Gladden longevity — Episode #18

Speaker 1:  Welcome to The Gladden Longevity Podcast with Dr. Jeffrey Gladden, MD, FACC, founder and CEO of Gladden Longevity. On this show we want to answer three questions for you, how good can we be? How do we make 100 the new 30? And how do we live well beyond 120? We want to help you optimize your longevity, health and human performance with impactful and actionable information. Now here's today's episode of The Gladden Longevity Podcast. The Gladden Longevity Podcast is provided for informational purposes only, it does not constitute medical advice. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The use of any information and materials linked to this podcast is at the listener's own risk.

Dr. Jeffrey Gladden:  Welcome, everybody to this edition of The Gladden Longevity Podcast. I think this is going to be a very interesting conversation today. I'm talking with Ari Tulla. Ari is a San Francisco-based entrepreneur. He's co-founder and CEO of a smart nutrition service called Elo. That's spelled E-L-O, if you want to Google it and check that out. And basically his mission is to transform food from being the leading cause of disease to actually being medicine if you will, or the leading cause of health. He's also an avid investor. He's involved in 40 startups, et cetera, et cetera [inaudible 00:01:30]. I suppose maybe on some level it's a typical Silicon Valley kind of interesting person. Ari, welcome to the show.

Ari Tulla:  Hey, thank you so much sir. Great to be here.

Dr. Jeffrey Gladden:  Yeah, it's great to have you. So in looking through your bio before we get to Elo and kind of what it's all about, I noticed that you are quite athletic. You're a rock climber, you're a snowboarder, you're a big wave surfer, or at least a wave surfer in Northern California. I'm not sure how big, but they range in size for sure. But I find that very intriguing because you're really kind of going out and living life. You're a husband, a father, et cetera, et cetera, and yet in your work schedule you're really integrating all these high level activities, which I think from the standpoint of living a long time, I want to stay young for a long time. It's not about existing for a long time or surviving for a long time. So I do a lot of those activities as well, but I'm just curious, tell me a little bit about your journey. Were you always athletic? Or how did that all start out for you?

Ari Tulla:  Thank you for the great question because we often neglect the fact that being healthy is not only about doing the things that you have to do, like eating right and recovering, sleeping, and moving enough that you have your body, but more people like you and me we get not just the physical value of being active but the mental value. It basically makes who we are and age is only a number like many people say and that's a fact. I mean you don't need to stop doing things you love if you get older, and I'm in middle age today and I've been an active athlete all my life, and I admit I'm addicted to doing what I do. And if I have an injury or something happens in my life, work gets too busy, I have travel too much, I mean nobody wants to be around me if I can't do the fix of 10 hours at least a week of activities that I deeply love. So that's kind of what I am and I'm made that way, and that's I think interesting point because a lot of people they have hard time getting off the couch or getting out to the wild or finding the time, because it's not something that they have done all their life. And I understand that's a really difficult step to take, but for some people like myself, I mean it is like an addiction, I cannot do it, I have to be there all the time. And in COVID for example you couldn't go skiing or you couldn't go even rock climbing, they closed all the cliffs and all the indoor climbing as well. I picked up my old hobby of mountain biking, and I think I did 10,000 miles of mountain biking all with COVID, and what a life. I mean I've been living 15 years in the Bay area, and I had really not done a lot of mountain biking here before. And now I've found all the trails in Marin and where the whole sport was invented. And that was a blast, best time of my life in COVID doing that many, many, many hours on the beautiful trails.

