Published on and by Antler
Antler’s content series “It All Starts with People” delves into the passions, motivations, and vision of the exceptional founders Antler partners with around the world. Bringing a clarity of vision to Antler’s latest spotlight is Piet Hein van Dam, co-founder of Clear, the award-winning digital self-help tool for diabetes patients.
Standing two meters tall, Piet Hein van Dam has cut caffeine and alcohol from his diet. A keen cyclist and cook, he meditates daily and sails around the Frisian Islands. Three years ago, he switched from soya to Greek yogurt with his breakfast muesli and replaced his morning apple with blueberries. Now the Amsterdam-based HealthTech and data entrepreneur is on a mission to help millions of people worldwide also become the best and healthiest version of themselves by stamping out type 2 diabetes.
“I’ll tell you why I’m doing this,” van Dam says, “In most places, a can of Coke is cheaper than a bottle of water. What the f*** is going wrong there? This is why the life expectancy in the US is decreasing.”
It’s no coincidence, he says, that the regions where soft drink sales are highest are also those where diabetes is most rife. “Sugar is the new smoking,” van Dam stresses. “We lie on our couch, we drink what brilliant marketeers have told us we’re supposed to like, we watch a TV series that a smart algorithm on Netflix has told us we’ll enjoy. And if things go wrong—which they do, usually—then there’s some bright pharmaceutical company that has some stuff for us.”
Van Dam’s solution to this global health crisis is both clear and Clear, a digital self-help tool for diabetes patients. Founded in 2019 to offer a health program with a glucose sensor, a smart AI app, and personalized nutrition advice through a realfood coach, Clear aims to guide users to a healthier lifestyle through the right eating choices—starting with the thousand new type 2 diabetes patients diagnosed per week in the Netherlands.
“All these beautiful technologies out there—behavioral science, IoT, AI—are used and applied to benefit these big multinationals. I started Clear because I wanted to use those beautiful technologies to benefit you. Spotify tells you what to listen to, Netflix what to watch—but nobody tells you what to eat. Why is that? There will be one billion diabetes patients in 2050. And nobody tells you what to eat. This is why I do it.”
“Where’s the incentive to make people less sick?”
When van Dam joined the inaugural Antler residency in the Netherlands in 2019, he had already turned 50 and arrived with a long, successful career behind him. Was he the eldest in his cohort? “Well, they said—very kindly—the ‘most senior.’ But it’s the same thing,” he jokes.
It was van Dam’s first job after graduating with a PhD in chemistry from the University of Amsterdam in 1993 that sowed the seeds for Clear 26 years later. At Unilever, the multinational consumer goods company, van Dam was responsible for functional foods—products that entered the market with a health claim. For approval, he learned that a clinical trial must provide proof of a benefit for 30 percent of the population. Struck by this figure, van Dam asked his superiors about the remaining 70 percent.
“They said, ‘But Piet, this is biological science—it’s very complex and comes down to population averages. If we put something on a package that decreases the cardiovascular risk in a population by 30 percent that’s quite good, right?’ And, of course, they were right.”
After five years as a research manager—during which he won the Golden Jubilee Award for Excellence in Research—van Dam moved on to new pastures. In the following two decades, he made a splash as managing director of a market research company before becoming CEO of numerous early-stage ventures. He presided over two successful exits in AdTech and MediaTech while specializing in monetizing and consumerizing data, then segued into FinTech where, most recently, he was head of data at Yolt, the smart money app. But something was bugging him.
“I thought, ‘Okay, I’m still this startup, scale-up CEO. I never started a company from scratch, but I didn’t fancy the next four years in my attic, failure after failure.” Then he heard about Antler. The prospect of being fast-tracked into a pre-MVP product appealed. Ditto the fact that many Antler portfolio companies raise additional funding within 12 months of a residency. “I found that impressive,” he says. But despite his confidence in being among the lucky 10 percent who made the cut, he still needed an idea.
“Every industry that we know of has been digitalized or personalized,” van Dam says, talking through his thought process. “Easy industries come first—like advertising, online travel, and e-Commerce. Of course, it’s not easy to build Booking or Amazon. But conceptually, it’s replacing one business model with another.”
