Joining the team at Levels Health
Near misses, hostile doctors, and the next phase of my career
My dad almost died when I was 20. They caught what would have been a widowmaker heart attack at 99% blockage with a test he almost didn’t get— the hospital told him it was assuredly going to show nothing. The test took all of two minutes, the first image damning enough to move immediately to the nitroglycerine patch and blood thinner. Most remarkable was his age — 44.
5am rolls around after a sleepless night, I drive to the hospital for the ungodly call time with “2% fatality rate” rocking around my head — very nice of life to give me zero days to prep for this. Being in a hospital humbles me to tears, the juxtaposition of peak human competence and frailty of existence leaving words woefully inadequate. We said goodbye to him very literally that time. 1/50 isn’t likely, but fuck that dice roll, I’d rather not roll it at all.
Surgery was 7 hours, and come the end of hour 4 I couldn’t help but start to feel mad. His heart was literally stopped and removed from his body, it lying on a table now while they played plumber with the vasculature, and a cadre of devices acting in concert like God to keep him alive. How did we get here without a single shred of definitive early warning?
In the ICU I had similar tearing, life very obviously suspended in a precarious balance of beeps and sparklines. What did we all do to deserve such a miracle? My dad was barely awake, enough to lock eyes with me as I told him I loved him, holding his hand and watching the ventilator do its work. As the nurse told us our time was up, he squeezed my finger to let me know he was gonna be okay, a pressure I can still recall like it was earlier today. 2% still bandying about, we retreated to the waiting room for another 3 hours of eternity.
—
The decade after this experience with my dad would have have two major themes emerge around food and health.
First, my own experiences with paleo, keto, and reading on metabolic fitness had me eschewing the decades-old FDA diet recommendations. It was out with whole wheat bagels and white rice, and in with avocados, olives, and macadamia nuts (oh, and more bacon).
Second, waking up to 23andme results the literal day after our wedding, my wife and I were immediately thrust into a series of near-misses of our own, both with a possible autosomal recessive disease for our kids, and also for each of us a highly elevated predisposition to heart disease or cancer later in life. Welcome to marriage!
Hostile conversations around food
My brothers and I sat in the hospital room the night before surgery as the doctor had very human moment with all of us. He told us he had a dad too, that he missed his dad every day, and that if he was us he’d be scared as well. He also warned us of the perils of smoking for hearth health, and said that if we also kept our cholesterol down we may be able to skirt the genetic tides pushing us into treacherous waters. His only other recommendation was diet and exercise — whatever the hell that meant — gently making reference to the food pyramid on the wall. My dad ate from the list of heart-healthy approved foods that night for dinner, a list that very un-ironically featured oatmeal, orange juice, white rice, and whole grain toast.
Now almost 15 years after that conversation, I’m convinced that there should have been less emphasis on exercise and cholesterol, and way more emphasis on food. Smoking continues to get a bad rap (as it should), but I’d be curious to know what amount of the blockage was a direct result of cigarette particles, or his likely correlated inflammation and insulin resistance that would have gone undetected for decades. My bet is that his food truck American diet was amplified by the smoking.
My personal start to experimenting with low-fat diets and intermittent fasting came on recommendation of my crunchy roommate at the time, as there had started to gather a huge plume of smoke around research of a carbohydrate+insulin model of metabolic health to challenge the current prevailing calorie balance model. Paired with new research of lipid particle size, inflammation markers, and more clinical success with reversing type-2 diabetes with a ketogenic diet, it was abundantly clear that the existing medical establishment could be literally dead wrong about how many of our bodies are processing food.
As with any low carb diet, you’re necessarily forced to cut out the abundant supply of cheap hyper-processed shelf-stable carbs, and to adopt more fibrous plant and animal products. We can debate the merits of bacon at a later time, but it’s more apt to point out that I greatly increasing my leafy greens, eggs, and plant based snacks like hummus and guacamole. Paleo does a great job at keeping most peoples’ blood sugar steady, and it’s impossible not to feel like a million bucks when the massive sugar swings and crashes go away for the first time in your life. Understanding that the body and brain we have was selected for a long time ago, it’s hard to reconcile that this diet just feels better for the body, even if we’re foregoing the massive quantity of grains beckoned by our health czars at the FDA. One of these must be wrong, right?
As with most first-they-ignore-you sea swells, the greatest resistance came from the person paid to be most on my side — my primary care physician. Time and time again I would have the same conversation as if literally regurgitated from an outdated textbook. It’s unbelievably hard to sit across from somebody who has Medical Doctor after their name, and tell them you think they haven’t exactly been doing enough reading on the science of food, or that the 1 course they took in medical school isn’t nearly enough for them to be giving relevant advice. So you don’t, you sit there and nod as they, too, make reference to the food pyramid on the wall.
Here’s a sample of literal quotes. Any of these sound familiar?
- “I myself eat a balanced diet.” (under whose definition of balanced?!)
- “If your LDL cholesterol is high you’re at greater risk for heart disease. Simple as that.” (no mention of particle size)
- “These diets like paleo are just fad diets and soon we’re going to see people will be dying from them” (completely ignoring existing obesity rates and declining life span on recommended American diet)
- “If you want to try an esoteric diet, the craziest I would go is the Mediterranean diet” (esoteric…lovely)
- “Here at One Medical we like to practice evidence-based medicine” (my favorite. thanks doc, but i think what you’re saying is ‘the studies from 30 years I know about’)
No individualized care, no knowledge of the newer research, no appetite to even have the conversation — the trifecta for a checked out patient. I started to dread going to get a physical, and stopped talking to them about food altogether.