Dr. Jeffrey Gladden:  Yeah, I love that. I mean you've touched on a couple of things here, one is that you have to be adaptable. So many people, the gym's closed and they said, "Well, I can't work out." It's like if your whole workout schedule is linked to whether the gym's available or your trainer can come over or whatever, really it's an inadequate response to the question that's really being asked, which is how do I stay fit and healthy? So I think it's really, really important to always be adaptive like that. And then I think the other thing is that you and I have been athletic since we were kids, I mean I don't ever remember not being athletic, right? And I think that for people that don't have that, what we've developed is actually the ritual of this, where it's not a habit anymore it's actually a ritual, it actually defines who we are as a person. We are athletes, we are active people, we are adventurers, we are all these different things. And I think that it's really important for the listeners to understand that if you're sitting on the couch or if you're trying to get going, what you're trying to do is not get to a point where you actually get in your X number of workouts a week, not where you check the box. What you're really going for is to transform your whole psyche, to actually open up a new area of joy in your life which is exploring, discovering being with nature, whatever it is. It could be hiking, it could be walking, it could be trail running, it could be anything. But to get out and actually do that, I think that's such a life-changing kind of shift. So I would like the audience to move away from checking the box that I've been active or checking the box that I ate the right thing, and move into this opportunity that exists in terms of how can I really connect with the planet in a brand new way? How can I actually redefine my own life? And I think that's kind of what you're saying.

Ari Tulla:  100% and life it should not be work. We already have work and some of us love what we do, many of us find it annoying at times and life should be ups and downs. But the point is that if you have... the precious time you have for yourself, and I think about that a lot because in having two young kids... My son is seven, my daughter is three, we don't have a nanny. Our life is the classic busy life of parenting and then running a company and been doing this for a long time. It's not easy to find the time, but I have to be able to do that and I use calendar to block the time, and there has to be time for yourself. If you never give time for yourself-

Dr. Jeffrey Gladden:  That's right.

Ari Tulla:  You're not going to be a great husband. You're not going to be a good father, and you're not going to be a productive person on this earth. So those are some things that I really try to do and it may sound like selfish at times, but my wife is [inaudible 00:07:38] And yesterday I did the long ride in a beautiful weather, and when I come back home I'm best me for the remainder of the day.

Dr. Jeffrey Gladden:  That's right.

Ari Tulla:  And I go out often early like 6:00 in the morning, so I'll be back at 9:00 and I'm much better person than I would've been without doing what I did.

Dr. Jeffrey Gladden:  Yeah, absolutely. I think that's another key thing, is that doesn't just happen, particularly if you don't have that inner drive, where you're not identifying as being an athlete your entire life, where it's like you get up, you don't even want to go to the bathroom, you don't even want to maybe eat something but you definitely want to get outside and do something. If that's not your instinct, then really blocking it onto your calendar is the first step and then not allowing that... Think of that as a sacred time. It's actually time for yourself. And not only are you getting stronger and better but... I don't know about you but I'm out there thinking about things and sometimes I just go into a flow state and I'm thinking about nothing, but sometimes I'm also processing things and it's really, really precious time. So I would encourage everybody to actually dedicate that kind of time every single day quite honestly, because if you're going to do it three days a week well then which three days are you going to do it? Is it going to be tomorrow? It doesn't feel right today, so it's always tomorrow and you'll never get it done. So anyway I'm a big advocate of dedicating yourself to that seven days a week. So with that being said, with all of your physical activities, it sounds like there was some nutritional journey in here as well, probably thinking about fueling yourself, recovering yourself, all that kind of thing. Do you want to talk with us a little bit about that?

Ari Tulla:  Yeah, so I've been very fortunate of being able to live life without having any big issues with my health personally. I think the only one... You asked about the big waves, small waves. I mean I would call myself tiny wave surfer today, maybe eight years ago before we had [inaudible 00:09:32] I was trying to be a bigger wave surfer and I had a buddy of mine who became a real big wave surfer, who has done [inaudible 00:09:39] and has done Mavericks and has done a lot of these spaces. And I think my turn ended eight years ago in Hawaii at Pipeline. I was trying to get the pipeline barrel under my belt, and I took a big fall and hit my neck into the reef and broke my C6-C7, nothing too bad but bad enough that six months later I couldn't feel my other hand at all. And it took almost a year to recover, so today I'm trying to surf the smaller waves and be pretty modest about it. But you don't want to go too far so you're going to break your body, because the older you get the more easy you break. And then again if you can't do anything for a year or you can't recover properly, not a good deal. So my story in nutrition is a long-winded one, but briefly to give a highlight, my wife had a thyroid tumor 22 years ago in Finland. Healthy athlete, 20-year-old woman who find out she has a big tumor on her neck. And that had to be of course removed, luckily there was no cancer beyond. But the other thyroid was partly removed away, and then that led into a lot of autoimmune diseases, hormonal imbalances and unknown unknowns. And of course much more as a-

