December 22, 2020
The Ultimate Wish List Featuring Tools for “Quantified Self”
By Julie Gregory, Chief Health Liaison for Apollo Health
For all of the good little boys and girls looking for gadgets to help with the protocol, I’ve put together the ultimate wish list of tools that can help you monitor your health by quantifying various biomarkers to track your progress. I’ve specifically chosen products that are foundational to brain health. For organizational purposes, I’ve put each item into a category, but there’s considerable overlap in some as they offer a multitude of features. There’s no better gift than good health, and each of these recommendations will provide information that puts the power in your hands to enhance your overall health and cognition.
There are only two shopping days till Christmas, and many of the manufacturers (not all) are offering deep discounts for the holiday season. (All prices were correct as this post was published, but may change.)
I’d be remiss not to start with foundational basics. If you’ve been on the protocol for a while but haven’t begun to check your ketone level, it’s time to start. No surprise, your brain needs adequate fuel to function at peak efficiency. A neural fuel shortage — cerebral glucose hypometabolism — precedes and accompanies Alzheimer’s disease, and those of us with the ApoE4 allele exhibit this neural fuel shortfall as early as our third decade. For a deeper understanding read, “Why is Ketosis Important for Brain Health?”
The great news is that ketones can offset this pathology, and we can easily measure them to monitor our progress. There are two methods of monitoring ketones: with finger sticks that measure a ketone called beta hydroxybutyrate (BHB) or by breath that measures a different kind of ketone called acetone (measured by ACEs). See goals for both below.
BHB Goal: This may be a bit different for everyone, with those more seriously affected needing higher levels, up to 4.0 mM. In general, you should aim to be at greater than 0.5 mM in the morning and try to get to 1.0 to 2.0 mM at some point during the day.
ACEs Goal: By testing multiple times per day (3 to 5), try to achieve an end of the day score of 120 ACEs.
See my top picks for measuring both types of ketones below. Apollo Health subscribers can log in for detailed information and instructions in “Monitoring Metabolic Health: Tracking Glucose and Ketones.
- Precision Xtra Blood Glucose & Ketone Monitoring System ($27.50)
This is a small handheld device that uses a drop of blood obtained by a lancet(a pen-like instrument with a tiny spring-loaded needle on one end) to test your glucose and ketone levels (BHB) by using separate strips. The Precision Xtra is considered the most accurate in its class, especially for low levels of BHB, and widely available at many pharmacies and online. If you shop around for deals, glucose strips can be found for approximately 50 cents, and ketone strips can be found for around $1.50 each. I found an excellent bargain from a reputable dealer on eBay for $20 ($8 shipping), including the device plus ten glucose and ten ketone strips.
- Keto Mojo (starts at $44.99, free shipping, includes ten glucose and ten ketone strips)
This is a similar dual system device that also measures glucose and ketones (BHB) through finger sticks. While it can detect low levels of BHB, it’s somewhat less accurate than the Precision Xtra above. The big bonus with this system is the less expensive strips. On the manufacturer’s website, glucose strips can be purchased for 23 cents and ketone strips are 80 cents when purchased in quantities of sixty.
- BIOSENSE™ Breath Ketone Meter ($299)
This is a pocket-sized breath ketone meter that you blow into multiple times throughout the day (3 to 5) to get your ketone level (acetone, measured as ACEs.) While acetone and beta-hydroxybutyrate are different kinds of ketones, a recent study found an 80% correlation between the two. Results will be displayed on the device and on a corresponding app that will allow you to track your levels throughout the day. BIOSENSE is the only brand that we recommend because it measures acetone accurately enough at low levels. It’s regularly priced at $299, but Apollo Health subscribers get a discounted price of $269, found here. BIOSENSE data is also seamlessly integrated into the ReCODE mobile app.
Adequate oxygen is another of the foundational underpinnings for a healthy brain. It’s no surprise that those with disordered breathing during sleep are at a much higher risk of developing dementia. Unfortunately, the vast majority of those affected with sleep apnea (periods of stopped breathing during sleep) are unaware that they have this condition. Thankfully, through continuous pulse oximetry performed at home, you can check your oxygen levels throughout the night, which may alert you to an issue that you can address with your physician.
Oxygen Goal: Normal oxygenation is between 96-100%. You want your nighttime levels to be as close to your daytime levels as possible. Levels below 96%, especially for a sustained period, warrant further investigation with your physician. (Levels will be lower for those living at high altitude.)
