In this eleventh episode, Daniel Maggs enlightens listeners as to how today we are flushing away our bodily waste daily without first capturing the highly-valuable data it contains. He details his companies forthcoming smart urine analyzer that provides personalized health advice. He shares a lot of excitement as to where home and personalized health is going.
Lee: Hello, and welcome to the show Daniel.
Daniele: Thanks very much for having me Lee.
Lee: I appreciate it. I can’t remember how I came across yourself. I know that I follow a partner of HAX, Benjamin Joffey who’s a friend, and I believe that bisu came through the HAX hardware accelerator program.
Daniele: Yes. So Ben’s a great guy. HAX is a program we went through in 2017, three month accelerator. They were an early stage startup, they helped get us through, fundraising, product development, user experience, and then… Yeah, they invested in us. So we have a lifetime partnership as it were.
Lee: So does that mean you had to go and live in Shenzhen? Where are you just now?
Daniele: So I’m in Tokyo right now. I’ve been here for the last six or a bit years, but I was in Shenzhen for three months for that program. And then they have an office in SF, and I go to SF reasonably regularly now. I typically go to US once a month.
Lee: What caught my attention was, I saw you claiming that, I don’t want to say claiming because I actually think you’re correct, so it understates it. You’re on record as saying that we’re flushing terabytes of data down the toilet. And your aim is to help us capture that data for health and fitness. And you also said you think the toilet will change it from a waste collection device to a data collection device. I think you estimated in a five to seven year time frame. So that perspective of changing the toilet to a data collection device, could you briefly explain that?
Daniele: Sure. So I’m not the first person to talk about health sensing in toilets. This is an idea that was really raised 20 years ago by a Japanese company called Panasonic, and 2008 a Japanese company called Toto actually made the first such product. Which is about $4,000. It was installed in elderly care homes and it detected glucose in urine. And two years later they shut the whole thing down. And there are a couple of reasons for this. One is that the technology that they use, called microfluidics was very much in its infancy at the time, the whole field is only about 27 years old. So by then it was about
Lee: Microfluidics is 27 years old?
Daniele: Roughly speaking. And the second one is it was very expensive and bulky. Probably the most important issue is that what they were detecting in urine was glucose. And that’s something which may or may not appear even if you have high blood sugar. So it has what we call a false negative risk that the user might think, “Ah, my blood sugar is not high because there’s no glucose in my urine.” But actually their blood sugar is high, it’s just it’s not appearing. They learned the lesson the hard way. But technically speaking, it’s already been done, but just not, I think in the ultimate way it’s going to be done. So let’s talk now about what it’s going to become.
Daniele: There are two sources of data from your body that you released in the toilet, one in the urine and one in the faeces. The toilets of the near future will be gathering data across a range of sources. Naturally you can gather a lot of this data outside the toilet, there are some things that having a toilet form factor make it easier. So for example, if you want to do very deep analysis, for example of metabolites, or highly complex sensing, you need a lot of space.
Daniele: So if you wanted to have a, it’s called a mass spectrometer, it’s basically a lab equipment. You would need probably the form factor of a toilet to have a place to actually conceal it, it would not be a portable product like ours. If you want something that’s more simple, but still highly actionable like how much salt is in your diet, how much potassium, how much magnesium, you could use something that’s a lot more small. It could be in the toilet, but could also be portable.
Daniele: But let’s come back to the important point is, what actually is in your waste, okay? It’s your information on your diet, your protein intake, your fruit and vegetable intake, your hydration, your electrolytes, it’s hormone markers, testosterone, estrogen, progesterone, pregnancy fertility, hormones, cortisol, you can test the saliva but urine is also good. It’s inflammation markers, it’s markers of oxidative stress. And these have different sensing technology that’s required.
Daniele: I see sometimes people have the perception that blood is the gold standard of health tracking, and there are many biomarkers for which that is the case so glucose 100%, vitamin D 100%, but are many biomarkers of which urine is the gold standard or even saliva, say saliva cortisol, saliva is best possible bio fluid for testing cortisol.