Dr. Jeffrey Gladden:  Yeah, so she got autoimmune issues, just so the audience understands, a lot of times thyroid can be related to autoimmune issues [inaudible 00:11:04] things like that. But when the thyroid is off, it'll affect everything else, all your other hormones, your brain function, bone function, muscle function, mental clarity. I mean it's really kind of a master hormone if you will so yeah.

Ari Tulla:  Thank you for that summary and it really was complex because suddenly you find out that you're different than you used to be. And of course medicine... we love [inaudible 00:11:29] so she was medicated with medications, made it probably impossible to get pregnant ever. And these are medications you can't stop taking if you want to stay normal. So we spent many years to find ways to go around that because we really wanted to have a family. And we found in the end that food was able to help her body to [inaudible 00:11:51] inflammation. Think about type of diet like keto today, where you have very low carb, where you get body in the state where it can actually lower inflammation and then heal itself, because a lot of the autoimmune diseases are about chronic inflammation, your body can never heal itself properly. So food became medicine to us and over the years it helped us to get pregnant, and we had a long battle with that. Like many couples we had to use IVF, we had to do all these things, spent many years and many hundreds of thousand dollars of money to get pregnant. And then after all that work our first son died. So that was kind of my history of nutrition and life of healthcare, and I became-

Dr. Jeffrey Gladden:  So was that a miscarriage, Ari? Or was he born and then passed? Or how did that happen [inaudible 00:12:43]?

Ari Tulla:  Our son was born basically two days before the cutoff time in California. So some of the states it would be incubated but basically held the baby boy that you have in your arms, and you see the baby take the last breath in your arms so not a miscarriage in the sense [inaudible 00:12:59].

Dr. Jeffrey Gladden:  Okay, so it was premature? He was a premature?

Ari Tulla:  Yeah, just two days too early.

Dr. Jeffrey Gladden:  Two days too early. Oh, that's so sad, I'm so sorry to hear that. Yeah, nobody should ever have to lose a child. I have great friends here where I am that just lost a child, and I think they're always part of your family. I mean he's still part of your family, right?

Ari Tulla:  Yeah.

Dr. Jeffrey Gladden:  So that's kind of a beautiful thing too, but yeah I'm so sorry to hear that.

Ari Tulla:  Thank you.

Dr. Jeffrey Gladden:  So, anyway this is quite a story now, so you're really struggling to have a family and you're finding that the foods that you choose, whether they fan the flames of inflammation or whether they actually tend to calm inflammation, is playing a key role. And so tell us where you went from there, was this your first son that passed?

Ari Tulla:  Yeah, this was about a decade ago and at that time we... As you know many parents who have this happen I mean they press the pause button and they really think about the life priorities, and they think what they want to do. And at the time I was running [inaudible 00:14:04] games and app studios and a unit at Nokia, one division here in the Bay area. And I was just about to start a new company in the space of video gaming. I spent many years in the gaming space since I was-

Dr. Jeffrey Gladden:  You're a gamer?

Ari Tulla:  A teenager. I was a gamer and then I was also building games for a long time and running these companies. And I decided to completely change my hot course, and I went and started a healthcare company called Better Doctor. And the idea was to help people find a doctor they loved, because we had really hard time finding the right care with all these problems we had. And when you come from Europe to the US... In Europe, you basically go to a doctor's office or hospital, you get care. In here, you have to pick one of the million doctors and they are all different like you well know. So it is a really painful problem and so I made that my profession, I decided that I'm going to spend next 30 years of my life to make healthcare better, help people live better lives. And we also started the family fund to invest in startups in this space, human performance, human health behavior, [inaudible 00:15:12]. And my wife also went from corporate and became [inaudible 00:15:17] consultant, worked with Marie Condo on helping people to reduce the amount of stuff they own and only own things they really do care about. So that was a big moment for our life.