Van Dam’s research told him that just three industries had yet to make the digital transition: healthcare, government, and oil. He ruled the last two out. “I didn’t have too much experience in healthcare,” he admits, “but I understood why it was complex. The patient is not the prescriber, is not the payer, is not the supplier. And the business models are quite rotten because most people working in healthcare make money because people are sick. So, where’s the incentive to make people less sick?”
This was van Dam’s starting point. And if he found Antler attractive, his own track record ensured the feeling was mutual. “I’m 55 now,” he stresses. “Clear is going to be the masterpiece. There’s not going to be many startups after today because it’s mentally, physically, emotionally, and financially very intense.”
Taking inspiration from the Tour de France
Van Dam embarked on his Antler residency in April 2019 without a clear business plan in mind. He decided to adopt a novel way of narrowing down his options. “I literally started with a blank sheet of paper,” he recalls. “What a luxury. I was with 70 others and I thought, ‘Let’s see what brilliant minds are out there.’ I learned to be quite transactional. In the first week I worked with everyone, enjoying the ride, learning a lot. Then in week two I started to take it as a Tour de France.”
This tactic saw van Dam—the son of a nuclear physicist and a healthcare manager—create a daily ranking with his three favorite topics to help him come up with a general classification akin to that of the world’s most grueling bike race. “This was really how I approached it,” he laughs. “I ranked my ideas along two dimensions. On the one hand was the rational part: do I think it’s intellectually good? Will it work? Does it have potential?”
And on the other hand? “That was more the emotional part—what I call the ‘wet eyes index.’ If I can explain the idea to you and my eyes blink or get a bit wet, then I’m involved. But if I tell you the idea with blank, crystal eyes—like say another FinTech product—then there’s no emotional attachment.”
After two weeks, van Dam joined forces with “a very great, bright scientist” called Georges Janssens with whom he shared a fascination in the biology of aging. Central to their burgeoning business was the knowledge that everyone’s reaction to food is personal, as confirmed by a Weizmann Institute study in 2015. Their idea hinged upon the real-time biodata monitored by a minimally invasive sensor that measured blood glucose levels via an arm patch.
The game-changing sensor—on sale for €60 online—would form the core of the precision nutrition technology behind Clear. “We now had a way to measure this personal reaction to food, one that was available to consumers, with high accuracy, and was both convenient to use—that’s to say, did not involve poop samples—and scalable.”
Many of their fellow founders were soon using the sensors to measure their post-meal responses and peaks. “After the weekend they were queuing up to ask us questions,” van Dam recalls. “Things like, ‘I spiked on a carrot salad but how can that be when carrots are meant to be good?’ People were going hypo [hypoglycemic] during the night and asking us if they were diabetic. It got so busy that at a certain point I thought, ‘S***, this is traction.’”
No sooner had van Dam managed to harness the scientific basis, technological opportunity and personal motivation of fighting the big multinationals, than disaster struck: his co-founder walked away.
Unstoppable founder spirit at a time of crisis
“We worked our a***s off for three months and got through to the next phase with a €100,000 investment. Then after we got back from a week break my co-founder said, ‘You know, this startup life is too demanding—I’m stepping out.’ At the time I felt every emotion possible, but first reaction was”—cue one of van Dam’s catchphrases—”‘Wholy chips!’”
Janssens’s sudden departure presented van Dam and Antler with a quandary since solo founders are not generally allowed within the process. But van Dam already had so many balls in the air—not least the 60 clients who had paid €199 to be part of a two-week program that involved a seminar, sensor installation, guidance, and a full nutritional report. “These people needed someone to explain to them the science. So I really had a problem. Who was going to help and coach them? I needed a good white coat and a credible bio-science co-founder alongside me fast.”
He reached out to Antler and told them to keep their faith. Thankfully for all concerned, an agreement was made, and van Dam received the investment he needed to keep running. A few months later, he found the ideal co-founder in Madelon Bracke, an immunology, hematology, pharma-epidemiology, and regenerative medicine specialist with a PhD from Utrecht University.
