How to Determine Your Ketone Levels Without Finger Prick Testing

Benefits of Breath Ketone Monitoring with Jim Howard

Monitoring your progress on a keto diet is essential to helping you meet your health goals, whether you want to lose weight, increase your energy levels, reduce inflammation or improve brain and heart health. 

On this episode of the podcast I speak with Jim Howard, developer of the Biosense Ketone Breath Monitor. The Biosense offers a convenient way to measure your blood ketone levels throughout the day without the hassle of finger prick testing. 

We discuss different factors that affect ketone measurements, how tracking your ketone levels can help you uncover your physiological responses to diet and lifestyle factors, how to prepare your body for keto, and more.

In This Episode

Episode Intro … 00:00:45
The Start of Biosense … 00:03:56
Validation of Breath Analysis … 00:05:33
Ketones & Metabolic Response … 00:07:43
Ketones & Exercise … 00:12:40
Fat Oxidative State & Restoration … 00:16:42
Additional Applications of Biosense … 00:21:37
Biosense App Information … 00:23:35
Gamification & Motivation … 00:28:01
Fasting Protocols & Autophagy … 00:31:11
Episode Wrap Up … 00:38:05

How to Determine Your Ketone Levels Without Finger Prick Testing - Podcast330a JimHoward

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Hey, everyone. Today I speak with Jim Howard from Biosense, which is a validated medical device for breath ketone monitoring. I’m actually quite excited at the prospect of how this may personally helped me dial in some of my diet. I had used the device for a few weeks, and I was surprised to see I was getting kicked out of ketosis from seemingly innocuous foods – like some coffee with a little bit of half and half and butter. However, if I’m able to – and this is something Jim through our conversation today helped me better realize – pick out what few things may be thwarting my ketosis, that could be helpful. Jim also helped me to appreciate – and we’ll of course elaborate on this in the body of the discussion today – is that ongoing ketosis may not be the ideal mark, but rather these periodic bouts in ketosis to realize therapeutic gain; where you prime yourself and get ready for ketosis, and then you aim to spend as long in that therapeutic target area of a day… a few days or so… perhaps even longer… depending on what you have going on, as you can.

You use the Biosense Breath Ketone Monitor to help you learn what you can do and what you shouldn’t do to maintain those therapeutic episodes you’re trying to purposely get into ketosis. So, I’m definitely very appreciative of Jim, his time, the company, the work they’re doing, the validation that they’ve gone through and helping me better understand how to use this tool – not so much trying to be in ketosis 24/7, but rather looking at this as using ketosis for therapeutic bouts; using the device to help you weed out things that are kicking you out of ketosis. Of course, there are finger pricks, but those get really old, really fast. That’s one of the main reasons why I wanted to have Jim come on today and to pick his brain. With that, we will now go to the conversation with Jim on the Biosense Breath Ketone Monitor.

➕ Full Podcast Transcript

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

DrMichaelRuscio:

Hey, everyone. Today I speak with Jim Howard from Biosense, which is a validated medical device for breath ketone monitoring. I’m actually quite excited at the prospect of how this may personally helped me dial in some of my diet. I had used the device for a few weeks, and I was surprised to see I was getting kicked out of ketosis from seemingly innocuous foods – like some coffee with a little bit of half and half and butter. However, if I’m able to – and this is something Jim through our conversation today helped me better realize – pick out what few things may be thwarting my ketosis, that could be helpful. Jim also helped me to appreciate – and we’ll of course elaborate on this in the body of the discussion today – is that ongoing ketosis may not be the ideal mark, but rather these periodic bouts in ketosis to realize therapeutic gain; where you prime yourself and get ready for ketosis, and then you aim to spend as long in that therapeutic target area of a day… a few days or so… perhaps even longer… depending on what you have going on, as you can.

DrMR:

You use the Biosense Breath Ketone Monitor to help you learn what you can do and what you shouldn’t do to maintain those therapeutic episodes you’re trying to purposely get into ketosis. So, I’m definitely very appreciative of Jim, his time, the company, the work they’re doing, the validation that they’ve gone through and helping me better understand how to use this tool – not so much trying to be in ketosis 24/7, but rather looking at this as using ketosis for therapeutic bouts; using the device to help you weed out things that are kicking you out of ketosis. Of course, there are finger pricks, but those get really old, really fast. That’s one of the main reasons why I wanted to have Jim come on today and to pick his brain. With that, we will now go to the conversation with Jim on the Biosense Breath Ketone Monitor.