Dr. Jeffrey Gladden:  So she went from corporate America into basically getting people to see that when you own things they own you, the things own you, you don't own them?

Ari Tulla:  Exactly. So I mean helping people to... Because we have too much stuff. And basically reducing the amount of stuff you own or owning and buying the only things you care, it's like external meditation, it simplifies your life, simplifies the brain. So in our household you have a number of things you own, we have about 200 items per head and that's all we have. So it's so minimalist and as you can see there's not much stuff in my room here.

Dr. Jeffrey Gladden:  No, but what I see behind you and the audience can't see this... I mean the room is comfortable, it's painted, the walls are painted nicely, but what you have is you have art, and for me I can't live without art. I go into a lot of people's places even my kids and they don't have anything on the walls. I don't say anything but it's like I couldn't live here.  I mean I have to have art, give me something. So, yeah I understand that because this is also interesting, this decluttering of your life just like you declutter your diet or whatever else, just lowers your stress and enables you to stay focused, enables you to actually have more joy I think quite honestly, and less time distracted taking care of all this stuff and actually more time for each other. I suspect that's what you've discovered with this.

Ari Tulla:  100% and really my turn is that we built this doctor finder company and it was a wonderful experience to spend almost decade building a company where we really help people to do one of the most difficult things in their life. Access to care is a really, really difficult problem today, even now in America because many [crosstalk 00:17:14] people can't even call the doctor's office today. 

Dr. Jeffrey Gladden:  Yeah. To your point it's not just even access to care, it's access to the right care, right? So I think that's also the thing you were really trying to focus on.

Ari Tulla:  Yeah. Yeah. And so we built this doctor finder company, it proved to be fairly big and we helped 20 million people to find a doctor, but in the end it became like a API and a backbone data company for everybody in the healthcare industry. So 3000 companies then used our data about doctors to build better systems, and we sold it to private equity four years ago and then I was a [inaudible 00:17:49] two years I was a CEO of a bigger company that is building all the doctor networks in the country basically for Medicare and the states and the big insurance companies and big hospitals. So they all use our tools, a company called Quest Analytics. And last year I think we helped 200 million people find a doctor indirectly, so it's pretty cool that you started... you have your own problem, and then suddenly the whole nation is getting benefit of this. So I was really, really proud about everybody in the team and all that wonderful work we did over the years and now I want to do this again. I want to do it in the [Tristan 00:18:24] now the idea is to build a company that can help people get the right interest in. And our goal is to get the million people that we can feed better and heal them. That's my goal and I hope we get the 200 million people in the next decade.

Dr. Jeffrey Gladden:  Yeah, that's awesome. Yeah, it's true that I think a lot of our endeavors really come out of our own problems or our own challenges for our own opportunities, depending on how you want to look at them. Yeah, so that's a great story, so I'm intrigued. So you did have a healthy child a few years later it sounds like-

Ari Tulla:  Yeah, we got our second son and then we have a daughter and they're healthy and everything is fine. They are here because again we happened to find a doctor who was able to do a procedure to my wife that has been done few hundred times in the world. And my company at the time was able to help us to find the right doctor. So how cool is that? 

Dr. Jeffrey Gladden:  That is super cool. That is super cool. So what procedure did they do for your wife if you don't mind my asking? If you don't want to answer that's fine too but-

Ari Tulla:  Well, common reason for early birth is of course weakness of the body and we were able to do something to fix it. 

Dr. Jeffrey Gladden:  Okay, great. Great, great, great. All right, so tell us now... so you became aware of the fact that food was actually really part of the solution for you being able to have a family with your wife, right? And so out of that, you started ELO to try to help people, and so give us a little bit of your mission for ELO. I get a sense of the breadth of it in terms of wanting to affect a million people and help them eat better, but what's the actual mission statement. What is it that you're really trying to accomplish?

