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The World is Moving Fast. Futureproof Yourself Weekly.
Your front-row seat to the Future of Business, Tech, Life, and Human Potential.
On Futurecaster with Kimberly Bates, learn through thought-provoking conversations with world-leading founders, AI experts, scientists, engineers, doctors, business leaders, technologists, investors, and everyday builders. Each episode unpacks the real opportunities shaping what’s to come and the blind spots along the way.
Kimberly Bates is a world-renowned futurist and executive brand leader. For over 20 years, she has advised some of the world’s most valuable global companies and iconic brands, from Fortune 100s to fast-moving startups, helping them anticipate change and shape the direction of their industries, customers, and culture. Her work has driven future-ready brand and business transformations, breakthrough products and services, and entirely new business models and revenue streams.
The Futurecaster® Podcast is on a mission to make future thinking available to everyone. If people can see these opportunities for themselves, they can help create them.
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Sandeep Misra (00:00)
We had a situation where one of our patients had seen tremendous success once they got on our program. But their dosage for Metformin was not adjusted because again, our healthcare system.
So you see your doctor, then 90 days later you see your doctor. But that doesn't mean that diabetes stops for the 90 days, right?
Blood glucose was dropping below 70 and the team was like something is not right. So they called the patient and said, Hey, we're noticing this over the last three days. Your Metformin needs to be adjusted because we are seeing chances of hypoglycemia happening. So you need to go
quickly call your doctor. The doctor goes, gosh, we got adjusted by half. So they dropped the dosage by half on Metformin and the patient was fine. Those alerts in combination with the AI models to flag it to us and the clinical team and the care team looking in the back and going, ⁓ we need to get in touch with this patient as soon as possible.
That's what the future is gonna be.
Kimberly Bates (00:52)
Welcome to the FutureCaster Podcast where we give you a front row seat into the future of business, life, and human potential.
Kimberly Bates (01:02)
What if everything we've been told about health is already outdated? GLP-1 drugs are everywhere. Millions of people are using them. The world calls it a breakthrough. But what if they're not? What if it's just the beginning of something far bigger? Metabolic dysfunction quietly drives most chronic diseases today, from diabetes to heart disease, cognitive decline, and even inflammation. Yet we still treat it the same way we did decades ago, reactively. We wait until something breaks, and then we try to fix it.
In this exciting episode, I sit down with Sandeep Misra, co-founder and chief growth officer at the human led health tech platform, Heald, which aims to reverse type two diabetes, to explore a fundamentally different trajectory. A future where metabolic health is continuous, predictive, and AI coordinated.
So the real question is no longer how will we treat metabolic disease in the future. It's whether we will allow it to happen at all. Because in the next era, health won't start with a diagnosis. It will be continuously cared for and corrected.
Kimberly Bates (02:04)
Hi Sandeep, welcome to Futurecaster. Thank you for joining me today.
Sandeep Misra (02:08)
Thanks for taking the time to speak with me.
Kimberly Bates (02:10)
I'm really excited to talk about metabolic care with you
Sandeep Misra (02:12)
Now it's a topic that's near and dear to my heart
Kimberly Bates (02:14)
So you've worked at the intersection of cloud infrastructure, enterprise tech, and healthcare in the past. So what made you believe metabolic health would actually be the next big thing and really require an entire rethink?
Sandeep Misra (02:28)
That's a great question. know, moving from enterprise tech into sort of the customer facing the patient facing healthcare, ⁓ specifically our metabolic health, that was a that was an interesting, interesting move for me. Obviously, I've spent the last, you as you mentioned last 20 years, I've spent in enterprise health tech working for the likes of Amazon, entity data across strategy, product development, sales, all that. And
There was one thing that was constant that we learned, that I learned in technology specifically, that if you want change to happen, you got to do it at a system level. and be able to get, know, rather than being reactive, get real-time feedback, be more adaptive, be more predictive in some cases. And what we felt when we decided to start this company, me and my ⁓ co-founders that
that was lacking in this specific area. And I'll get into a little bit more detail about the metabolic health diabetes specifically that we've focused on. But when we looked at individuals getting healthier, obviously metabolic health, gut health is the root cause science has proven over and over again for a lot of the top seven chronic conditions and beyond. That was sort of the initial
thought process that there is a better way. And that's how spent my entire life. I got to always ask the question, is there a better way personally and professionally? And in this case, if I'd like that metabolic health needed a new redesign, new thinking, a system level sort of an approach. And that's why we decided to go down this, this venture and, ⁓ start Heald to solve the problem.
Kimberly Bates (04:04)
That's really great. And speaking of that, I would love to let the audience know exactly what Heald is and how you think it's different from other connected solutions in the market. What's your white space positioning?
Sandeep Misra (04:17)
We had sort of a different approach to solving the metabolic health, specifically pre-diabetes and diabetes-focused solution. Because we realized, obviously, that, as you said, there are plenty of health tech companies. There's apps left and right that track the meals.