Daniele: In the case of urine, you want to test electrolytes and pH for example, the urine test is much more reliable than the blood test. Probably sodium is the only electrolyte in serum that’s really good because most of your sodium is held in your blood. Most of the non-sodium electrolytes are held outside the blood. So really what we say is, this is about a missing piece of the health puzzle that’s completely painless, that you have to produce enough sample every day. Getting enough serum at home is obviously very difficult as Theranos found out. And with a single measurement taken daily or even less often a week, gives you the overall picture of, okay, what is looking good and what needs work without having to obsess about the detail of your health.
Lee: Thank you for the great introduction. I also was of the opinion that blood was, I’m laughing because I realize lately I’ve been realizing I’m wrong. I also had implicitly accepted that blood was a gold standard. But then Incidentally, and I wish I’d had a lot more time to go into the field before talking with yourself or maybe it’s a nice coincidence, because sometimes it’s better when you don’t know things when you talk to another. Certainly for an audience.
Lee: But I came across Dr. Linda Frassetto, who is a nephrologist. Have you heard of her?
Daniele: So Linda’s a Emeritus professor at UCSF, and Linda is someone who’s main focus is taking care patients, I should say, who have kidney disease. So chronic kidney disease, which means basically over time your kidneys are naturally declined, they decline to the point that you need medical assistance and people with hypertension or high blood pressure.
Daniele: But what she’s also very interested in, that’s her medical work. As a researcher is, what are the factors that actually cause these conditions to occur? And how can we help people maximize the use and health of their kidneys as long as possible? As it happened, she’s an advisor to bisu. And I’m not a medical doctor myself, but she gives very good advice in terms of the biomarker research and so on, to make sure that we stay on the right path.
Lee: First of all, that’s awesome she’s an advisor. Do you have a list of advisors on the website because I must have missed that one?
Daniele: Yeah we do. So
Lee: She’s already listed there?
Daniele: She should be, yeah. So she’s the medical doctor who’s a nephrologist. So a kidney doctor essentially, there is Dr. Alan Garber who is a endocrinologist or a diabetes doctor. There’s Molly Maloof, who is a, really I’d say a digital health expert. So she’s a practicing doctor, but she’s more focused on wellness than medical practice in the conventional sense. And then we have a couple of biomarker experts Dom D’Agostino and a regulatory advisor. So, yeah, they’ll have their own area of expertise.
Lee: I’m going to check the website as we talk. So I only became aware of Linda recently. So that was a nice coincidence. And she seemed just one of these people who just lives for their field. And when I was looking materials from her, I coincidentally, because I’d already invited you to the podcast and started thinking, “Hey, she’s focused on sick patients.” And then I started getting excited because the relation between the kidneys and aging.
Lee: So then I’m like, Okay, why? Why are we not taking measurements of people? Because she said that many of the patients who end up, by the time they end up in the hospital, they’ve got 24% of their kidney function. That’s quite shocking. And then when I looked at what the various testing around the kidneys were, well it wasn’t super expensive or super complicated in most cases. So it was like, “Why are you letting people lose their kidney function over time? That reactive healthcare model.” So it just seemed another area where healthcare, just like with diabetes, lets you sail into over 10, 20, 40 years without telling you you’re already on that trajectory.
Daniele: Yeah, I mean, it is a big issue. There are roughly 14 million people I think in the US, for example, who have kidney disease. 90% of them don’t know they have kidney disease. And the typical way people find out is when it’s too late. Maybe stage three at the earliest. So if you’re age 60 to 70, it’s very common for people to have what’s called stage two kidney disease. So significantly reduced kidney function, but just prior to the stage where you need treatment, and people often, many will die before it goes to that stage, many do require treatment. But part of the problem is that kidney disease is a chronic condition, which means it develops slowly over time. It’s like you don’t necessarily see it when it’s not acute. It’s not hitting you in the face.