Ari Tulla:  Yeah, the mission statement is simply we are trying to make food to be medicine. And today as you well know food is really the poison that is causing us to die young, causing us to die of chronic condition, causing us to die of COVID because we have conditions that are underlining and causing us to be weak against illness. So the kind of the broad view of what we're trying to do is that we are trying to establish this idea called smart nutrition. And you might not heard about it before because we kind of invent it so it's a new thing, but the idea is that smart nutrition is three things. It is personalized, it's made for you, it is precise, crowded in science and lastly it is proactive. And maybe some other people have done food... like persistent food or medicine type of things. But I mean this is a new thing when we think about it also being proactive, meaning that it gets better over time. It learns about outcomes on your body, it can be a scale, it can be your [HRV 00:21:14], it can be your sleep, it can be your biometric data from your blood, it can be your glucose, whatever you collect data from the body, we can actually link that back into the nutrition and have this real time or latent feedback ropes that are going to help you to improve. So my ultimate thing every time I do anything in life is that if you can measure something, you can improve it.

Dr. Jeffrey Gladden:  Absolutely. 

Ari Tulla:  We have not been able to measure things around nutrition beyond the fact that weight scale or maybe your cholesterol readings, but those are all back view mirror data, maybe a month before you see a number you did something or you have done it every day for many years. And the funny thing in a way that you of course know really well, having your experience I read about it takes about 20 to 30 years to get sick. Having metabolic issues it takes long time and you can even look fit and healthy, but you can have serious issues in your health that you just didn't know about because you might be eating... for example you might be eating a lactose or something that you know you have been allergic to or over sensitive to all your life, but you have never really tested it. So there's so much we don't know but if we can measure something, we can always improve it. And that's kind of the underlying factor behind idea of the smart nutrition and smart watch what it does. What is a smartphone? What is smart car? What is smart home? It's all about those ideas like personal, it knows about you, it learns about you and it's precise, it's somehow founded in science. And the funny enough thing is that many, many, maybe 18 years ago I was at Nokia, a small Finnish mobile phone maker. Some people might remember that was the biggest company of the world at the time in valuation, like the Apple of today. And we had invented the mobile phone and I had signed the team of Nokia that was building the first smartphone in '95.  Some people might remember who are a bit older, and that time we ended up calling it mobile computer. And I remember that on the whiteboard somewhere there was a smartphone also, but nobody picked that name, they picked the mobile computer and I don't want to make the same mistake twice. So I'm going to call this now smart nutrition. 

Dr. Jeffrey Gladden:  Got you. Well, that's fascinating. Yeah, that's fascinating. You go all the way back to the beginning of the smartphone so to speak. Yeah. I think when we think about realtime feedback we're massive fans of it, we feel like realtime coaching is the best coaching, right? In our practice. And so anything we can do to do that we're huge fans of. There's a lot of trackers out there now, Whoop, Oura rings, Apple watch, Fitbit, I mean all kinds of things like that. When it comes to food, it's a little bit trickier to kind of get real time feedback, right? I mean you can monitor sleep, you can monitor sleep quality, certainly every single client of ours... I don't drink alcohol per se, but every single client of ours that drinks alcohol they notice that their sleep is significantly impacted by it, right? And so we do get that kind of feedback, but are you developing tools to actually give us more kinds of real time feedback than what we can get off a tracking device like that?

Ari Tulla:  You're correct today that we don't really have a lot of real time feedback loops on nutrition, and the ones we do like glucose monitors that you can put on your arm are quite invasive, and they only look at the one view of the macro composition I.e glucose. And that might not be the right way. We are learning a lot, so we are involved as an investor in few companies in the space. I've been wearing those devices for a long time myself and I have learned a lot, but at the same time I built games for a long time and games are... they're basically these applications that are user experience that you get addicted to. It's so compelling to do some things in the games that you do it over and over again. And if you've built a... you gamify things like glucose monitoring, what are you gamifying it for? Or what are you going to do as a person to optimize the game? You don't eat, you don't exercise because those are the two things that will increase a glucose level. If the game is to keep steady or low, you will not eat and you will not exercise. So it's a really difficult game to build and I'm a bit worried about the apps and the services today that they might actually make people not... maybe they're going to be a bit healthier, but they [crosstalk 00:25:53]