Back in the day when first apps came out, was all about, you start typing on the screen, you got a dropdown, you pick and you track your meal, and then you see the macros, you go, well, yeah, that makes sense. You hit track. And that was the extent of it. With the advent of AI, with the advent of computer vision and all those advanced technologies, it became better. It became a little bit more accurate. So there was never a shortage of information. There was a never shortage of health tech or companies that would do...
one or two areas specific to metabolic health, be it meal tracking or be it giving advice on fitness or whatever the case might be. why HEALD is different when we built it, technology is good to make people or help people give them the right information to make changes, but you still need a human in the loop to hold somebody accountable, right?
And most of the solutions that we came across were either a hundred percent tech, which is you've got zero interaction. Everything is app based or Saas based. And you just interact with the machine back and forth to get the information and you move on. That was less impactful to people because they missed that human in the loop part. Or they were on the flip side. There were companies that were trying to make changes on metabolic health, diabetes, type two diabetes management and all that. And they were all human interaction.
Where it became a real challenge to scale, to have flexibility because people are busy, their families, their work, they can't just be on schedules every single time to go meet somebody. So we said, let's build something that is hybrid, which is tech enabled, but human led. And human led will still keep the human in the loop and bring the accountability and the emotional and the personal touch to the equation. And
Let's focus on the key scientific areas of lifestyle modification. Most of them that have been ignored. So people, everybody knows you should eat broccoli or carrots or salads. mean, God, everybody knows that. The rate of ⁓ metabolic disorders keeps growing, right? So it's a behavioral change that requires a different mindset, right? So not only do we look at nutrition and fitness,
we brought in the layer of behavioral health. So we started analyzing sleep and stress patterns as well. And the behavioral coaches, specifically human behavioral coaches, they work with our patients to identify the gaps on the behavioral side and help them with the cognitive side and the behavioral therapy side to say, anytime you're stressed out, let's work on stress mitigation strategies rather than using food as a sort of a comfort blanket that most of us do.
I ⁓ love a good sandwich or a good burger, when I'm a little stressed. I'm just going to go have, or I take my daughter out for wings and we enjoy that, but that's not sustainable and that's caused the problem. So at the end, what we decided again was, hey, let's have a solution that is a hybrid tech-enabled human led and focus on the behavioral modification. So the mental side of it that all the companies have ignored, they've done one or two or the other.
Kimberly Bates (07:39)
This is a really tough space to be in because there's so much responsibility when you're in this space, it's kind of different from enterprise tech. There's not, there's responsibility there, but this is people's lives. So in connected health, trust is actually the product. It's not a feature.
Sandeep Misra (07:41)
Mm-hmm.
It is.
Kimberly Bates (07:55)
So for
AI founders and health tech founders, this goes way beyond encryption, you're operating across layers of responsibility from data protection to real world outcomes. You have to think about protecting your patients from hardware failures, as we've seen recently. So could you give some advice to AI health tech founders
of what it really takes to protect all of these things, protect the company, protect patients and everything in between.
Sandeep Misra (08:21)
Yeah, beautiful question because I think with the acceleration of AI and the adoption of all that, people are getting impatient and trying to build out something that they can take to market quickly, right? And to your point, when it comes to health, health tech, actual lives of people, mistakes can be amplified, can be catastrophic, right? So you have to have the right framework across the board from operations to clinical.
to the security infrastructure, all that, right? You have to have the proper guardrails. And technology aside, obviously there's several tech solutions that give you the ability to have the right audits, right guardrails in place for HIPAA and making sure PHI is protected and all that. Those are pretty much table stakes at this point. And if you're not following that as a company or starting out in sort of thinking, yeah, we'll do that later, man, you are doing a disservice to a lot of people.
So first of all, don't take the shortcut, right? it, get it ready, get the infrastructure in place to do that. We have a clinical team in the background, right? So anytime we come up with a new model for analysis of let's say a data point, be it nutrition or medication or in the blood report, right, or blood work.
our clinical team will first sign off on that before we put it out there. And if they're not 100 % satisfied, they will just say, guys, we're not doing this. We're not taking this message to the market. We're not taking this capability to the market. We're just not going to do it because we're not confident. And I'll give you an example where this happened. We were making some tremendous progress with some of our patients and our results were getting noticed by a lot of consumers out there.
And a lady approached us and she said, hey, I've been following your company. I see what you're doing from a nutrition and sleep stress and fitness perspective. And I want to sign up. So we started talking to her. like, right, tell us a little bit more by yourself. What's going on? And she said that the reason she was coming to us was because she had gestational diabetes, which is very common. It happens to a lot of women that are pregnant. And what we told her was, we're sorry.