Founder & CEO Piet Hein van Dam and
founder & CSO/Head of Bioscience Madelon Bracke
This setback and his subsequent reaction taught van Dam a lot about himself and the new world he had entered. “I learned that this quality of an unstoppable founder is something that resides inside yourself,” he says. “Georges stopping didn’t say anything about me. It was a test—and I hardly slept for weeks—but the call was beyond my control.”
Van Dam realized that his future success in the venture capitalist game would hinge on his response to such tests.
“There’s so many things that go wrong, went wrong, and will go wrong. So it’s all about this unstoppable attitude. Being a founder is really tough. There’s only one reason to get up—and it’s not because of someone else. In hindsight, it’s good that I got this test after three months. I’m not in this business because he wanted it. I’m in it because I want it. And still, three years down the line, I’m doing this because I want it.”
Keeping the body air conditioned through precision nutrition
Clear.bio started out as a tool to help users reach their optimum energy to perform at their best throughout the day. The precision nutrition technology derived from the arm patch measures post-prandial response and alerts users to spikes in glucose levels.
“Your body works like an air conditioning system,” van Dam explains with another on-point analogy. “It likes to have the amount of sugar in your blood flat—just like when you have a nice temperature around you. When you eat the wrong things, it’s the same as having the air conditioning on with the front door open. It works, but there are large fluctuations and at a certain point the system will break down. That’s what is called type 2 diabetes.”
Peaking can lead to weight gain and the loss of energy and mental focus—as experienced in the after-dinner dip common to so many of us. Where it gets complicated is with the so-called “banana test”—the scientifically proven idea that one person’s response to eating a piece of fruit can differ entirely from another’s. It was while experimenting with his own sensor that van Dam tweaked his breakfast regime and decided to go teetotal.
Clear.bio’s precision nutrition technology derived from the arm patch measures post-prandial response and alerts users to spikes in glucose levels.
“I saw how alcohol disturbed my entire metabolism. If I had a drink then my ‘safe’ breakfast the next morning was no longer safe. Now I know exactly what to eat to give me more energy between eight and eight.” As a result, he not only feels and performs better, he functions on one hour less than the eight hours’ sleep he used to target. Is he currently the best and healthiest version of himself? “I’m doing pretty well. I think I’m close.”
Phase one of the launch saw Clear repackaging an existing product—the FreeStyle Libre 2 sensor made by the pharmaceutical company Abbott—with their own personalized app and nutritional advice. “The original app that came with the sensor is not an intelligent thing,” van Dam explains. “It just gives you the data. You want to know if the banana was good or not—but the app just doesn’t tell you that.”
Clear’s app improved the user experience because van Dam and his team developed a food score that took things to another level. “The peak from a banana can also be the peak from you running for a train, or the peak from having sex. And it gets really difficult when you have a banana after sex…” It was the job of van Dam’s team to negotiate these peculiarities and build the intelligence to isolate the effect of a single meal, before presenting that to users in an accessible way that would establish new habits and pinpoint the best diet for them.
Getting over the line to secure investment
Van Dam says that Youri Doeleman, Antler Partner in the Netherlands, told him afterwards that, “from the beginning it was clear that you were going to build a successful company.” Be that as it may, the situation was still a precarious one for Clear.
Even before Janssens walked away, doubts surfaced about their product. The focus on biological aging was not taken wholly seriously and it dawned on van Dam that Clear had come up with a solution without really answering a problem. “We created problems when we tried to make people 200 years old,” he admits. “We were about to stop—I’m not kidding. We didn’t discuss it aloud but we both thought it was a great solution for nothing.”
Janssens’ withdrawal forced van Dam to refocus his efforts and rally around his product. Stuck between a rock and hard place, he focused less on the aging aspect and more on the therapeutic and digital healthcare angle. At the end of 2019, van Dam successfully pitched to an audience of over 100 potential investors on Demo Day, and a first backer came forward.