DrMR:

Hey, everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio, joined today by Jim Howard. We’re going to be talking about this nifty device that I actually found to be a fairly massive convenience gain. It’s a breath ketone monitor. If anyone has gone through the laborious task of pricking themselves multiple times per day to monitor ketones or glucose, it gets old really fast. I recently came across this device. Jim was nice enough to send one my way, and let me do some experimentation. Jim – first of all, thank you for allowing me to not become a pin cushion and go to breath rather than the pinprick.

JimHoward:

Thanks for having me and happy to help in your personal journey there.

DrMR:

You said something before we started recording, which is research is one of the mainstays of what you guys are doing. I’d love to hear a little bit more about your background, the company and what you guys are doing as we launch into the conversation.

The Start of Biosense

JH:

Yeah. I’d love to. As background, I’ve been in digital health since 2001. I spent some time with CareFusion in the respiratory diagnostics side of CareFusion’s business. After the company was acquired, I got involved with Washington University and doing tech transfers. This opportunity came to us not directly through WashU, but indirectly. It was some guys that had figured out how to fractionate breath, which means that – at a very high level – to measure only the right part of your breath to have a highly accurate measurement. In breath, it’s one of three different types of ketones. So, breath ketone is acetone. It’s been very difficult to find an accurate measurement and these guys figured it out. I’m an investor in the company and then I joined the company. It was a clinical product. It was designed as a clinical product – originally for Type 2 Diabetes reversal and working with a large virtual clinic in that space. Ultimately, the Biosense device came to market. Part of our business is now engaged in the research side, and we have 10 pharma and academic clinical trials right now. It’s the only clinical grade breath acetone device on the market. It really just fits into the model of when you need to have a full picture and resolution of ketones changing all day. You can’t do that with a finger prick. So, it’s non-invasive, multiple measurements per day. That’s why we came in business. That’s the background.

Validation of Breath Analysis

DrMR:

Right. Awesome. Given the fact that we’ve – I don’t want to say debunked – highlighted some of the shenanigans that go on in the medical device and testing space, I think our audience is always curious to hear about the validation studies. I’m assuming the validation was against either a blood draw or a blood prick, but tell us a bit more about the validation of the breath analysis.

JH:

Sure. The 2019 trial – the PI was Jim McCarter, who was the Head of Research at Virta Health, not Abbott’s, and there was a St. Louis trial with 19 subjects, I believe. It was the first study to really look at breath acetone compared to BHB (beta-hydroxybutyrate), which is the finger prick. I would say that venous draw of BHB is the gold standard – capillary draw is roughly 20% off of that. So, capillary is good – it’s not great. That’s been what’s primarily used in the consumer – for Type 2 Diabetes and obesity treatment protocols. Two primary things came out of this study in 2019. This was published in PeerJ last year.

JH:

Number one – you have to check your ketone multiple times per day. So, single ketone measurement of any type – be it BHB or acetone – is 50% off of a time-weighted average. We know that, our clinic customers know that and you know that. It changes just like glucose. You should never assume your ketones are the same all day. With a time-weighted average, we then compared it to BHB measurements. We did five measurements a day over the course of two weeks, and about 1200 data points. The R-squared was 0.83. So, what that means is that the correlation was very high. Almost all of the test subjects were at a lower level of ketosis. This is the equivalent of under a 2 mM on BHB, which would be 20 on our proprietary measurement. This is an ACE, and stands for acetone, essentially.

Ketones & Metabolic Response

DrMR:

Gotcha. You struck on something I’m hoping to give our audience some guideposts for. What should the daily ketone output look like now? I’m assuming it’s not going to be the same for everyone, but there are probably some commonalities for first thing in the morning. I’ve noticed that I have lots of ketones. I’d love to pick your brain for my own personal gain, but I’m assuming it’s going to be representative of what many people are also wondering. When I would have my morning coffee, I would be out of ketosis maybe 20 minutes after that. There’s no sugar. It’s just a quad espresso with some butter and some half and half. Maybe we can start there. If someone’s starting to monitor this, I’m assuming morning ketones are going to be fairly common. Is it usual for you to see caffeine and/or some fat putting someone out of ketosis or is my metabolism that far gone?