We have not tested our models out yet for gestational diabetes. She actually was like, don't worry about it. I just want the right nutrition guidance. so she went ahead and signed up. And me and our co-founders, in our daily huddle, we go, man, this is something that we just do not want to undertake. It's not safe for her potentially. We don't know. So let's talk to our clinical team. So we called our clinical team in in-house endocrinologist. She was like,
Absolutely not we are not gonna put the risk that the baby and the mother's life at risk chances are nothing's gonna happen because again we are focused on lifestyle modifications, but that's not something that you want to risk, right? And so we returned her money refunded everything she was a little unhappy But it was like as a startup it is really hard to walk away from revenue But you still have to do the right thing right
I won't be able to live with myself if something happened, right? So to your earlier, question about how do you protect the patients, first of all, have the right reason why you're building the company in mind and make sure that you don't compromise on that. That's the basic, most core fundamental. And then make sure the right infrastructure in place to do the audits, the challenge, to put the right security protocols, protect the PHI role-based access. So like, for example, me as a...
as a chief growth officer, co-founder, I have no access to any information about the clinical side of any of our patients. Not something I get involved with. Our care ops team has access to that. I don't look at it. I don't get involved in it. If a patient calls me or wants to talk to me and they want to share with me, that's a different story. I don't specifically, I don't have the role-based approval to go see that information.
Kimberly Bates (12:14)
Are there any tools, that your company is utilizing to make all this real, make it happen, that you maybe couldn't have used five years ago for a company like this?
Sandeep Misra (12:24)
The most popular ones are obviously front and center for us. So when it comes to web design, ⁓ quickly spinning up websites on framer and using APIs from OpenAI for a lot of the analysis. From ⁓ Anthropic, obviously we have some models that we have built using
Claude Code, example, know, Figma, Canva, all those tools that are easier for startup now spin up for presentation and visual there and UX and all that. I believe we use a company called Sprinto and Sprinto does all the audits for us and, you know, the make sure that we are up and up on the HIPAA certifications, the PHI and all that.
But those are sort of the tools that we have used. We as many low-cost available tools for us, just like any other will.
Kimberly Bates (13:16)
Do you think there are any startups in the healthcare clinician side of things that are game changing and helping smaller startups today?
Sandeep Misra (13:24)
There's a lot of stuff going on in ambient listening into the clinical setting right now where, you know, patients are walking in and as they're interacting with their clinicians, the ambient listening tools are making sense of the conversation and then using AI to not just translate it, but gain intelligence out of it and putting it back in the electronic health record. I think that's where lot of development has been done.
But outside of that, think wearable tech is something that's becoming a lot more popular, right? So mean, if you look at companies like Oura Whoop, I think that's where a lot of the development is gonna happen in the coming up in the future. And they're already starting to see some of that, some of those changes where what you have on your wrist, what you have implanted in your body is gonna be feeding the data on a regular basis.
I fully expect implantables to come out that are able to analyze the inflammation markers real time. Because at the end of the day, the core of every illness is some sort of an inflammation, right? So I fully expect implantables to come out that will be able to say, know, triggers or warnings that will say inflammation is spiking up or down whatever the case might be.
But that's where I see most of the work being done.
Kimberly Bates (14:34)
I want to get a little bit into CGMs. How are you handling some of the controversy with some of the devices that aren't working? Are you looking for other partners, new solutions? there's companies like BioLink that are really pushing their Shine Patch. It delivers
the glucose data through optical interface. So it's operating different. January AI is already predicting your glucose response before you even eat anything. So we're moving from reacting to forecasting.
Sandeep Misra (15:04)
That's a great question. We are agnostic. you know, we either it's BYOD, if you want to bring your own CGM, sure, bring it and it will integrate with our app and our technology. If you want us to provide it, we've got ⁓ Dexcom as well as Abbott that we work with most frequently.
And we are keeping our eyes open and evaluating all of them on a regular basis.
our thesis is that we will let consumers dictate what we should work with, right? When it comes to something that's gonna be on their body or in their body, right? So if there are companies that make significant progress or if our business model changes to be more tech heavy, sort of concierge,
24-7 every single data point is analyzed left and right then yeah that makes sense for us but for now I think we're sticking to the basics because people are comfortable so we let the market and the consumers dictate what they what they want to use but that's what that's probably the
the easiest way to address that for us right
Kimberly Bates (16:04)
if you're tracking someone over time, your AI systems can pick up the issues in the data before it could become detrimental to people because it is a matter of life and death. So you might be able to set up or build a new system in the future that alerts people, Hey,
We're seeing something off with your data, check your device and kind of ping them and have that be part of your service because the manufacturers don't have that.
Sandeep Misra (16:31)
And actually that's, it's very interesting. say that we, we do that proactivity already. I'll give you a quick example. And this is something that I was discussing with the team the other day We had a situation where one of our, guess, one of our patients had, had seen tremendous success once they got on our program. right? But their dosage for Metformin was not adjusted because again, our healthcare system. is a little bit more.