Bracke then joined in January 2020 to shore up the scientific side of operations and steady the ship. Users increased, money came in, and recognition followed. Clear had already won a prestigious healthcare award when, almost one and a half years down the line, they decided to pivot in February 2021.
Claiming the niche: Pivoting on type 2 diabetes
“When you’re building a consumer app,” van Dam says, “one of the lessons you learn is that, if you sell it a thousand times, then the data will tell you where to be. Because phase two is to claim the niche.”
Canvassing their early subscribers revealed a clear correlation between closer goals and higher retention rates. Early users were treating the app with the same expectation as they might with Uber: a desire to get to a destination from anywhere in an allotted time. With healthcare, this was unrealistic. “People wanting to be the best version of themselves is quite a distant goal; running a marathon faster is already a bit closer; but getting rid of medication is really close. And in this case, it was diabetes,” van Dam says.
Diabetes is the fastest growing chronic disease worldwide with one billion patients estimated by 2050. More specifically, an estimated 783 million people will be living with type 2 diabetes in 2045—staggering figures for a disease which is entirely lifestyle related. “The air conditioning has been on with the front door open for too long,” van Dam repeats.
“The standard treatment for type 2 diabetes worldwide is to fix it with medication,” says van Dam, before delivering the bleak verdict: “But the point is—you don’t fix it with medication. You never stop. You’re a chronic patient. After years of taking Metformin, you get insulin, then after that your finger or toe may have to be amputated, and you die 10 years younger etcetera.”
If lifestyle is the cause, then it follows that the solution can be found outside medication by making small, smart adjustments to one’s lifestyle.
“If you are diagnosed,” van Dam boldly claims, “Clear can help you get rid of the disease within three months. That is what we do. We are a digital self-help tool for diabetes patients. You can fix at home what you actually got at home.”
In other words, while the pharmaceutical industry is selling arm patches to make patients inject more, Clear uses them to make patients inject less.
Hitting the bullseye with “Barney”
In the summer of 2021, soon after Clear was named one of the 10 “hottest startups in Amsterdam” by Wired magazine, van Dam received a call from the manager of Dutch sporting giant. Raymond van Barneveld, one of the most successful darts players in history, had been forced to retire from the sport, in part because of his type 2 diabetes diagnosis years earlier.
The Metformin prescribed by his doctor gave the five-time world champion bouts of retinopathy and neuropathy. “If there’s something you don’t want as a darts player it’s problems with your fingers and eyesight,” van Dam confirms. But a positive article about Clear in a newspaper had forced van Barneveld’s manager to reach out. “He called us and said, ‘You have to help Raymond.’ So we got him. It was hard work. But we got him back.”
By tinkering with his diet, van Barneveld leveled his blood sugar and lost 2.5 kilograms. Within half a year, the 54-year-old qualified for a prestigious event—regaining his professional tour card 14 months after retirement. In February 2022, he won the first tournament after his comeback at just the third time of asking—his first title in eight years.
Seeing van Barneveld battle back was something of an epiphany for van Dam. “I was thinking, ‘Chips, this is happening for all those other millions of diabetes patients.’ They’re not like me or you, they’re all like Barney. They listen to their GP. They just take medication and then after five or 10 years they stop what they do because it doesn’t cure them. Fantastic,” he adds with a dollop of sarcasm.
Van Barneveld’s celebrity status in the Netherlands has helped spread the word better than any marketing campaign. “Barney is in the center of our vision because we think all diabetes patients are like him,” van Dam says. “These are people who need to be told there are carbs in bread. Many diabetes patients in the Netherlands now know Clear, which is good because when they go to their GP, they can have another option to try.”
Reimbursement and taking a leaf from Facebook
Van Dam’s target is to get the one billion diabetes patients currently on Metformin off medication and back into a healthy lifestyle with the help of data and software in a highly scalable way. After a series of successful clinical trials, Clear is now teaming up with the biggest Dutch insurer to get their product fully reimbursed in 2023.
