a chance to sort of get feedback, adjust, get feedback, adjust. And then when you if you want to step over the regulatory hurdle, you have a lot of information now to sort of make that play. Historically, the playing was not necessarily easy to do. I mean, getting this data, if you think about, you know, billions of users, that’s a lot of data that you get to sort of look at and screen and decide what you’re going to do next before you do it.

Maz Brumand: Yeah, you know, I think it’s not that linear within Apple because very strong privacy stance. So it’s not like you can just grab the data and do whatever you want with it. But I think your general concept is true, right? If you take the idea of being startups and think about like, OK, I’m going to iterate, I’m going to try a bunch of stuff, I’m going to iterate and then I’m going to come up with the product and I’m going to go build that right hypothesis test results building. You couldn’t historically do that enough. Right? Because you just do what? It’s locked, right? It’s now locked. You cannot make a change. So even if you found outk, let’s say you did that. You created a product and then things changed like, OK, I can’t. Yeah, yeah, it’s like, sorry guys, I know you really want that feature, but it’s not going to happen. I do agree that it’s just changing the conversation and then thinking has been fantastic. And, you know, it’s also really important to say there is a reason why the regulatory space exists and the fact that we do need protections that the FDA and others put into place. So it doesn’t take anything away from that. It’s the question is like how do we create other ways to allow innovation to happen while keeping people safe? And in the right things?

Harry Glorikian: Oh, yeah, I mean, I believe me, I love the FDA. Don’t don’t misunderstand me, I think they they definitely like have to play their role, right? But on the other hand, I love the fact that you can actually interact with someone, get data, identify signals, be able to sort of iterate on that. And then when you, you know, when you find something really worth sort of moving on that may be beyond wellness, that that opportunity has now opened itself up assuming, you know, privacy and everything else is is kept, you know, under control. But I think the advances that have been made say in the last five years have been unbelievable. You know, some of these things that we’re talking about five years ago were really not available. And now, you know, I can manage myself fairly remotely and get a longitudinal view that I can share with my physician that helps him understand my body better.

Maz Brumand: Yeah, yeah. I couldn’t agree more. I think this idea that you would have these episodic visits with your doctor and they will not be informed from any of the past interactions or data, it’s just we’ll look back on this in 10 or 20 years and think, Wow, that was a huge influence on health, where every interaction is like a surprise to the doctor because there’s nothing informing them other than a paper thing that you filled out, which nobody reads, and they’ve got to make decisions about your health.

Harry Glorikian: Yeah, I mean, I think about these things like, you know, I walk in, I give them a longitudinal view of my, you know, whatever I’ve been tracking. And the human brain is amazing at looking at a pattern and seeing something that’s out of line. And if it looks normal, they just go, Hey, that looks great and move on.

Harry Glorikian: So we know, you know, obviously you’re being in this space for a long time. You’ll know a lot of the research is also done in, you know, in perfect situations. And it’s done on a cohort that’s probably not representative of the entire world. So, yeah, I think it’s both things. I think one is if it’s not out of the normal, which is probably a large standard deviation, it gets passed through. And then also, if we just don’t know because we didn’t have the tools to research the way that we’re doing research today. And this is my point about Apple changing, also thinking about research not being, you know, 30 people in the northeast that we studied. And then we came up with the guideline for the entire world. It doesn’t work that way. So I think, yeah, I think there is a lot. I think we’re in the early innings of really changing health and health care, not just Levels, but everybody. I think the big players, us, the health care systems, the payers, and it’s pretty exciting time. And you know, you asked me the question of why did I leave Apple to come do this? It is because there’s just so much interesting stuff going on, and it is the time to actually make those leaps in collaboration with people like Apple and then hopefully one day also with the payers and the provider.

Harry Glorikian: Yeah. No, and I think their world is changing, too, just because now we’re, you know, moving more towards paying for outcomes as opposed to, you know, I pay you for everything that you do. So. Anything else that I didn’t ask you that is your burning to to tell us about Levels or do you think we covered it?

Maz Brumand: I think I think you covered most of it. I think there’s just so many things to talk about in this space that we could probably go on forever if you want.

Harry Glorikian: Yeah, no, I’ve been I’ve been trying to convince people that that are interested in health, wellness, energy, optimal, you know, optimum performance that having a CGM and getting a good feel for. What’s the right food, when to have it? What happens measuring it, et cetera? You know, and being able to give them the right feedback, being able to give them maybe an alternative food that so they don’t have to give up something necessarily that they really like. Those are all important feedback loops to give them.

