From the CEO: April 2026
Fertility and metabolic health, full-body MRI, prediabetes remission research, and a water filter recommendation.
Four things on my mind this month
1. Fertility, metabolic health, and the preconception window
Maybe it's my life stage, but fertility is the health topic I'm hearing a lot about right now—specifically how to improve the chances of a successful pregnancy and a healthy child. Fertility is often framed as a narrow reproductive issue, but when you zoom out, it looks much more like a whole-body metabolic health state. There's a clear relationship between metabolic health and leading causes of infertility like Polycystic Ovary Syndrome (PCOS). It's also increasingly clear that both parents' health and lifestyle behaviors—like lifting weights, dietary choices, and toxin exposure—can directly affect a child through epigenetic changes.
That's why I was excited to interview Dr. Ann Shippy on this exact topic. Our conversation gets into both her experience helping patients get to the root causes of fertility struggles and the practical lifestyle changes people can make to optimize the preconception window—the months before pregnancy, which may be one of the most underappreciated windows in medicine. If this is an area you care about, let me know. Levels will do more here.
2. Full-body MRI and the case for health data abundance
I had a chunk of HSA funds built up and finally pulled the trigger on a comprehensive full-body MRI from Prenuvo. The findings were interesting—mostly for the insight into my spinal health (I've had persistent pain from bulging discs that I'm managing with high protein + creatine and consistent strength training). But what's more interesting is how to think about scans like this in the first place.
I've gotten strong reactions to my perspective on this tech in the past, typically along the lines of: "You shouldn't proactively scan like this because you might find something insignificant and end up with an invasive follow-up you don't need." I think that concern is reasonable, but only because we're so used to data scarcity. In fact, it defines exactly why we need more testing, not less. When testing is abundant—early, accessible, and affordable—we won't feel pressured to act on every result. If a finding is ambiguous, we can just wait awhile and get another scan. If it gets worse, intervene. Otherwise, keep tabs over time.
That's how I'm thinking about this diagnostic: as a "soft-tissue health baseline" I intend to compare many future scans against. I picked Prenuvo because they have their own machines, imaging centers, and clinical team, which sets them apart from other consumer options.
3. Prediabetes remission and cardiovascular disease
This study found that achieving remission of prediabetes (even temporarily) over a 1-year period was associated with a 50% reduction in cardiovascular death and heart failure over a 20-year follow-up. I appreciate that the study considered more than just A1c—it also looked at fasting glucose and 2-hour glucose after a glucose challenge. Yet another reminder: a) biology is a fully interconnected system and b) disease thresholds are arbitrary. Optimization needs to be our objective. Unfortunately, only ~10% of people in this study were able to maintain prediabetes remission after a year. That's why sustaining improvement over time requires better tools. These participants didn't have access to CGM or products like Levels, and I'm excited to see how technology can make results like this far more achievable.
4. Product recommendation: British Berkefeld water filter
My conversation with Dr. Shippy reminded me how much the inputs to our metabolic health state aren't limited to food. One high-leverage example is drinking water. This is the water filter system we use at home. I grew up with one, and my large family probably put something like 50,000 gallons through it over the years. I love gravity filters because they're elegant, portable, durable, and they work when the power goes out (I've had to put melted snow through one more than once!). They also have nearly zero plastic exposure and maintain the water's dissolved mineral content. Highly recommended.
Follow me on X here. Other than Levels, I have no affiliation with any of the products mentioned or linked above—I'm just a satisfied customer.
—Josh
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