It's more reactive, right? So you see your doctor, then 90 days later you see your doctor. and then 90 days later you see your doctor. But that doesn't mean that diabetes stops for the 90 days, right? Things are happening in your body over time, right? So they got our program. They saw massive improvement, but because their metformin was not adjusted,
Blood glucose was dropping below 70 and the team was like something is not right. So they called the patient and said, Hey, we're noticing this over the last three days. What's going, tell us what's going on when you're sleeping at night. goes, man, yeah, I've been waking up, you know, with night sweats and I just feel weird. Go well, there's, there's your, there's your reason Your Metformin needs to be adjusted because we are seeing chances of hypoglycemia happening. because your blood glucose is dropping below 70. So you need to go
quickly call your doctor. make sure that it's typed right in accordingly. They called the doctor and said, hey, my team was looking at my data and this is what's happening. The doctor goes, gosh, we got adjusted by half. So they dropped the dosage by half on Metformin and the patient was fine. So to your point, Those alerts in combination with the AI models to flag it to us and the clinical team and the care team looking in the back and going, ⁓ we need to get in touch with this patient as soon as possible.
That's absolutely the case and That's what the future is gonna be.
Kimberly Bates (18:09)
Yeah, so you're becoming a feedback loop company Let's talk about diet culture for a second. GLP-1s shifted the whole conversation from judgment-based
Sandeep Misra (18:18)
Mm-hmm.
Kimberly Bates (18:20)
eating to biological informed eating and people feel way more empowered. You know, there is something dysfunctional about my metabolism, and this is real and I was being ignored for years. So I think there's a lot of relief out there.
but you really need to change behavior when you're on it and then understand
how you could prevent some of the side effects. So you need someone to help you through that. Is that something that you foresee providing in the future?
Sandeep Misra (18:44)
I'm glad you brought that up. So one of the features that we, because we saw this trend continuing and the train has left the station. It ain't coming back anymore, right? So GLP-1s are not going anywhere. They're only going to gain more popularity. So what we said was how can we support people that are...
using GLP-1s, right? Our nutritionist is, example, if somebody is on GLP-1, we know that there can be a chance of muscle loss on GLP-1 as a potential side effect. So how can we calibrate their nutrition plan? So even if they're consuming less, they're consuming enough protein to offset any of the negative side effects and still not have a muscle loss for lack of a better term, right? So that's how we calibrate the nutrition plans.
Besides that, we just launched another feature in our app as a response to this which is what we call a wellness whisper. And every time you track a meal ⁓ within our app, it will give you a fullness score for that meal,
So now people start to see, okay, I'm gonna be full longer by consuming this or am I gonna be full for a shorter duration of time by consuming this? So it starts that behavioral change slowly to say, ⁓ so every time I eat, let's say cottage cheese and honey with almonds, my fullness score is high and I'm not that hungry, but every time people know I eat a slice of pizza, it's gonna be lower.
Kimberly Bates (19:58)
Mm-hmm.
Sandeep Misra (20:04)
But people want to see that, right? That feedback loop that you referred to earlier, that certainly helps. So yes, we are constantly looking at building capabilities to help people, support people that are on GLP-1s to say, hey, if you're struggling with nausea, if you're struggling with muscle loss, let's design a nutrition plan that offsets those things while getting you to a point where you feel, can I pause it for a little bit or get off of it if I need to?
you have the structure in place to make those decisions as your body dictates and as your doctor recommends.
Kimberly Bates (20:38)
and
One of the things I was thinking of was, as I see it, you're actually creating the metabolic streaming service of the future. So I'll explain what that means. So metabolic data streams 24 seven, like it is into AI systems, episodic doctor visits, so today you say, you meet every three months and you do your blood work. Well, those visits start to dissolve in the way that they're structured today. Care shifts more towards this always on.
Sandeep Misra (20:53)
Mm-hmm.
Kimberly Bates (21:08)
ambient form. So it expands beyond glucose into hormones, inflammation, drug response. And so instead of waiting for labs, like the model is today, interventions, it's adjusted in real time. So you have this real time doctor or clinician from Heald that's always on available to you in real time. The hospital
in future won't even be a place. It'll be a continuous intelligence layer around our bodies. how will this evolve the doctor clinician model as this future becomes pretty real 10 years from now?
Sandeep Misra (21:42)
Metabolic streaming services. PATENT THAT PLEASE! You're right. I think that is the evolution where Again data should dictate the response right? and in the past it's been Badge processing for lack of it or talking nerd lingo. It's been badge processing rather real-time Now to your point we have the the ability to always know what's going on. and I'm a
I'm a technophile for that man. My wife makes fun of me because I have the smart ring, I have the watch, I have the CGM. And she's like, what are you doing? was like, I love data. I love to see what's going on in my body at all times. And my smart scale that's sitting right behind me is the body measurements. So I think those are gonna become table stakes for any sort of clinical setting as well. So there's gonna be physicians that are There are going to be physicians that say, hey, we're only gonna take patients that are willing to at least
get the data so we can make clinical decisions. And we're only going to work with those patients. And because of the shortage of physicians, you know, that we're facing in not just in the US, but around the world, I think the companies that can take that data and make sort of the clinical recommendations real time without being physicians is going to become more more important, right? And that would facilitate obviously
remote access for healthcare as well. So if you look at rural areas in the US as well, there's lack of continuous care, there's lack of proper care for a lot of these patients because they don't have access to physicians, right? So that would solve that problem as well. But I absolutely see that in the future, me as a person, I will have a data profile, I'll have a digital twin for lack of a better term, where my doctor is seeing Sandeep virtual and...