Maz Brumand: Yeah. And you know, you bring up a really good point because a lot of people think if they want to take control of their health, whether they lose weight or want to feel better, they have to make these massive changes. They’ve got to stop eating all the foods that they like. They’ve got to go to the gym, you know, two hours a day. And my personal CGM experience showed me the opposite. There was just a few tweaks I needed to make to change the outcomes completely. And, you know, and the reason I was doing the things I was doing wasn’t because I was like, Hey, that’s my cheat, and I really want to enjoy that. All this stuff was I didn’t even care about it. Like, I really didn’t think that oats is so much better than eating eggs in the morning. Like that was not but science. I mean, the best available science of the time was that eggs are bad due to cholesterol and oats are heart healthy. And so so a lot of it is also not just figuring out based on real data that’s personalized to you, like one of those small changes that I can make that will completely change my life. I mean, that’s what’s magical about this technology. It’s not somebody writing a hypothesis piece about the general population that’s know makes no sense with your lifestyle, but also but instead figuring out okay, based on you, your physiology and your lifestyle. How can I? I can help, you know?

Harry Glorikian: Yeah, I mean, my new book just came out on, you know, how to incorporate technology into your life. And I always tell people, I’m like, Pick one. Like your scale. If you see the if you see the line going in the wrong direction, maybe it’s time to course correct, right? Or, you know, a wireless blood pressure cuff, right? I mean, blood pressure is one of those things that sneaks up on most people. They don’t see it until it’s too much of a problem. Well, if you notice that it’s moving in the wrong direction, right? Maybe you’ll lose some weight. Maybe you won’t add as much salt. It’s these aren’t huge changes because you’re trying to do it early enough that you affect where the line is going. And so a CGM is the same thing in a sense. And if you have enough of these in your arsenal over time, I think you can do a pretty good job of managing, at least extending. That you know how healthy you’ll be for how long.

Maz Brumand: Yeah. You know, we think about this in a… I’ll explain how we think about this. So we kind of look at certain metrics or bio metrics or information from your body. You can think about it. There’s a law. There are high frequency, and give you feedback. Let’s just call them feedback metrics for a second. Right, these are things that, for example, my glucose, when I see that move in real time high frequency, I can change my behavior. And these are all high frequency, completely correlated to your behavior on short-term outcomes. And then there are other metrics that are much lower frequency, meaning you don’t take them all the time but are really representative of your of your health, right? Which is, for example, is my A1C below or above a certain amount, is my blood pressure below or a certain amount, is my waist circumference below a certain amount. That really shows you the outcome. And then the question is how can I influence behavior by measuring these feedback metrics today and based on the science and correlations that we know leads to better target metrics or health metrics in the future? And so that’s kind of the framework where help affect behavior today with high frequency metrics to drive better outcomes with lower frequency, more outcome driven metrics in the future.

Maz Brumand: Yeah, no. And I totally agree, and it really is going to come down to the data that you’re putting in the way the software does its analytics and then communicates back with the individual because some of this has to be put into normal speak as opposed to sometimes when you talk to a physician. They’re using acronyms and a language that most people can’t necessarily easily understand.

Maz Brumand: Yeah, yeah, definitely. And I think there are three problems probably to solve to really get to mass market. I think one is the hardware-software, making it the software more intuitive and more insightful. The hardware cheaper, less intrusive, so on and so forth. I think the second problem is the research problem, right? How can we actually find understand these real time metrics better and its correlation to long term metrics? And what are the best ways to influence behavior? So there’s a big research component there, given that a lot of these things are new. And then the third one is the social aspect of it, to make sure that people understand it, providers understand it, payers understand it. So how can the ecosystem adopt this new way of thinking and new way of affecting health and wellness? So I think you have to have all those three to really make a big impact at the much larger scale than earlier.

Harry Glorikian: Yep. No, couldn’t agree more. It was great having you on the show. I wish you and the rest of the Levels team good luck in this upcoming launch. And you know, I should probably go get another CGM and tack it on and and see what’s changing over time.

Maz Brumand: Sounds great. Thanks, Harry. It was a pleasure.

Harry Glorikian: Thanks.

Harry Glorikian: That’s it for this week’s episode.

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