Dr. Jeffrey Gladden:  They make the wrong decisions, right? They make this wrong decisions based on the data, exactly. Cause it's not intuitively obvious when glucose goes up or down, it may be appropriate to go up, right? And so I always talk about the fact that biology is really an economy of balance. It's not about trying to push biology into one corner like we're going to eat keto seven days a week, 360... it doesn't work that way. And it doesn't work that way that you shouldn't go up at times, right? To meet a need of some sort or that it goes down at other times. So I think that does make it challenging but I feel like we do need better real time feedback, and I think if people pay attention to how they feel like if you eat something and all of a sudden you feel sleepy, that's feedback right there, or you eat something and all of a sudden your brain's not as sharp as it was 30 minutes ago, that's feedback too. And I think even though we may not have something you put on your wrist to tell you that, I think learning to really pay attention to how you feel after you eat certain things or do certain things is certainly a good first step.

Ari Tulla:  And to continue answering the question of what can we do real time? So today I think at Elo we decided to take a step back and not go into the glucose monitoring yet. We are not looking at different companies, we are looking at the science, we are looking at the outcomes and now we're going to have millions of people wearing these devices in the coming two years. So let's learn about it and define whether that will be the right thing to do for us as a company. So instead we decided to take another box because every time you innovate and we are building something that nobody has done before on the planet. So it's not easy to know what to do, so we built a box that we want to test things that you and me and agree. And you as a medical doctor you trust in the blood work, we have common agreement that certain findings in your blood panel will mean something, and we can do something about it. So we basically took that as a first box and we decided to focus on at home blood testing. So you collect at home, you send it to our lab, we do the test. We do about 13 biomarkers and the ones that you test on your pace as well. Lipid panel, A1C for diabetes, looking at minerals and vitamins, looking at the information, we do homocystine today. We don't do CRP because CRP is not specific enough in our opinion, to understand where the problem might be in your body. And then what we do, we take that data we throw in and mix a dietician. So we have one on one session with the dietician every time you turn the service to know you better, to understand you better and make sure you understand the data we got from you. Of course, we also do a comprehensive health survey questionnaire, and we also connect to all the verbal devices like. I have the Whoop, I have the Aura, I have the Apple Whoops and we can do that with Apple Health, that's really seamless today to connect all the data. And that becomes the kind of data we have about you, and then we use AI models to define what so you then have in a form of supplements and food as well in a moment. But we started the supplements to be able to kind of have one on one correlation. Like you have low vitamin D, we can improve that with vitamin D. You have a high HDL or low HDL or high LDL, we can have an impact in certain supplementation. And also of course we do it in a way that the codes is helping you to modify your behavior. Most people I think you and me as well, we have some blind spots. We do certain things with nutrition that are not good for us, and those can be taken away. And like you said every day helping the person to modify small behaviors, not big, you don't stop eating meat completely, no maybe you stop eating meat every breakfast, maybe you stop eating or putting sugar on your cereals. Those are the small things that make a big difference. So that's what we do and then we track every 90 days of blood again. So our feedback look today is a pretty long one if you think about the blood, but over the next coming months we are adding a lot more things, like we have now add for example next day, how do you feel? Your score in your day? You put your feet on the ground in the morning and you say one to five or one to three, how do you feel? That is maybe the most meaningful, single thing you can do to your life, because if you feel better in the morning you've been doing something right the day before, and you are more or likely to continue doing that feedback group again.