Sandeep Real doesn't need to be there. And then he's making recommendations based on Sandeep virtual data and then Sandeep Real is acting on it. And then he's seeing the improvements or modifying titrating medications, adding, subtracting, whatever the case might be. But that is the absolute, that's not just the absolute possibility. I don't think it's too far in the future. I mean, we're not talking about 20 years from now. We're probably talking five years from now, right? If not sooner, right? So I think that's probably where I see it happening.
It's gonna be EXCITING TIMES! I think it's gonna be a little scary for some people, but I think it's gonna be exciting for the ones that are willing to adapt and adopt those changes.
Kimberly Bates (24:08)
So let's talk to the doctors and the clinicians out there. Don't you think they need to start thinking about this future because it's going to disrupt their roles. They're some of the smartest people in the world. They're some of the most helpful and loving people in the world. They need to start thinking about their own personal IP and create their avatars that they rent out to companies like yours and others because they might not get that
hourly fee anymore with patients. The whole model is going to be blown up within five years. Helping your own doctors and clinicians and nutritionists and all of that create their digital twins.
so that they can have that IP.
Sandeep Misra (24:41)
Beautiful idea. I think so we are already seeing parts of that in our with our work. because we have physicians that have approached us in a few markets and We already have four physicians that have rolled this out where they approached us and said, listen, we are not with our patients during the 90 day window when we see that we don't see them, but you guys are. So can you serve up that data to us rather than me?
bugging my patient every 90 days to figure out what the heck did they do the last 90 days. So you are an extension of us. you as an Heald you're an extension of us. And I am making my recommendation to those patients based on what you have gathered, the data you've seen, the reports that you're generating and giving us the insights into this patient's life, which they did not have before, right? They would rely on patient memory to say,
Yeah, I think I eat pretty healthy, Dr. Kimberly. And you're like, yeah, BS. I'm looking at your data, bro. You're not eating healthy. You eat 80 % of your meal outside. And when we look at your meal consumption, 40 % of packaged goods that you're eating are highly processed. They didn't have that information till now. And we are providing that, obviously, with the consent, because it's coming directly from the physician to the patient. But to your point,
They are looking at us and saying, can we scale this even more? I know when you start talking about the healthcare delivery model in the US, credentialing is a big challenge. Where are you located? Are you credentialing in a different state? Can you provide care from Georgia to California to Kentucky to Kansas? Those are all systemic issues that need to be solved. But I absolutely believe that a physician will be able to go, hey, I have 500 patients.
Right now I can only see 10 of them every single day. So my cycle repeats every 50 days. I want to be able to be available for 300 at a time every single week. Right. And that would be facilitated by using the data that the patient is generating, serving it up and having the real time conversation, be it an avatar or, you know, AI generated messages or virtual meetings, whatever the case might be. but it's going to accelerate.
Kimberly Bates (26:58)
So if you think about even chat GPT that can operate anywhere. And that's what people are going to end up doing, because they're not going to want to be told, yeah, you have to wait three months to talk to your doctor or three weeks or whatever it is, or you want to talk to your favorite person.
Sandeep Misra (27:04)
Mm-hmm.
Kimberly Bates (27:14)
So they're gonna turn more and more to these platforms.
Sandeep Misra (27:16)
I think these tools are going to empower the patients a lot more. the good thing about these AI engines as well is they're giving the people the ability to also learn how to ask the questions, right? So if you type in chat, GPT that, Hey, runny nose, fever and headache, right? It will give you a certain response.
but that it also suggests, do you want to do this, this, this? So you start making that behavior change as well to say, am I going to ask the next right question, they're going to use that information to empower themselves and have a more meaningful conversation. with their physicians as well, Because the information will be served up to them in a manner that makes sense to them.
and that they can learn from And that they can digest and disseminate as they see fit.
Kimberly Bates (27:56)
I'm seeing that with myself. A long time ago, well before any of this was being discussed, I had built my own health advocate agent. And I can tell you for a fact that it's helped me with interventions that have completely 100 % worked and no doctor has ever given me any advice like that.
I've been telling doctors there are clinical studies going on that they don't even know about, that should about. So that's really disturbing to me. I feel more empowered now. And I think more and more people are going to start thinking like this.
Sandeep Misra (28:26)
As AI proves itself to be making the right decisions and not hallucinating as much or making the wrong call, people are going to start trusting it
So now when you look at an archetype of a person like me for example, right? Hey somebody who grew up in an Indian household lived in India till I was a teenager, moved here. I have a certain cultural demographic, genetic makeup and I'm sure there are people like me, right?
So if I am going through a certain illness, for example, or if I'm going through a certain clinical condition, what is a like person or a like population? What does that data show? And what would work the best for that like population? Doctors can't do that humanly. A human doctor cannot do that. They don't have that data. But AI does, right?