JH:

It’s different for everybody. That’s the number one thing – it’s different for everybody. It also changes significantly in that same morning, depending on what your protocol is. Do you have high cortisol levels? Are you working out, as well? So, whereas breath ketones would tend to go up in a workout, BHB would go down. Are you having a carb restrictive breakfast? It sounds like you do. Do you have this morning effect where glucose is produced and you have low ketones? What can happen with some people – like myself and probably you – is you have ketones because you haven’t eaten in 14… 16…18 hours. So, it really is different for everybody. That’s why it’s really critical to measure this over the course of a week – 3 to 5 times a day. You really start to understand your metabolic response to all these things you do. That’s a video – it’s not a snapshot. That’s really the purpose of the device – behavior modification and education on your own physiologic responses.

DrMR:

It’s interesting you say that. I have noticed that my morning glucose tends to be a touch high. I believe this is known as the ‘dawn effect,’ where if you’re doing low-carb most of the time and exercising, you tend to have this glucose sparing effect in the morning. Let’s maybe start there because I’m assuming there’s going to be a facet of our audience that’s in this similar boat. I’m assuming that’s not a bad thing. It’s just an adaptation, but how do you interpret that? Do you use that to change behavior in any way? Some of these may be hard to answer, but as best you can…

JH:

When you look at these, are you in an exploratory protocol? Do I just want to learn about myself as a biohacker? Or, is this the basis of learning about myself prior to a therapy for Type 2 Diabetes reversal or obesity reversal? Whatever that ends up being – clinic driven or self-care – it starts with this education about myself. The reality is if you get the dawn effect, you’re one of those people that has a dawn effect. Okay? So, don’t fight it. This is your baseline of ketones and glucose for the day. If your goal is to have an elevated ketosis level, whatever your protocol is – be it fasting… ketogenic diet… it doesn’t matter to us – then you should modify your behavior to get there. You don’t know it until you track it. Fasting is probably one area. It is the number one dietary protocol now. It’s also has the most misinformation. “Do an 18:6 diet, and by the way, in your 6 hours of eating, eat whatever you want.” You shouldn’t expect to have very many benefits from that, and you’ll see that by testing. It goes along the lines of the dawn effect or whatever your cause is. Learn about yourself first. Number two – make adjustments to get where you want to be.

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Ketones & Exercise

DrMR:

Now, regarding exercise, I am assuming that that’s going to rev ketones, but I also know that exercise will – at least in the short term – lead to a spike in glucose. It’s not the same spike as if you had a Twinkie. It’s mobilization to feed these massive glucose sinks of muscles. What are you noticing in terms of trends or interpretation regarding ketones and exercise?

JH:

Yeah. Again, it depends on the type of ketones. Just very quickly – the mitochondria metabolizes acetyl acetate, which can turn into BHB as a storage ketone, and then turn back into acetyl acetate. So, BHB is a storage ketone. Acetone is a one-way street that is excreted and exhaled in your breath. So, BHB are your circulating ketones that you would use in a workout. That’s why they would be depleted very quickly. So, your ketones will go down. What we see is acetone tends to go up. You’re exhaling these ketones, and you’re seeing that will go up and then it would come back down. A little bit of a reverse of what you’d see in blood ketones, but you’ll see they’ll come back together in an hour or so. That’s typically what we see.

JH:

Now, in the long term, your goal may be to have a higher level of ketones – let’s say it’s for weight loss. We have a 5 to 10 scale of ACE’s – that’s weight loss. You get 10+ and you’re looking at your anti-inflammatory impact. That’s what I have to be in at 6 knee surgeries. When you get 15…17+, you’re going into more of an inferred autophagic zone. You see that on all those fasting apps. They just kind of guess. This is a biomarker to do that. But my point is – for those different zones to elevate, there’s a lot of really good protocols. Deplete the glycogen stores first, maybe have a carb-restrictive 24 hours prior to, then do a fast and you’re checking all the boxes. You’re restricting carbs, you’re depleting your glycogen stores and then maybe do a fast for 24/48 hours. It takes less and less time to do it, and you’re trying to get into one of these zones. In other words, as opposed to focusing on a time doing something, it’s the time in the zone because that’s where the reparative work is.