Dr. Jeffrey Gladden:  for the immediate feedback, but I think you're back to actually people keeping track of how they feel, right? And they could even keep a journal of that. And I think the key areas are how clear is your brain? How clear is your thinking? How big is your memory? What's your energy level or you have aches and pains? Are you feeling inflamed? Are your hands swollen, your feet swollen or whatever it is, right? Simple things like that and then what's your gut feel like, right? Are you bloating? What's your stool quality? Do you have diarrhea or you're constipated? Some things like that all of a sudden become useful when you collect 7, 8, 9, 10 of those things and then all of a sudden you can start to see patterns. So yeah I think this is where we are, I really kind of crave the day though when we can drop a nano bot in the blood and it's measuring a 100 different markers and-

Ari Tulla:  But we are getting... I love the nano bot idea, but we are getting there, and it's been really wonderful to work on this. So this idea I have today, I had the same idea 11 years ago, but I decided to start the doctor finding company first because it felt more attainable, doable at that time and I was right. Now we barely have enough science, we barely have enough knowledge to do the nutrition play, and I think the time is right. We are maybe a little bit early, but we are getting to the time when things will happen. So my co-founder... we have three founders. So one of them spent a decade at Apple, he was in the Apple design team that worked with [inaudible 00:32:03] and Steve Jobs to build all the products we love today. 10 people team built all these things that are wonderful. And he was of course involved in like the Apple Rings and the Apple Bots and many other things. So it's really interesting when you have a person who's been thinking about this for a decade and kind of knows what Apple will probably do in the long term, of course he can't tell us, but there's a lot of things that will happen. Like the glucose monitoring, it will be in a wrist in the next five years. And we can also likely see the blood panel on a high level at least in real time on your wrist. So once those happen, we will have a very different viewpoint into the real timeliness of the nutrition. So the time is happening soon and I think... I don't know if you have tried the glucose monitors-

Dr. Jeffrey Gladden:  Oh yeah. [crosstalk 00:32:56] We've used them all the time. The interesting thing is for us is that there's always another curtain to open up, right? So take hemoglobin A1C. So, we'll have people, myself included I have a hemoglobin A1C of around five or whatever it is, and yet if I do a glucose tolerance tests my blood sugar will shoot it up to 160 or 170 because genetically I don't recognize the load coming into my system. So I'm slow to release the insulin and my sugar will spike and I'm doing damage right then. And then the insulin comes out and I crater on the back end, right? Because I'm getting this big response now to that big surge, so now my blood sugar drops to 50 and there are a lot of people out there with hemoglobin A1C that look normal, but they can still be diabetic for an hour particularly when they're eating something sugary. And there's so many things that are important about that because we know that high sugar for that hour is actually damaging the arteries. We know that people that have insulin resistance, they can have a normal hemoglobin A1C but it's requiring six times the amount of insulin to be released, to control the blood sugar as it should. And then consequently insulin is actually driving cellular senescence. It's actually accelerating the aging process right in the arteries and then throughout the body and increasing the risk of cancer. There's lots of curtains to open up here to actually see what's really going on, and that's kind of what we do in our practices, look behind as many curtains as possible to get the full picture. It moves us beyond a course what we can do in real time or what we can do over the internet, but we're all in on how good can you be kind of thing, so that's our approach. That being said when I look at it from our vantage point, I think there is so much that could be done to really help people in general, right? So I'm very enthusiastic about that, it'd be interesting to chat with you about that offline.

Ari Tulla:  And I love what you do because I mean you are kind of throwing a little bit... you're throwing a bit more than what we can do in scale today because the price of course will be a bit inhibitive factor. Like even as an example doing the insulin resistance testing, you have to [inaudible 00:35:07] you can't today do it from the fingerprint today. That's one of the two tests you can't do. So you have to then add a [inaudible 00:35:14] to come into your home or you have to walk into your lab, and that is a really difficult thing to do for most people who are busy. And we are trying to like, look what can we do in a setting where we're not going to break the bank? So ELO day as an example when we offer, we do the testing every 90 days, we are giving you [inaudible 00:35:31] the dietician you can communicate every 90 days on Zoom, and then you can communicate on an app every day if you want, you can send a photo of a food you eat or a product you want to have, and they can give feedback instantly, and then we give you supplements every 30 days. That's $99 a month, so it's a pretty affordable price point and there's of course a lot of now conscious clinics where you pay between 10,000 and $400,000 a year to get access to really, really great care. I'm doing that myself and I'm learning a ton and I'm getting a traumatic amount of value, but I understand that not everybody can take 10,000 to 50,000 a year and spend it on their health on preventing-