I think it's gonna happen where the trust will build up and people will be able to say, I'm gonna hand over my sort of the first level.
clinical sort of recommendation to AI and I'll be comfortable with that. mean, personally, I won't have any problems.
Kimberly Bates (29:31)
In the future we're really detecting drift and we've talked about that today, drift in the data so that you're seeing like real time signals coming in.
Do you think about a future where insulin resistance, metabolic dysfunction, inflammatory risk could be corrected before symptoms even appear?
Sandeep Misra (29:46)
So my first startup we had built a predictive analytics platform for population health management and value-based care for the top seven chronic conditions, cancer, heart, asthma, osteo, all the, you the top seven biggest burden chronic conditions. And one thing we started doing, which was, which paid dividends, especially on the pediatric side.
was we were looking at, for example, pollen and allergen data for zip codes where our patients were, right? And the kids that were going to school and they were elevated pollen count, they were elevated allergens, the schools were getting a direct message, parents were getting a direct message to say, hey, you might wanna do two pumps of inhaler today rather than one because there is elevated level of
allergens in the air. So that way the kid does not have an asthmatic attack in the school ending up in the ER. So we were predicting that sort of a behavior because we knew that this patient was more likely to develop to have that problem. Now, when you extend that to, say, example, metabolic inflammation, marker insulin sensitivity, we already know There are foods that obviously cause more insulin resistance
by culture than the others. So once you start putting all that together and say, hey, here's the overall picture for a certain archetype and now narrow it down, narrow down the funnel to say Sandeep as a human being, there's an 85 % likelihood that he's gonna suffer from this, this, this. So here are the proactive measures that you can do before it happens to stop this, this, and this.
That's farther out in my opinion, but that is certainly gonna be the evolution ⁓ across all diseases, even metabolic health, if not specifically.
Kimberly Bates (31:30)
I hope companies that are listening to this, founders that are listening to this right now, and inventors please build this because we need this more than ever
do you see a future where we each have a digital twin that simulates an environment where our biometrics can live inside. And so we can test out interventions before they actually happen in real life. So there's companies like TwinHealth that are already showing early signals of this, right?
there's companies predicting, response to food, stress, sleep and drugs, which is where you're headed and kind of playing in. So trial and error of medicine, disappears. We simulate first and then we actually execute on our bodies.
if you go to the doctors or you're using a platform like yours and someone suggests you take a new medication or even experimental medication and they said, well, we can test it with your digital twin first in a simulation before you take it so we can understand what your side effects might be to see if you might suffer more from nausea, and all the other things or...
Sandeep Misra (32:17)
Hmm.
Yep.
Kimberly Bates (32:32)
lightheadedness or will you faint? Right? I think patients would be very interested in testing it on their digital twin before they ingest anything So that's where I think companies like Nvidia are actually gonna empower that because they're using simulations right now to train robotics so they could easily, and I'm sure they're already doing that, working with healthcare companies.
Sandeep Misra (32:40)
I would.
Kimberly Bates (32:54)
to invent this future. I believe that that's the company that's probably going to drive it the most. I think it could benefit patients in the future, just so we don't ingest and put things into our bodies anymore that don't need to be there.
Sandeep Misra (33:09)
Well, and you know, honestly, from a personal experience too, so I did go through a period of a couple of years ⁓ where I was struggling with an autoimmune disorder and the doctors couldn't figure out. And one of the drugs that was being prescribed to me was just not as effective as it had worked for a lot of patients, right? But the doctor based it on their understanding of the disease and, this is the first line medication that I use on a lot of my patients. Hence, here you go, you know, take it.
And for a year and a half, it's not doing anything. So when I switch doctors, she goes, why would she do that? It should have been this drug. So it's like, just wasted a year and a half of back and forth But to your point, if it was like, hey, let's just pop it into the digital twin and say how the body would react and would it even be effective or not? The efficacy of a drug, I think is just going to be as important as just the side effects out of it too. So I think if that could happen, man, I'd be...
I'd be all about that. yo, let the digital Sandeep suffer first before the real Sandeep has to take it. I'm okay with that, absolutely.
Kimberly Bates (34:11)
I agree with you. all of the things that we're talking about today obviously have massive implications for insurance companies, employer, health care, even the economics of our country in general.
Sandeep Misra (34:18)
Yeah.
Kimberly Bates (34:25)
imagine insurance moves from paying for disease to underwriting Metabolic resilience in the future. Employers invest in metabolic stability as a productivity driver. I mean, that would be a dream come true for companies like yours, once you really start tying that to productivity and outcomes, business leaders will get on board quite quickly. And then at a national level, we have fewer chronic diseases, lower costs, stronger
mental health and also cognitive health, longer lifespans. The GDP and metabolic health stop being separate metrics. So we start measuring metabolic health, like we do GDP tied to productivity and labor and economics.