Daniele: And we also have a medical system that typically has weak incentives for preventing disease conditions, but you can test to see if you have kidney disease. If you have an annual physical you can see what’s called a GFR, glomerular filtration rate, or basically how efficiently your kidneys are working. And you can also test for protein in your urine. But that’s really like an end result. What’s perhaps more important is actually the behaviors that are causing these conditions to develop. So typically, its high carbohydrate intake, together with high salt intake, and what’s called a high dietary acid load. So having a diet that has a lot of animal proteins, grains and things like cheese, and not much fruits and vegetables, and that’s something that accelerates the decline of kidney function.
Daniele: So, really, the important point here is that your liver is incredibly resilient, it can regenerate even after losing a lot of function. Your kidneys cannot regenerate in the same way. So in a world where many of us are increasingly living to age 100, investing in good kidney health is a really wise choice. So I think she raised a really important area in people’s health. Many people who have conditions like diabetes as well, typically develop things like kidney disease at the same time.
Daniele: So it’s not a small problem and it’s something that we can all be aware of not be afraid of, but just really take some smart steps to protect ourselves
Lee: Because of her who had made me aware of exactly what you said that the kidneys don’t regenerate like the liver. And that we’re putting unnecessary loads in the kidney and I think we’re doing in lots of ways, but a primary one being, as you said, a diet, a high acidic diet. And jumping into diets, just a little tangent here. I have been experimenting with diets for 10 years. And I’ve been involved with companies working in AI space to determine what the ideal diets are for your unique biology. At least that was the aim. You begin naive, I’m laughing, because a few years later you realize how naive you were.
Lee: And the problem I have when it comes to diet is, I upset vegans, if I don’t hail the flag for veganism, and I upset the low carb or keto community if I don’t hail the flag for that, and yet, I appreciate both. And because of Linda, I have, typically I’d be low carb, we can call it that but to be honest, it’s not low carb but just eating like traditional did. That’s the only dietary advice that I’m solid on is don’t eat processed food, and when you don’t eat processed food, you have what’s technically a low carb diet since we’ve been uping our carb content in the last 30, 40 years in particular.
Lee: And so I lost a lot of weight using keto. So I saw the intervention that a ketogenic diet can be, and I think it very good as a short term intervention, and I do realize that we should cycle into ketosis occasionally in the year for longevity reasons. But because of Linda, I realized that I probably should cut back on dairy for example, because of the load and it ties into, I couldn’t correlate some of the work by Valter Longo, he pushes pescetarianism and veganism as a path to longevity.
Lee: And also a lot of work I saw on the ketogenic side for longevity. What I came to realize is we should take care of the stress upon our kidneys and we should measure it. And you say that the doctor does what is called GFR. I’ve never saw that available. I think it’s calculated, I haven’t had time to look into it. I think it’s some calculation that’s made. And I’m not aware of doctors doing that. But I do know that I periodically test creatinine and BUN and I’ll do an albumin to creatinine.
Lee: So I’m not sure if doctors do GFR, traditional doctors.
Daniele: That’s a really good point. So I actually learned recently there are more than one way to estimate kidney function and creatinine is very commonly tested. So creatinine is basically a waste product or something called creatine, which many people I’ve heard off take creatine supplements. Creatine comes from muscle protein. So every day, typically one to 2% of your muscles are turned into creatinine and excreted at a steady rate. So it’s a really good measure or it can be a good measure of kidney function.
Daniele: But it can also be influenced by things like dietary of protein intake on how much muscle you have in your body because that’s also converted. But for that reason, there are other methods to estimate kidney function which do not involve creatinine. So yes, it’s not the only way.
Lee: Yeah, so if you have a high body mass I think you have or if you have a lot of muscle I think you can have a quite high levels of creatinine. But if you’re elderly it tends to be on the low side.
Daniele: So yes, it’s not the only way to measure it but people also will be testing BUN and creatinine to get a picture of where your kidneys are at.
Lee: Okay, but this GFR – do you know if you can go get it tested that easily? I’m just not aware of it and yet after listening to Linda, GFR is on my to do lists to look at as a marker, and I’ve not got to the point in the to do list yet.