Dr. Jeffrey Gladden:  Absolutely. Yeah, no that's right. That's right. Yeah. And I think that's exactly right, I think it's about trying to... if we can do 50% of what we're able to accomplish in what we'll call a high end all in kind of clinic, that still has tremendous value for the population, right? And I think that's where you're focused. So what's next for you with your program here? What do you... I see a little bit of a pipeline here with more sensors, more data, more feedback, more AI, more coaching, et cetera. But are there things in particular that you're focused on in that general [inaudible 00:36:49]

Ari Tulla:  Yeah. So there are few ways we are going to go about, so the number one now has been to kind of build the box where we can innovate and we can now validate that. So we run a test last year, a clinical trial with 150 people, and we saw traumatic outcomes. We saw people 90% of people actually having a significant impact on the biomarkers that we focused on. And these are really the biomarkers that you will also focus on, on your clinic. And it really is not only because we supplement people, but mainly because we give them great [inaudible 00:37:19] and we help them to change behavior. Changing behavior is the key piece of everything that we need to do in health today. So the next steps really are to how do we expand the box? And the box is going to be nutrition. How do we get people food? How do we get people different type of products that are going to help them in their life? I can't talk about the specifics today because we're going to have big announcements coming this year, but there are three more products coming out this year that are fundamentally innovative in this space. And really I think the whole goal I have for the company in the long term is to become a marketplace. Think about Costco for example, Costco is the marketplace for [inaudible 00:37:58] high quality, good price. You have other marketplace that maybe like a farmer's market is basically organic marketplace for buying those produce. Elo will be the health marketplace where you can buy all type of nutrition products that are going to be helping you either stay healthy or in a medium long term also reverse chronic conditions. And I think you of course are doing this daily and you have done some of this to yourself. I have done this in my family as well, you can reverse a condition because of the right nutrition. And that is one of the biggest single things that will happen in the global healthcare in the next decade. We will have interventions for... we already have for type two diabetes company called Virta Health is doing amazing work on reversing type two diabetes every day. I'm really proud to be part of that company as an investor, and then there are of course [inaudible 00:38:52] who are doing a little bit more incremental, but impactful stuff. There are companies looking at cancer, how can you help people in the cancer treatment with nutrition? For example, ProLon diets have been seen to be quite effective, but there are many, many others like heart disease that you talked about and you are expert in, there are many interventions there and you don't need to be keto, you can be Mediterranean, you can be vegan and you can be vegetarian. Many things will work as long as there are right program behind it.

Dr. Jeffrey Gladden:  Yeah, I think that's right. And ProLon of course is the five day fast mimicking diet that I just mentioned which has tons of benefits quite honestly, which leaves me to two points that I'd like to touch on with you. One is the lack of nutrient density in food. There's been such a decline in nutrient density and when I think about food, like I go to the store now and I'll buy a whole variety of greens and it's hard to munch through a whole pile of greens. I mean my jaws get tired trying to chew it all, so what I do now is I actually take a big pot and I put water in the bottom of it like reverse osmosis water or something, and I throw a whole heaping pile of greens in there. And then I just turn the burner on and I keep tapping it down until all the greens are kind of into the water. And the water may be kind of on the verge of boiling and I turn it off, and I run it through a strainer and then I just collect it. And I have to tell you that for whatever reason, those are like the best greens on the planet. I don't even put anything on them. They're just so sweet and tasty and crunchy still, and I think what I love about it is that I'm eating very nutrient dense foods. And when you eat very nutrient dense foods, it takes your hunger away. So, we're constantly over fed and undernourished, and I think that, right? And so I think allowing people to get access to nutrient dense foods is critical. So you could do that with greens or whatever if you're listening to this and I just put them in the refrigerator and just pull them out and eat servings through the day. But one serving of that is like four servings of trying to munch a salad. So anyway when you think about that though in this whole growing issue and how do you... organic food has different nutrient densities throughout the year, and there's all these issues around pesticides and everything else that are blowing around in the air, it's hard to get clean nutrient dense food. Do you have any thoughts about that? Do you do anything around that?