For all its challenges, the pandemic provided fresh impetus. With patients unable to visit physical healthcare locations, Clear’s accessibility put the product at the forefront of a sudden shift. “It is a tailwind for us that now, on a policy level, digital healthcare is being pushed,” van Dam stresses. In their favor is recent clinical research which shows implementing Clear would save the Dutch state €319 million in annual healthcare costs, which have grown 300 percent over the last 15 years.
While personal dieticians are, on paper, offering a similar service as Clear, van Dam is quick to stress that these dieticians are working within the 30-percent hit-rate based on population averages that he first encountered at Unilever, not people and individuals. Other competitors in the diabetes sector, meanwhile, are struggling to enter the clinical reimbursement system and, crucially, lack the “granularity of data” that makes Clear stand out.
Since launching, over five thousand participants have signed up—mainly in the Netherlands, but also in 20 countries “from Australia to Canada.” With beachheads in Portugal and Brazil lined up, van Dam is convinced of the huge potential in a global digital health market valued by McKinsey at around $350 billion in 2019, growing to $600 billion by 2024.
“Data and software can change people’s behaviors,” van Dam says. “We know that from our dear friend Mark Zuckerberg, who showed that people buy differently and vote differently. We’re just transplanting this concept into a different area—not into buying or voting but eating. For a good purpose—not for a multinational, but for their own health.”
Money talks as Piet Hein hits his sweet spot
Can van Dam put a figure on Clear’s potential? “Let’s do the numbers,” he says, citing the 60 million diabetes patients in Europe, 15 million in Brazil, and 35 million in the US. “So we’re already talking about 100 million people. Let’s say we take a one percent market share—which would be a real underestimation—and we would work with one million patients.” If each of these subscriber patients in turn spent €300 a year, that would give €300 million in revenues. Another serious underestimation, he says.
“It will be beyond one million patients,” he affirms. “This is why we started the company—because we wanted to help millions of patients. Now bear in mind that those figures are static. There are a thousand new diabetes patients in the Netherlands per week. We are focused on the onset. So, send them to me—to us—and we will make sure they never get hospitalized or medicalized in the first place.” This ambitious vision for Clear is the subject of a forthcoming TedTalk recorded by van Dam a few months ago.
It is precisely this drive—along with the meditation, yoga, and exercises he does religiously between 6am and 7am—that gets van Dam out of bed each morning. “I’m really at the center of what I want to do,” he says with eyes that are the opposite of blank. “I’m happy that I can do what I do for the benefit of others. Yes, I have to make sure the company grows and we turn a profit etcetera. These are the rules of the VC game, but they are not the outcome. So I’m very happy—I’m in my sweet spot at the moment.”
The “intensive meditation” before taking breakfast with his wife gives him the mental clarity to help cope with the quotidian pressures of managing a small team of 10 people. Being so tall and spending so much time at his desk requires vigorous sessions with an exercise ball and stretching bands—followed by a 45-minute cycle into the office on an e-Bike (for the three days per week when not working from home).
Sailing and hiking with his two sons (aged 24 and 21, both have flown the family nest) helps him decompress, and while he struggles to find any alcohol-free beers to his liking, he can at least tolerate non-alcoholic wines. (“It’s a social experiment,” he says. “Against a great glass of Sancerre, sure, it doesn’t taste so good. But it makes a nice change in my diet to water.”) In five years, he hopes Clear will have at least 10 people working in 10 different countries—“Easy,” he adds—and he already has his eyes on a stint in Portugal.
Having successfully negotiated the choppy waters of launching an award-winning healthcare app—not least the frantic eleventh-hour search for a new co-founder—van Dam is bullish about Clear’s place in a diabetes technology market thought to be worth $40 billion in the next decade. There has even been a reunion with Janssens, who recently returned as one of the company’s affiliated scientists and nutrition experts.
“The first three years of Clear were about proving the reasons for our existence,” van Dam says, taking stock. “We’re now clinically approved. We’re almost reimbursed. We help patients. We’re being prescribed. It will work. So it’s no longer about existence. Now it’s about which league we will play in. And I want the Champions League. Finding the right balance is difficult. I don’t know how to strike it yet. But, of course, I will succeed—I’m full of confidence.”