Absent getting set up with concierge medicine, it was feeling impossible to get any sort of accurate read on the current state of my metabolic health. I buried my head in the sand of youth, committed to one day maybe being able to get some actual data around how much actual risk I was in for heart disease or imminent heart failure.
My own near misses
Day 1 of marriage for my wife and me started with a romantic hungover breakfast, petting the goats that lived on property at our venue, and then getting some pretty raw news about the possible health of our future kids. It took weeks to come to grips with things, feeling so utterly helpless that our core DNA material could have such a drastic impact on not just our lives, but our future kids’ lives. Welcome to the ethical big leagues.
Thanks to the knowledge of our situation, we were able to get beyond the kid thing and onto a healthy pregnancy, but fast forward a few months and another bomb drops — 23andme finally got permission to release BRCA results to the entire user base. Not only did my wife have it, but we also had a daughter 6 months in utero, a train running brakeless down the track. Again, nothing to do in the short term (except be angry), but in the long term quite a lot to do to plan for prophylactic care. Adding in my already-known heart disease disposition, we were now a whole family heading into separate battles in the coming decades. What a lovely Leave it to Beaver episode.
Back on these damn dice again; dice I really, really don’t want to roll. Hopefully one day I can head into that same hostile doctor at One Medical to get an infusion of CRISPR to clear all this up, but that’s not today, and today I must choose to be excited to have the data. The data let us act; they get the dice to change hands, and they turn the game into a multi-move game.
Thinking about my next decade of work
After leaving Atlassian, I knew the next act of my work needed to count in a way that Statuspage didn’t. It was a fantastic exercise in capitalism, but fantastic exercises in capitalism must breed forward moral obligation if we can expect the world to continue on an arc toward less human suffering. My kids one day are going to understand the life they were born into, and I damn well better have shown them that we’re called to spend our time and emotions working on hard issues when we can. I need them to feel that in their bones.
Climate began as the entirety of my search for what was next. And how could it not be? We just got done with a stretch of heat setting 3 of the 4 hottest days ever recorded here in Seattle, an unremarkable event given similar events happening every month around the globe. There’s also a tremendous amount of truly exciting work being done by companies like Patch and Nori on negative emissions, Joro and Watershed on the accounting side, and venture firms like Lowercarbon and Prelude (just to name a few of each). The current situation is undoubtedly bleak, but the future is incredibly bright.
In the end, I never got climate to resonate in a way that let me make the leap. I talked to many startups and a few VC funds, and nothing was really landing. As we welcomed our baby boy in February, there was nothing serious on my plate.
Joining the team at Levels Health
Rewind back to November, I got beta invite to this new company called Levels Health, working on metabolic health as a whole, and starting by expanding access to continuous glucose monitoring for folks looking to get data around how food actually affects them. Not in theory, in reality. I love this stuff. As one of the founders puts it, metabolic dysfunction is the massive trunk to the tree that eventually branches off into cardiovascular disease, type 2 diabetes, accelerated cancer growth; the list is truly tremendous.
Our evolutionary playground saw food scarcity as the default, and as such we never were selected for a trait that let us truly feel into our metabolic system. A few hundred thousand years later with a glut of processed food always on hand, we’re completely ill-equipped to understand the thrashing that system is doing for most of our waking hours when given a typical food pyramid diet. We don’t usually feel it until it is much, much too late; a perilous open loop system.
Putting the sensor on for the first time felt like a superhuman experience. Whereas I previously was getting a reading once a year — fasting only — I now had data every 5 minutes. Some napkin math with the opening to Rent gets us to more than 100,000x the resolution, and most importantly is enough for your brain to feel it as a closed feedback loop with the food you’re putting in your body.
It’s hard to overstate how truly transformational this is; let’s enumerate:
- That healthy oatmeal and orange juice your parents fed you? Pretty garbage after all. So is white rice. Pizza is actually not as bad as it seams, but that’s just for me. What is it for you? Each food takes on a whole new meaning when you see the glucose+insulin cycle thrashing in realtime.
- Sleep, stress, and exercise also affect your glucose and insulin levels (among others), and it’s important we pay attention to all of these. Understanding your environmental influences lets you make good lifestyle decisions to promote healthspan.
- Most people have some form of “I eat pretty well” as a piece of their identity narrative, and it’s best we quickly dispense of all qualitative narratives if we want to get serious about preventing major disease. Having a guard watching over all your food intake dismantles the narrative, and lets you make better decisions when you’re tempted to cheat.
- Finally, the best part of a closed loop system is getting rewarded when you do well! Staring down a sleeve of Oreos late at night usually entails giving in and regretting, or resisting and feeling that loss from the exercise of self control. Seeing measurable positive impact to a metabolic score gives you the reward you need to balance the equation in your favor.
Three weeks after Jack was born I had an email in my inbox from one of the founders, as they were literally going through their beta customer list and matching it up with LinkedIn profiles. There was an immediate resonance and excitement that I had been missing. Let’s talk.
It felt like so much of my life experience — my dad, being a software founder, and now my own near-misses and having data to tip the scales in the future — was preparing me for this industry being the next major arc to my story. Feedback loops matter, and data matter. We have the sensors, let’s start getting them to the masses so they can control their story.
I joined as part of the technical team in June, and it feels amazing getting back to work on something so existentially meaningful.
A few quick plugs
First, we’re hiring for software engineers, and if any of the story above resonated with you then we should talk — feel free to reach out or book some time. The stack is node/next/typescript on the back end and React + React Native for the front end and mobile pieces, but honestly that doesn’t matter right now. If you’re on fire about the mission, any stack is going to be fine.
Second, if you’re on the waitlist already or want to try the product, you can use the following link to get moved to the front of the line. https://levels.link/r/SCOTT