Daniele: One possibility is that it’s a test that’s used commonly by nephrologist, but not necessarily by general practitioner. So that’s a question that’s come to my mind now, that it might be something that’s not commonly included in standard physicals. But if the doctor, your GP say in UK at least, general practitioner thinks you might need to get a further inspection, might pass his nephrologist and then the nephrologist might run that test. So I’m not 100% certain but that’s one possibility.
Lee: Okay, it’d be my understanding it would require a referral. It started having myself think about just going to a private hospital and asking how much it would charge to do that. We jumped into the deep end which is okay, but what I haven’t done so far is mentioned your company and your product. Your company, I think is Bisu and you have something which I-
Daniele: No it’s-
Lee: Oh, please correct me.
Daniele: If you say bisu, to be honest there’s no one right answer although we prefer bisu. Let me explain where the name comes from. So bisu is an Egyptian God of human health protection. Most people have heard of Ibiza, the island. And Ibiza is an old Phoenician name meaning dedicated to bisu, so people think of Ibaza as being a pleasure island and good times having fun. Bisu is a God who made even disease go away and good times and having fun come in. So we’re a company that’s about helping people have a healthy, happy life.
Lee: That seems a laudable aim. And you have a product, I think it’s called The Body Coach.
Lee: Are you still calling it The Body Coach? Okay, could you introduce it please?
Daniele: So, Bisu Body Coach is a urine analyzer that gives you personalized feedback on your diets to help you really do one of three things. To get fitter, so to improve your exercise performance, to lose weight, or to, we say protect your health. But if you’re getting a little bit older, you might have some health concerns or you need to watch out for certain things. It’s something you can be using to keep yourself on the right track, specifically right now it’s testing sodium, potassium, magnesium, calcium, so your electrolytes, hydration, Ph as a marker of what we call acid load and two types of ketone.
Daniele: So it’s a little bit different from a conventional urine ketone test, it has two ketones rather than one. I can go into that more than a bit. And the same device can test many other things. So we have a roadmap to release. This year we’re going to release the diet test, and then next year a saliva test for oral health, so cavities, gum disease, a pet urine test, a baby diaper, so checking a baby’s health.
Daniele: And then some classic tests like pregnancy and ovulation and urinary tract infections. But really what we’re focused on is not so much traditional diagnostics, like maybe you have a disease, maybe you don’t, which a lot of the time is not going to show anything, so you’re spending money and not getting much back, but rather things that will create a feedback loop to understand, are electrolytes in the right ratio? Do I have enough salt relative to my water intake? Do I have enough say, green vegetables in my diet to counteract the effects of that cheese and having? How far in ketosis am I reeling? These kind of insights is what we’re focusing on right now.
Daniele: It’s both. A classic blood ketone test tests beta-Hydroxybutyrate or BHB. It’s the dominant ketone body in prolonged ketosis. So, there are three forms of ketone BHB, AcAc and then acetone which is technically a waste product of acetoacetate which breaks down from the acetone in your breath. And BHB is formed from acetoacetate. So we say acetoacetate or AcAc is reduced to form BHB. You can switch back again. But the more you’re in ketosis, the more BHB is produced relative to AcAc.
Daniele: If you test in urine, the conventional test strip only tests AcAc. So what happens is that the amount of AcAc appearing in urine goes down for obvious reasons because more BHB is being produced relative to AcAc. And that strip also has a pretty, I can say high detection threshold. The smallest concentration it can detect is quite a lot higher than the smallest amount that can appear in the urine. So people who use the urine test typically find the first one to two weeks, “Okay, I’m getting some data,” and it stops. “Oh no, the strip has stopped working.” What’s happened is not that you stopped excreting ketones, but you’re not excreting enough acetoacetate to anything to register. So what our device does is, it measures both the BHB and the AcAc in the urine together. And the ratio between them shifts based on the stage of ketosis.
Daniele: So, roughly equal parts you’re an earlier stage and primarily BHB You’re in a deep stage of ketosis. And it keeps working even after the classic urine test strip has stopped working.