See several of my top picks for products specifically designed for this purpose. Neither require nighttime Wi-Fi exposure; only when downloading data via Bluetooth upon wakening. Apollo Health subscribers can learn much more about this topic by reading “Is My Brain Getting Enough Oxygen?”
- EMAY Wireless Pulse Oximeter ($99)
The EMAY Wireless Pulse Oximeter is FDA approved, has an iPhone and Android compatible app, provides continuous monitoring of both pulse and oxygen saturation for up to 40 hours, and allows you to download a medical-grade oxygen report. This system uses a traditional fingertip clip that could become dislodged during sleeping. For that reason, it may only be appropriate for those who tend not to move very much during sleep. The same model is currently available on Amazon for $59.
- Wellvue 02 Ring ($169 )
The Wellness 02 Ring is registered with the FDA, has an iPhone and Android compatible app, and also offers free software so that you can download your report, with detailed analysis to your personal computer to share with your physician. As the name indicates, the data is obtained through a comfortable ring with a built-in silent vibrating alarm that will notify you when you are experiencing either an abnormal heart rhythm or oxygen level. For a limited time, an extra 10% discount is available through the manufacturer.
Of all of the strategies that we recommend, exercise ranks amongst the highest because of the many benefits, which include increased blood circulation to the brain, upregulated brain-derived neurotrophic factor (often described as fertilizer for the brain), enhanced glymphatic drainage (which helps to clear amyloid-beta and tau from the brain), increased insulin sensitivity, reduced inflammation, improvement in sleep, mood, and much more.
Exercise Goal: Look for opportunities to move and stay active throughout the day. Aim for at least 30 minutes of daily sustained aerobic activity, such as with an outdoor walk, interspersed with running as you are able. We also recommend strength training 3 to 4 times per week.
Below, I’ll share some of my top picks for exercise trackers, some of which offer many additional features. Apollo Health subscribers can learn much about the benefits of exercise with detailed suggestions to protect cognition in “EXERCISE: ‘Just Do It’.”
- Pedometer ($24.99)
For those who eschew technology and Wi-Fi exposure but still want to track movement to stay motivated, consider this old-fashioned pedometer that tracks steps. It’s very easy to use, accurate, has a large display that’s easy to read and can be clipped onto your clothing or worn on a lanyard. Try to work up to 10,000 steps a day, roughly translated to five miles.
- Apple Watch, series 6 (Starting at $399)
Any version of the Apple Watch can sync to your iPhone via HealthKit and serves as an excellent fitness tracker, but I’ve specifically chosen the Series 6 because of all of the bonus features that can help monitor your overall health-to-benefit cognition. Please note that some older models may include some of the features highlighted below.
Let’s start with exercise. The Series 6 and older models will track 80 different types of exercises, from walking, running, cycling and swimming to boxing and strength training. It uses built-in sensors such as GPS, altimeter, accelerometer, and a heart rate monitor to work out an accurate calorie burn, as well as providing other metrics, including distance and pace. Additionally, it offers a fun new “three rings” feature that is guaranteed to increase your daily movement. You’re challenged to close the rings each day; one measures calories, another measures brisk aerobic activity, and the final one tracks how many times you’ve stood up during the day. Additionally, the Series 6, using the included ECG app, can perform an electrocardiogram (that can quite accurately detect atrial fibrillation and other rhythm abnormalities), provides heart rate variability data, and has a built-in 24-hour, non-FDA approved, oxygen saturation monitor that provides average oxygenation with a high and low range. The Series 6 also tracks and enhances sleep by prompting you to enter a wind-down period and measures the time spent in bed and asleep. Wi-Fi needn’t be on during sleep and nighttime oxygenation tracking and is only necessary when downloading data in the morning.
This version of the Apple Watch has a surprisingly long battery life and an enormous selection of watch faces and bands, with a higher price tag for the more upscale choices. For the fashionistas, there are even oodles of compatible off-label bands so that you can switch up the appearance of your watch to match any outfit. All in all, if you’re searching for the one premium tracking device that “does it all,” this may be the gadget to put on your holiday list. Additionally, all Apple Watch data is seamlessly integrated into the ReCODE mobile app.
- Fitbit with SP02 (from the Versa, Versa 2, Versa 3, Versa Lite, Ionic, and Sense collections, starting at $179)
Any of the Fitbit smartwatches can serve as an excellent fitness tracker, but I’ve specifically chosen those with the SP02 watch face because of the additional health features they offer to monitor overall health. All Fitbits sync up with the same app that allows for detailed tracking and monitoring of many health metrics.