DrMR:

It sounds like – and correct me if I’m wrong here – you’re giving people some keys to prime the ketosis and trying to get them into this therapeutic zone for a period of time, rather than monitoring the ketones daily (like you would with blood sugar.) For the continuous glucose monitors, I oftentimes just say do your normal thing, try to see if you can determine where the spikes are coming from and modify your diet accordingly. Are you recommending using these meters in a bit different of a capacity where you’re trying to hit that mark and extend that for as long as you can to get as much therapeutic benefit as possible?

JH:

Yes. Typically. CGM – which is a great tool right now, clinically and in the consumer market – is used to really start identifying what foods are increasing my blood sugar and putting me into whatever dangerous zone I don’t want to be in. So, time and range is so critical there. You get your glucose in range once you start to learn what’s causing this. It’s not that hard. You start to follow the foods that don’t do that, eat the foods that do that and exercise. You’re going to be in the zone that you need to be in. If you’re looking for a reparative state, that’s the other side of the metabolic switch. I would say step one is always to get your glucose under control and get your sleep under control.

Fat Oxidative State & Restoration

JH:

All weight loss programs try to put you into a fat oxidative state and they want you to be in that state as long as possible. You can go deeper in that state and the weight loss would be faster. Certainly the higher the ketosis, you’ll see a faster weight loss. This is typically through caloric restriction, very carb restricted protocols or fasting (which is even better.) So, that’s where the restorative part comes. It’s just that when you get to these higher zones, you’ll see a faster restoration. For those of us that have had a million knee surgeries and can’t get around very well – put yourself in a deep ketosis and see how fast the inflammation in your knees, arms or elbows goes away. It’s fast – it’s really fast.

JH:

It really is that time in that area where the restoration takes place. Obviously, there’s the whole autophagy question. When you get to the higher levels of ketosis – primarily through fasting – that’s where you’re going to see the noticeable recovery, cellular regeneration and toxin removal you would see in an autophagic state. I’ve seen test subjects where they’re doing four days in a high autophagy level. You see it in their faces really quickly. They don’t have the bags over their eyes, and it almost looks like they got a facelift. It’s all that time and range that they’re looking for.

DrMR:

Right. This is really helpful. We’re looking for this time in the therapeutic range. There are some things that we can do to prime the pump – get your glucose stable and get your sleep where it should be. I’m assuming you front-load this with a low-carb diet and have a good exercise rhythm going. Is that a good lead up?

JH:

Yeah. It’s preparation. I mean, this is just one therapy. There are a lot of different types of protocols that are therapies. Biosense is the behavior modification tool It’s a classified medical device, but it’s not a therapy specifically for obesity, Type 2 Diabetes, PCOS, Alzheimer’s or any of these, but the device is used in those therapies. It’s tracking ketones at home. The key thing is you’ve got to prime your body for this. For that therapy that a patient is in, you don’t just jump right into it, just like you don’t just jump right into weight loss. It doesn’t happen overnight. For weight loss, at least, you really should focus on the baby steps of establishing some ketone levels (like 1 and 2 on our device), as opposed to jumping on a scale, as that could be quite unmotivating.

DrMR:

Right. Well, this is actually really peaking my curiosity in terms of trying to prime the pump; to see how long I could extend my time or a clinic patient’s time. Are you seeing that people are learning, “Hey, that was too much protein. That was too much fat. I gorged myself on XYZ, even though I’m in this keto extend phase…” Are those some of the things you’re picking out as you’re using the device when someone’s in the phase?

JH:

Yeah. We can look at a patient’s data and can usually see what’s going on pretty clearly. Our mobile app will show your entire ketotic journey, as we call it, over the course of a week. You can share that with your clinician or coach. You can generally see if someone’s following a protocol very strictly, but they’re finding that over time, their ketone levels are higher. Maybe it’s stress-related, but let’s just say all variables are the same. There could be that modification to less fat/more protein. We see that over time – there’s some adaption. We also see quite a bit of adaption when someone does a lot of fasting. I do a lot of fasting. Dom D’Agostino – from University of South Florida – does some really good blog posts on BHB. For example, if you’re fasting for months and months and months – I don’t mean all at one time – you become pretty proficient at your body just storing less and less BHB. It uses all that very quickly. So a peak BHB level in a three day fast, for example, could be going down. Peter Attia also posts that and was like, “Hey, my Biosense measurements stay high. Why are my BHB levels going down every time I fast?” It’s because you’re just storing less and less. You don’t need to store as much. These are the things you learn over time. I would really focus on just your physiologic response to get in that target zone that works for you, and we’ve got that in our app.