Sandeep Misra (35:06)
You are you're so right and you would be surprised at how How close we are to that already we've had employers that have reached out to us from an economics perspective diabetes by itself is a 412 billion dollar problem for the u.s economy 412 billion Okay, there's between pre-diabetes and type 2 diabetes. We're looking at almost 120 million americans that are suffering from that so
The employers that have approached us with what they're telling us is the costs are prohibitive for us to begin with. The loss of productivity is an absenteeism is a major issue. And not just that, now with the GLP-1 drugs as popular as they are, the cost of the GLP-1 drugs, my God, for a self-insured employer is incredible.
So they're coming to us and saying, hey, if you make our people healthier and we can save money on the GLP-1 drugs and productivity and absenteeism, let's go. Right. And will you be willing to sign this on an outcomes based agreement? Right. And the answer for us is absolute. Yes, absolutely. if we can't stand behind what our thesis is, we should be a company that fails very quickly.
Right? So, so we're already in conversations with employers where they're looking at us as the sort of the metabolic health protocol for the entire company. You say, Hey, you're going to follow a certain path because we are paying for your insurance, first dollar to last dollars. So it is incumbent upon us as stewards of the company and money and everybody else, all the employees that we put the right structure in place and the right structure is Heald. We're going to put it in place.
We're gonna impact your health. We're gonna make you more productive. So obviously you are, from a revenue perspective, you're generating more revenue for us, but you're getting healthier at the same time. So you're living a better life for yourself, for your family, for your community as a whole. And we are so glad. So to your point, I think that is what's gonna end up happening and insurance companies are just gonna have to adjust. why not? Why not? That's the way we see it.
Kimberly Bates (37:20)
I like this idea of they don't have to pay for disease anymore. They underwrite resilience. we'll get into that a little bit later about future generations. So beyond diabetes and obesity, what's the next wave of metabolic therapeutics look like?
could you imagine in the future, here's some things that I've been thinking about for years, real time dosing patches, ingestible sensors, long acting or once a year injectables. So wouldn't it be great to get your terzepitide just once a year? Implantable systems like nutromics already exist. So eventually closed loop real time dosing.
So it's not only Heald, helps you with your tracking things and changing your behavior, but then it provides through device partnerships, real-time dosings in the moment of need.
I think this is going to become a multimillion-dollar industry in the future is clothing that influences our metabolic health continuously. the actual fabrics and smart fabrics that we put on our bodies and around our bodies so that treatment becomes infrastructure. And I think we're going to wear clothes that heal us in the future. It's not just to look good or make a fashion statement.
Sandeep Misra (38:35)
you know what, so when I was at NTT there were these ⁓ undershirts that were developed to be able to get the, biometrics of the race car drivers as they were driving to start figuring out the stress response and, know, at a certain turn versus at a certain speed.
versus at a certain position within the race, all that to get the biomarkers and be able to make those decisions real time for the driver. But I absolutely believe there's gonna be, and to your point, we don't know when that's gonna be, but sort of the healing filaments in the fabric that might be able to help with inflammation or with increased physical pain as it appears rather than.
man, now I can't walk because I've got such strong knee pain after running for three hours or three miles that now I gotta go sit down and ice my knee and pop in a few Advils just to feel better. So I think it's gonna be, it'll be amazing. I I'll use it. But the fabric for biomarkers already there, the healing path of it, I think that is a little bit in the future, but everything is possible at this point now.
Kimberly Bates (39:44)
Once these patches are invented and they go through the clinicals they have new delivery systems beyond needles, that might be able to be sewn into fabrics or used with fabrics.
Sandeep Misra (39:57)
a brilliant idea that, yeah, if needle-less delivery systems become the norm, then what's to say, hey, you know what, if you are, for example, and again, depending on the disease, but it's the severity of a disease, but for the most common ones, if that can be done, why not? I think that's a brilliant idea. I hadn't thought about it that way,
Kimberly Bates (40:16)
Yeah. We're going to have metabolic. We're going to have metabolic merch in the future and you'll be selling it.
Sandeep Misra (40:17)
That's why you are called the Futurecaster
Heald logo metabolic merch This will, no, I like that idea. think that's fantastic idea.
Kimberly Bates (40:28)
we can have a lot of fun. what are some of the delivery mechanisms that you think might happen in the future?
Sandeep Misra (40:33)
I think to me the biggest change is gonna be on the delivery side is the long-term dosage. Because when you look at patient compliance and patient adherence for medication, the reason a lot of the issues happen, and that's human nature, right?
So I think from the delivery mechanism perspective, think set it and forget it is going to be the biggest impact on those sort of delivery mechanism. And then closely followed by the needle less delivery mechanism where it's just a patch man. It's like, you don't have to worry about it. It's just again, set it and forget it.
The more you make it easy for patients, the more you take the friction away from them sticking to something, the more you're gonna see the impact. So I think those two are gonna be the most. But then I also see smart devices playing a role in patient reminders, right? So is it gonna be a smart pill bottle that is integrated with the Alexa's or the series of the world that are reminding to say, hey, you took your last dosage at 4 p.m.