Starting with exercise, the Fitbit will help you set and track your “active zone minutes,” monitor your fat burn, cardio, and peak activity, along with monitoring your heart rate. It also provides a daily step and floor count, allowing you to set personalized goals for each and providing badges and awards when you’ve met your goals. Additionally, like the Series 6 Apple Watch, it tracks heart rate variability and oxygen saturation, displaying the average values from your most recent sleep session along with a high and low range. (It doesn’t measure oxygenation values below 80%.) It’s non-FDA approved for tracking oxygenation, but it can still help you identify an issue for additional follow-up from your physician. Additionally, the Fitbit will automatically track sleep duration and stages — light, deep, and REM. Wi-Fi needn’t be on during sleep and nighttime oxygenation tracking and is only necessary when synchronizing data with the app in the morning.
Fitbit data is seamlessly integrated into the ReCODE mobile app. Several versions of the Fitbit (including early Versa and Ionic models) are being phased out and are now available at deep discounts (around $50 to $60), so bargain shoppers can get these premium features at a discount.
Adequate quality sleep is another foundational strategy that is closely correlated with better cognition. Too little sleep affects overall health and leads to obesity, diabetes, heart disease, increased inflammation, and a weakened immune system. All of these conditions are bidirectional and also affect brain health. Additionally, our memories are solidified and consolidated while we sleep. And new research has revealed that the glymphatic system, which clears waste, like amyloid-beta from the brain, works most effectively during deep sleep.
Sleep Goal: Your goal is to achieve 7 to 8 hours of quality restorative sleep every night.
Apollo Health subscribers can log into “SLEEP: The Antidote” for much more information along with detailed sleep hygiene tips. We encourage everyone to track their sleep quality and duration. Below I’ll share a few of my favorite sleep trackers.
- Dreem2 (special offer at $299)
While this may seem expensive, this FDA class 2 medical device is the most accurate sleep tracker on the market and, until recently, has retailed for $499. Unlike other sleep trackers that use proxy data to guess at sleep duration and stages, it straps onto your forehead and actually measures brain activity via EEG, along with respiration, heart rate, and movement, to provide an accurate and detailed sleep report via an accompanying app that is available for both iPhone and Android. Dreem2 also offers sleep coaching that reacts to your actual brain waves with tips on how to improve your sleep quality. For a detailed overview and review of all of the features. Read more here.
- Oura Ring (starting at $299)
What appears to be a simple (albeit masculine-looking) ring is actually a high-tech device. While it’s marketed as “the world’s best sleep tracker,” I have to respectfully disagree, as it relies solely on proxy biomarkers (as opposed to actual brain wave activity), but it’s a good substitute, and it offers a host of additional features that make it very attractive for protecting cognitive health. Let’s start with the sleep tracking features. Via, the corresponding iPhone or Android app, the Oura Ring delivers a comprehensive sleep report that includes your total sleep time, your total time in bed (which reveals your sleep efficiency), your sleep stages (light sleep, deep sleep, and REM), and totals all metric together for a nightly sleep score. It also monitors your temperature, heart rate, and provides heart rate variability data. The Oura Ring also monitors basic activity — your steps, distance, and calories burned. It has a long battery life, is water-resistant, very comfortable to wear, and all data seamlessly integrates with the ReCODE mobile app.
We know that stress is unavoidable, and in the short term, can actually be a positive reaction offering protection from harm when faced with a real threat. But, too often, we’re faced with chronic, severe, and unresolved stress that can have a devastating impact on cognition. Stress is inevitable, and we can best protect our cognition by learning to change our reaction to it by adopting regular stress management practices and integrating healthier habits into our daily lives.
Stress Management Goal: To build an effective stress management practice into your daily routine.
Apollo Health subscribers can read STRESS: Just Breath for detailed information on multiple options for stress management habits and tools, including mindfulness, meditation, and much more. For those who struggle to adopt a daily practice, see the recommendations below that can both enhance your application, and provide feedback to help confirm that you’re on the right path and provide motivation to continue.
- HeartMath Inner Balance (Starting at $96.75, discounted 25%)
If you like data and are motivated by immediate feedback, the HeartMath Inner Balance system may be a good stress-relief tool for you to measure your progress. HeartMath is based upon the heart rhythm variability (HRV) science showing that greater HRV is associated with reduced stress, increased resilience, and an improved ability to adapt effectively to stress and environmental demands. Higher HRV is associated with reduced biological aging and better overall health, specifically psychological, cardiac, metabolic, renal, and even improved survival rates with cancer. Those with a higher HRV also have improved cognitive abilities.