Additional Applications of Biosense

DrMR:

What other applications are people using this for? I’m assuming that for neurological health – whether it be brain fog, mental energy or depression – this is something that people are experimenting with. If so, do you have a certain zone? I’m assuming just some degree of ketones is going to be helpful and we don’t have to split hairs, but I’m just wondering if there’s any nuance there for people.

JH:

The protocols that our device is used in are not for the treatment. It’s just monitoring the ketones. So, the treatment protocol is more of a moderate level of ketosis. In our device, it would probably be a 10 to 15. They want to be above a 10 most of the day. So, for Alzheimer’s – especially early onset – you want to be in ketosis the better part of your remaining life if you want to avoid getting Alzheimer’s. We see that. Certainly epilepsy – the ketogenic diet specifically has been used as a treatment protocol for a hundred years. Right? So, adult epileptics tend to be in very, very high levels of ketosis; very, very high for their entire life, or they’re not having any carbs for the most part. Again, you can have moderate weight loss at low levels of ketosis… you can have pretty rapid weight loss in higher levels of ketosis. It’s whatever the clinician/coach puts you into the zone. We’ve got some embedded zones in the app, like I said, but keep testing yourself. You’ll see it. You’ll figure it out. It’s easy to figure out. You saw that yourself.

DrMR:

I’m assuming there are probably a number of clinicians listening to this, like myself, who might be GI focused. They’re saying, “There is a patient subset. I’d like to get slotted with this, but I don’t necessarily have all the nuanced background for the protocols of priming.” Is a lot of that in the app? Do you have consultants or coaches who can help people get some of this stuff started?

Biosense App Information

JH:

That’s a great question. In the app, we have cohort codes. So, if a clinic is a big enough cohort code where there could be an embedded zone that you’re looking for – where you set the actual protocol zone. So, I want everybody to be in between 10 and 15 ACE’s. Then, I look at the time and range. All you care about then is – I just want to know if they are 50% of the time in that range. That’s super simple. You know, the app has a sharing component. It integrates. You can see the trend line for the course of a week between visits or a month or daily, if you want to… their RPM codes, as well. If a clinic is treating patients virtually, there are RPM codes and obviously reimbursement with: 99453, 457, 99454 – your primary device monitoring RPM codes. We have protocols that we help with, too. From a coaching perspective, that’s more on the consumer side that we do coaching for. Those are group coaching classes.

DrMR:

Even better. So, if a clinician wanted to advise someone on weight loss, they can tell them to get the device and they have coaching. I think clinicians sometimes want to direct someone to a device or a program, but they want a little bit of reassurance that a patient is not going to come back with a bunch of questions they can’t answer, and that they’re going to get good advice when they do get there.

JH:

Yeah, you hit this on the head. We do not want to burden a clinician with any type of additional task whatsoever. If we can just be that voice between visits, that’s our role. If they’ve got a GI issue, 70% of them are going to be overweight anyway. Right? There’s a role of trying to get into a fat oxidative state that may be indirect, but it’s going to be helpful, and let us take the burden on that. It can be as simple as, “Hey, just get a Biosense device, track that and try to stay in a range of above five.” That’s it, and then a clinician can look at this once a month – not even for the RPM codes – just to know if there’s adherence and take the burden off of them. The data is empowering clinicians to do things they couldn’t do before and see things they haven’t seen before. The bottom line is no one knows about adherence. No one does.

DrMR:

It does help to have data to give you a sense on adherence. For clinicians, sometimes you have to give people more support; to meet them further to that halfway point to try to get them to where they’re trying to go. So, your points are definitely well taken.

JH:

The device came out in beta last year and we learned from our mistakes. The clinical side is that you cannot just drop this into a clinical protocol and expect it to work. The burden has to be on the company to really provide easy tools that it doesn’t have to come back to the clinic. That’s the reality of it.