Lee: Normally people who are first timers with experimenting on the ketogenic diet, go to the pharmacy to get urine test strips, so it’s eight euros, $10, something like this. And they do well to show when you’re in a… I want to say optimal “ketogenic state”. And they do work to show when you’re in that quote “optimal” fat burning ketogenic state. And in my understanding, here’s what I noticed myself was early on, they definitely were good. But then over the years actually registered low. And when you checked the BHB on a blood meter, you had high ketones.
Lee: So it was said that people who are keto adapted burn AcA better and therefore it doesn’t register in urine. You want to clarify that often beginners have high AcAc and then once people are “adapted”, and I’d like you to clarify that.
Daniele: Sure. Yeah, so it’s a very, very common perception that in prolonged ketosis, your body is consuming or using up more ketones and excreting fewer. I’ve actually seen, I think it’s at least one if not two papers that seem to indicate the opposite. So when you are [inaudible] when you’re in ketosis, that ketones are actually a relatively small percentage of the total amount of fuel your body is using from fat.
Daniele: You’re in a fat burning state, which means your body is also using fatty acids without converting them to ketones. It’s using the ketones for certain parts of the body that need them like the brain, for example, because fatty acids can’t pass the brain blood barrier. And there’s very interesting study that showed people who are in a state of nutritional ketosis in the earliest stages were oxidizing or using up about 95 to 96% of the total ketones produced. And after roughly two weeks of prolonged ketosis, this declined to a steady state of about 83, 85%. So they actually, as a share of total ketones produced oxidized fewer ketones rather than more. And the most obvious explanation for this is that in a more fat adaptive state, their body is more readily making use of fatty acids for energy in general. Because most people typically are not in a highly fat adapted state. They’re primarily used to using glucose for energy.
Daniele: So I’ve spoken on this topic to Brianna Stubbs of HVMN. She was the lead researcher there. And one thing I understand from her is that one factor that can have an effect on the percentages utilized of ketones as utilized is the availability of carbohydrate in the body, whether it’s glycogen stores or as consumed. So that’ll be a variable factor, but one thing that doesn’t seem to change is that in prolonged ketosis, BHB is a dominant ketone. So, there may well still be situations where yes, in deep ketosis, you do excrete as a percentage, fewer ketones isn’t in many cases much, that’s not the case. But for us, it doesn’t matter too much, because what we’re tracking, what’s really important to us is the ratio between those two ketones as they appear in the urine, not so much the amount because the ratio is indicative of the stage of ketosis. And that’s why it’s not something we’re not particularly worried about.
Lee: So this is quite exciting. So I’m just, I can be sure that listeners are following, could you clarify why having both AcAc and BHB and being able to do the ratios between them is advantageous to take in any one.
Daniele: So if you were to test BHB in your blood, you would have it obviously at very, you would know your ketones right now, you would have an actual measurement. It’s a great measurement. You wouldn’t know AcAc as well. So you would know the total amount of BHB in the blood but not the amount relative to AcAc. But you will still get a pretty good indication from the increase in BHB that you’re in deep ketosis, so no problems there.
Daniele: But if you’re using the urine measurement, essentially you’re getting a actionable painless alternative to the blood test that you can use as long as the blood test after the normal strip just stopped working. Another factor that’s important is, when use a normal urine test strip, people typically find that they don’t get ketones in the urine for the first couple of days unless they used to be in ketosis. And one adjustment we made to the BHB test is that the detection limit is very, very low. It’s not nought point one millimoles. So the standard, sorry to go a bit technical here, but the standard AcAc urine test strip has the detection limit of nought point five millimoles. That’s five times the renal threshold. And the BHB test that we have is nought point one.
Daniele: So you get early detection of ketones in urine in the normal urine test strip, you get long term detection, even after normal strip stops, and you get a clear indication of the stage of ketosis and it’s completely pain free. I understand that apart from a small subset of people who keep testing blood ketones, most non power users of blood testing blood ketone products typically stop after about three months. And that’s coming from actually a leading supply in the field. So yes.
Lee: Can you repeat that please. What stops after three months?