HeartMath works by using either a wired (iPhone only) or Bluetooth earlobe clip that transmits your real-time data to an iPhone or Android app on your phone or tablet. (I recommend the wired version to reduce electromagnetic field (EMF) exposure from Bluetooth.) You can see both your HRV and your coherence level. Coherence is a scientifically measurable state whereby psychological and physiological processes are aligned. Coherence is marked by a smooth sine-wave-like pattern in the HRV trace recording. It shows a synchronization between the heart and brain, aligning the two branches of your nervous system towards increased parasympathetic (relaxation) activity, as well as balance between HRV, blood pressure, and respiration. The goal is to achieve high HRV and coherence. The app provides you with real-time coaching tips as well as guided meditations to improve your numbers. The manufacturers recommend using it three to five times per day simply as a means of checking in to monitor your stress level.
- Muse 2 ($199, discounted 20%)
If you struggle with a wandering mind during meditation, The Muse 2 headband may be helpful for you. It’s a multi-sensor meditation headband that provides real-time feedback on your brain activity, heart rate, breathing, and body movements to help you build a consistent meditation practice. Muse 2 is an EEG device used by neuroscience researchers that uses advanced signal processing to interpret your mental activity to help guide you. When your mind is calm and settled, you hear peaceful weather. As your focus drifts, you’ll hear stormy weather that cues you to bring your attention back to your breath. Read this review for additional details.
Monitor Heart Health
The science is very clear that heart health and brain health are inextricably linked. A healthy, well-functioning circulatory system is vital to deliver much-needed blood to the brain. Research clearly shows that poor cardiovascular health, with age, can contribute to cognitive decline. All of the strategies outlined in the Bredesen protocol, combined with regular biomarker screenings, will enhance and improve heart health.
Heart Health Goal: To maintain healthy blood pressure, normal sinus wave rhythm, and pulse wave velocity.
There are multiple aspects of heart health, including hypertension (elevated blood pressure), irregular heart rhythm (atrial fibrillation), and poor pulse wave velocity (measures the elasticity of your arteries) that are associated with cognitive decline that can be quantified and measured at home to help you monitor your heart health.
- Omron 5 Series® Wireless Upper Arm Blood Pressure Monitor ($52.49, discounted 25%)
The Omron 5 Series is an accurate smart blood pressure cuff that will alert you to an irregular heartbeat and also warn of hypertension (elevated blood pressure). Research indicates that hypertension is a risk factor for dementia. By regularly monitoring your blood pressure, you can make an adjustment to your regimen and follow-up with your physician as needed. When synced with the accompanying app and HealthKit, it will enable you to integrate your blood pressure data with the ReCODE mobile app.
- KardiaMobile ($84.00, discounted 15%)
The KardiaMobile is an FDA-cleared device that, when synced with the accompanying app, allows you to turn your phone into a clinical-grade personal EKG monitor. It captures a medical-grade EKG in 30 seconds anywhere, anytime and can detect atrial fibrillation, bradycardia, tachycardia, or a normal heart rhythm. You can store your EKGs on your phone and email them to your physician as needed. As mentioned earlier, if you have the Apple Watch, Series 6, it can perform the same function and is integrated with the ReCODE mobile app.
- iHeart Internal Age ($195)
The iHeart Internal Age device clips onto your fingertip and displays your aortic stiffness (pulse wave velocity) on a corresponding app. The results are reported as “biological age” determined by an algorithm based age referenced means. The goal is to have a result equal to or younger than your actual age. Results from iHeart correlate closely with the SphygmoCor system, the gold standard for measuring pulse wave velocity. Poor pulse wave velocity is a significant risk factor for future cardiovascular disease and dementia. It’s an excellent way to monitor the effect that the protocol is having on your heart health.
By embracing technology and building the habit of “quantifying self,” we can begin to track and tweak all of the parameters necessary for healthy cognition for years to come. Many of these products will provide data directly to the ReCODE mobile app (available at the App Store) as long as you download the app that accompanies the product and regularly download your data as you collect it. Any product that is compatible with Apple’s HealthKit will provide data to the ReCODE mobile app. For those who aren’t Apollo Health subscribers, please see Dr. Bredesen’s most recent book, “The End of Alzheimer’s Program,” for detailed information on all of the strategies to enhance and protect cognition.