DrMR:

We’ve learned that same thing. Some tests we had used a couple of years ago were promising a degree of ability to personalize diet and patients came back more confused. I don’t think the companies had the right reporting, the right dashboard, the right layout and the right support. We learned pretty quickly from that, but that does definitely happen. So, I’m glad you guys are on top of that.

JH:

Yeah. There are integrations with different EHR’s and then there is integration with Heads Up Health, which a lot of functional medicine practitioners use. A lot of these integrations already exist. I have to say – one thing that we underestimated is the gamification. I don’t know if you noticed this when you used it, but I can tell you, breathing is a positive… bleeding is not. There is always the taking a breath, which is very, very positive. Remember, acetone – this is really critical to understand – is the only way that you can track that increasing fat oxidation. There are other consumer tools that track CO2. Those flatline when you enter ketosis, so they don’t track increasing fat oxidation. Just make sure you’re getting the right gas if you’re a clinician and you’re recommending this. There is a lot of misunderstandings there.

Gamification & Motivation

JH:

We misunderstood and underestimated the gamification of a number. For example – Let’s just say you’re a Type 2 Diabetic or an obese patient. That’s tough. You’re that way for a reason, you’ve had adherence difficulties to other protocols and diets and you rely on a scale, which is an outcome, right? You rely on a scale for your feedback, which is already flawed, but if you could breathe into something and see just this 1 or 2, it’s highly, highly motivating. We’re finding that the number of measurements is a lot more than a protocol would call for. So, the resolution of a trendline is even higher. We have a clinic in Connecticut called Pounds Transformation – really, really sharp group there. They’re seeing really deep, deep use – 40, 50, 60, 70 pounds because of the gamification. They’ll admit, “Hey, we recommend the device. We give it to them, we get the RPM, but they’re doing it. The patients are doing it.” I know it’s this gamification of having a number that is not a weight. It’s produce ketone bodies, produce more ketone bodies, get into low levels of ketosis and then get into moderate levels of ketosis. It makes the protocol a lot easier if someone knows why they’re doing what they do.

DrMR:

I have found myself testing multiple times per day for that exact reason that you’re saying. Like you said, when you bleed, it’s like, “Oh, I have to (begrudgingly) go do it now” but, breath is much more convenient. I do fall into that same thing. Every time I do something, I want to know – “I went in the sauna… is that having an impact? I exercised… is that having an impact…?”

JH:

Well, you’ve got to let us know. You’re a good guinea pig for that.

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DrMR:

Coming back to the consumer end for a minute – is there anything else that you think is a common insight that you’ve noticed as more data has poured in that consumers may want to just take into their ketosis experiments going forward?

Fasting Protocols & Autophagy

JH:

Yeah. Let’s just say that your listening audience and your clinicians are the average of United States right now. We know that roughly half – if not slightly more – of those entering a dietary protocol are not doing this for weight loss. So, we’re seeing folks really start to look at their health proactively for chronic disease prevention much more than they have before. Data enables that – number one. So, having solutions that impact that of – “I want to know, and I want to know it so I can live longer and free of chronic disease.” That’s a data-centric approach to note – is it working? That’s where autophagy gets really interesting – getting to these higher levels of ketosis on occasion. I would say that’s one of the insights I would provide in the consumer space. I think we fit in really well well, too. We’re always eager to add based on consumer needs in that area.

JH:

The other part that we’re really starting to learn a lot about is the fasting side. It is the number one dietary protocol. It’s the easiest. It’s the least understood. It’s been around for our existence as humans. It’s how we were built to occasionally eat. This is where there’s just so much misinformation about the 18:6 diet and all these different things. Everyone’s an expert. We’re always eager to learn more and more. We’ve got a really interesting infertility study in Europe where fasting is the protocol, as opposed to carb-restrictive. We’ve got another one that we’re going to do in Australia that’s really interesting for autophagy. I think this is going to be an area of focus for us as a company, as well as clinicians looking for high impact very quickly. It’s easy. So, we’re always willing to collaborate with clinicians on that.

DrMR:

Yeah. I would second your interest in fasting. I think Mike Nelson said it well. He’s probably not the first person to say this, but he said the two things he’s found to be the most effective for weight loss is getting people to increase their protein intake – because it crowds out other macros that can be more conducive to weight gain – and fasting because you’re not asking the person to do anything. He said it’s pretty easy from that perspective once you get them over that little bit of a hump – if they’re used to three square meals a day – and their fasting metabolism hasn’t kicked on in a long time. Once the dust is brushed off of it and it’s able to fire, that does seem to be a pretty easy intervention.