Now it's time for you to take another one in real time. You have to tell me you've taken it, be it an alert, be it a signal, be it a checkbox, whatever the case might be, where these smart devices are helping people remember, especially for dementia patients or Alzheimer's patients that are struggling with keeping a track of their medications. I think those three in my mind are going to be ⁓ the changes that I can expect to see in the next three to five years.
Kimberly Bates (42:01)
I also have been doing projects in this space for a really long time. we're going to inhale our medications in the future. So imagine that you pump it into your steam shower in the morning. You're already taking a shower every day. So you can inhale your medication. You don't have to remember to take your pills. So that's something that has come up in some of my futurism work in the past.
Sandeep Misra (42:10)
Hmm.
Man.
Man, I'm telling you Kimberly, if all this continues, we're all gonna live to 105 and the next thing you know, the world population is 14 billion and then we're going, man, it's way too many people.
Kimberly Bates (42:34)
Do you think the conversation around metabolic health will be shifting to
human performance in the future and that aligning our metabolic health really shapes our cognition, our mood, our productivity, even our creativity So the better your metabolic score, becomes almost status. So we manage our energy at the biological level. We can brag about the fact that we're highly productive
Sandeep Misra (42:59)
you're seeing that in athletes already, the high-performance athletes that do understand that that baseline, once that's said, once that's healthy from the gut health perspective, metabolic health perspective, they are better at their sport. I think it's just gonna get rolled out to normal human beings like me, where it's gonna be like, hey, I know you're not gonna...
you're not gonna play in the Masters or you're not gonna go play in the NBA, but within your max level of performance when it comes to physical activity, here's what it needs to be for you to achieve that. I think once people have that understanding, obviously I would love to have that right now. If I could understand what sort of a metabolic profile, for lack of better term, I need right now.
in order for me to keep up with my teenager and my 10 year old and their soccer and basketball demands, I'll do it in a heartbeat, right? So the patient empowerment or human empowerment on knowledge.
across metabolic health will have tremendous, tremendous impact across the board. Productivity, performance, mood and happiness.
Gut health and metabolic health. It has inflammatory responses within the body. So if you look at every single disease that human being goes through, especially chronic conditions, it's gonna point to how healthy you are from a gut perspective.
If you have a healthy gut, the microbiome is healthy, you've got the right amount of bacteria, and you are eating the right sorts of food from a protein, fat, carb sort of mix, the macros and then the tiny micros, you're going to be a healthy human being. gut is where it starts from.
and gut is where it ends. I didn't know that much about insulin resistance and the impact of that before we started Heald. I wish this was taught to kids in school or when they got to college and say,
hey, you're gonna make some decisions that are not gonna be ideal from a gut health perspective, but know the impact of those long-term from a cognition perspective, physical perspective, pain perspective, chronic conditions, beat cancer. And I mean, even now they're saying already that a lot of the cancers originate from poor gut health. That's how serious it's gotten. And most people still don't understand it. So my message to everybody is,
Learn, learn, learn as much as you can about metabolic function, gut health, the hormones that are generated as a result of that, insulin resistance. Learn as much as you can about that. You'll be much better off.
Kimberly Bates (45:36)
As I see it, you're starting to help create a world where metabolic
collapse is no longer accepted, where preventable suffering becomes really rare. So thank you for that and everything that Heald is doing for the world. As a founder, what do you want your personal legacy to be, to leave behind to Generation Beta?
Sandeep Misra (45:57)
that's what a wonderful question. By the way, thank you for bringing a lot of these to the forefront. was looking at some of your other work as well. And obviously, in just in this conversation, I've been able to see how your mind works, how you're looking at the future that is different than obviously, I mean, in some cases where even I looked at from the future of health perspective. So thank you for all the work that you're doing as well.
From my perspective, the legacy so when we started down this path of building this company, we had very simple mission, obviously make an impact ⁓ to people's health in a manner that is most fundamental, most basic. And as we establish gut health is the most fundamental, basic, impactful area of human condition. or human
But besides that, we have a very simple tagline that we try to stick to every single day. Can we build a billion dollar company with a soul? And if I can do that, we're successful. there's a lot of billion dollar companies. Do we have a lot of companies with a soul? I'm not sure we do.
And the example that I was giving you earlier about us saying no, that that mom that wanted our services, those are hard decisions to make, but they go to the underlying. Let's build a billion dollar company with a soul. But regardless of what that dollar symbol looks like, if the soul part stays intact for us as a company, for me as a, as a founder, I'll be happy.
for my kids, they ask me dad, are you not scared when you started your company, were you scared and all that. The world I wanna leave behind for my kids obviously is the one where, you can look at somebody and say, you are different than I am,
but we can treat each other with dignity, with decency, we can disagree. But if you fall down on the street, I should be the first one to run and pick you up, regardless whether I agreed with you or argued with you five minutes ago or not. And if you can do that, if the world can follow that, or at least my kids can follow that, I will have at least two responsible human beings and two good citizens that I leave behind, and hopefully they can just make that even bigger as they get older.
Kimberly Bates (48:03)
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Kimberly Bates (48:20)
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