JH:

Yeah, it is. We’re learning just more and more about it all the time. We did an anecdotal study just last year and we can tell you that it takes a lot longer to get into ketosis; a lot longer to get to these elevated autophagic inferred states than most people think. We may bring bad news with our device early on, but these baby steps become achievable. It just takes a little longer than most.

DrMR:

I’ll second that. I thought that I was going to be cruising into ketosis most of the morning because I pretty much do a morning fast – just some caffeine. I was assuming I was going to be all ACE’s from a ketosis perspective until maybe post-workout, and that wasn’t the case. So, it was a little bit frustrating for me, but I think that frustration is actually just a real gift disguised by a little bit of troubleshooting I have to go through to figure out how to unlock that potential.

JH:

Yeah. Now, that wasn’t snickerdoodle flavored coffee, right?

DrMR:

No, no. Just a quad espresso with two teaspoons of butter and some half and half. I may just have a strong response to caffeine or whatever, but this is actually something that I think is a frustration point that’s really an opportunity disguised like frustration. I think that’s important for people to keep in mind. Sometimes those challenges – and this also applies to business too – are actually opportunities disguised as a little bit of hard work and a need for some troubleshooting.

JH:

Yeah. That example you just gave – that half and half might be the culprit. You never know. I mean the milk sugars – although not a significant amount – could be the culprit. You’re different than me and bottom line, we’re all different. So, just withdraw that one day and see if you have the same result.

DrMR:

To your point, what a great behavioral change for me to recognize. It’d be a little bit bittersweet for me to give up the half and half because I really like it, but if I were to gain four hours a day in ketosis for that… I will let that go, no problem. If I was able to see clear data showing a ketogenic benefit I was getting by withholding 3 ounces of half and half, I would let that half and half go.

JH:

That’s a great example. There are biohack things we do here. We have companies that send us food all the time and the vast majority of it is not something you would want to use to maintain ketosis. However, we’ve been surprised, too. We were surprised by three. ProLon has a fast bar that literally extends a fast and it tastes so good. I was like, “There’s no way.” Jenny Craig has a fast bar and these are to extend a fast. It’s not really a fast, but extends your ketosis levels. Neither one of those decreased ketones at the 1, 2 and 3 hour mark with four of us testing it. There is Capello’s – an almond flour and cauliflower pizza – that I thought for sure would have dropped your ketones. However, we’re being surprised. The engineering of food is getting a little more scientific, which is great. There are just more options, instead of all these keto bars that kick you way out of ketosis.

DrMR:

Let’s flip over to the devil’s advocate side on this. I’m not sure if you’ve seen much of this. In the clinic, we see a fair cohort of IBS. Those who have IBS are more prone to being a little bit anxious regarding food. It can be a slippery slope into being neurotic about tracking and avoidance. Are you seeing any of that? If so, do you have any words of wisdom or encouragement for people?

JH:

No. We don’t. It doesn’t mean it doesn’t exist. It’s all about revelation. We reveal what people already had a little bit of an idea on and they’re learning more about themselves. We don’t see that, to be honest with you. I’d love to say some words of wisdom on that particular subject, but I just don’t.

Episode Wrap-Up

DrMR:

No problem at all. Well, this has been really insightful for me. Is there anything else that you want to leave people with? And will you also remind people where they can get a device if they want to plug in?

JH:

Sure. The app is really critical and we’re just coming out of the beta – we’ve got 8,000 users early in the first year. You can get it at mybiosense.com. The coaching add-on that we’ll do – just stay tuned on that because we have some cool promotions on group coaching that we’ll do for some specific areas like fasting and things like that. It’s a great tool for patients. It’s a great tool for consumers. Obviously, our clinical trial business is very separate.

DrMR:

Awesome. Well, Jim, I might be cursing you for a day or two if I have to give up my half and half, but I think it will be well worth it in the end.

JH:

Yeah. Let me know how it goes.

DrMR:

I will, and thank you again for taking the time. It’s been a great conversation.

JH:

Have a great afternoon. Thank you so much.

DrMR:

You, too. Alright. Bye.

Outro:

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