Daniele: I understand from a leading maker actually of blood ketone testing devices, that most people who are, how can I say, not typically a male biohacker, but often say a female dieter, for example, it’s quite common in the keto space. Stop using the blood testing, ketone blood tests after about three months, so that’s the typical customer lifecycle is three months for those test strips. And there are some people who say, “Well, I can feel ketoadapted without a test.” But also pain is a major issue for many people as well having to keep using the lancets. So that’s an issue that we obviously overcome.
Lee: Okay, I was wearing a continuous glucose monitor, years before they were popular. And similarly, I was measuring ketones. And yeah, I very rarely measure nowadays because I know where my blood sugar is. I know where my ketones are. You just come to know these. The only time I measure my BHB and glucose is when I’m trying to work on the glucose ketone index.
Lee: You’ve heard of GKI? Okay, so you know that you want to achieve certain values there in order to reduce your chances of chronic disease, live a longer life, et cetera. GKI is very cool. It’d be super cool if you could build it into your Body Coach.
Daniele: Yeah, when you have a urine measurement to getting an average over time, right? So the comparison point would be if you’re testing during the day, one urine test to the last three hours typically of blood ketone data. And if you were testing day to day in the evening or morning, it’s more like an average. But I think if people want to know the ratio right now, then probably the best one to use is the blood tests because it’s really a spot to test.
Daniele: Really the value of urine is that, with a single with a single daily data test or even twice weekly, you’re getting an overall picture. And not just looking at the ketones themselves, but also looking at ketones relative to things like magnesium, sodium, potassium, and other markers. So I think people are very concerned about the glucose ketone index, they should test for blood, that’s great.
Daniele: But if they’re looking for more general tracking, I think the urine test is probably going to be the more comfortable option to use.
Lee: Appreciate it. The only other thing that instantly pops to mind of importance I must bring up is, I understand the benefits of BHB generally and it’s a great blood test, et cetera. But I again picked up the acetone like breath based ketone tests, like Ketonix or Levl, and I think the Levl last time I checked was $400. So maybe it became cheaper, I’m not sure but it was pretty expensive. And I was led to believe that what was the best in terms of ketone monitoring is acetone. So maybe if you’ve got any comments on measuring that as well and their worth.
Daniele: So I think their level’s a great product, I would never seek to detract from that. Breath acetone seems to have a good correlation with BHB. So I’m not saying that you should use our device as the only device for testing your ketones. What I am saying is, using a breath measuring device you’re getting a single biomarker, and one of the beauties of urine testing is that with a single test, you’re getting 8-10 biomarkers with a single test. So it’s very efficient for your time and also for your cost in terms of the feedback you get.
Daniele: So again, Levl. great products super happy to see them in the space. Some people would prefer just to use that ketones, don’t test anything else. But I think if people want to go beyond just ketones, and see more of a picture of their health and see those things together, then the urine test could be a more efficient option.
Lee: Yeah, where you’re pushing into or indicating is the too often we’re measuring single point in time, single variables for an individual. Once you’ve worked with these numbers for years, you begin to see that the numbers actually don’t mean that much as we are led to believe. Checking them against a lab reference chart can often be quite meaningless. You have to understand what many of the biomarkers are at that point in time in relation to each other.
Lee: And secondly, how they change over time for the individual. And the more you realize that is the more, I’ve come to realize how absurd a lot testing is, it’s only for a quick diagnostic to put you in a disease bucket or not. That’s all it seems to serve. And sometimes that putting you in certain disease buckets, quite a few people actually don’t belong in them. And I get the sense that it’s to drive pills and procedures if there’s some misalignment there in the healthcare system.
Lee: So is this is what you’re indicating, that it’s more of a graph, more of a network that’s going on, and individualized one. So it’s better to look at multiple markers simultaneously and particularly over time for that individual, which healthcare cannot offer today.
Daniele: Healthcare plays a really important role. Obviously there are certain issues like especially if you’re in the US, people don’t necessarily have a positive relationship with a doctor because it’s very expensive just to go and get seen. I live in Tokyo and people here, especially the older will go to the hospital just because sometimes they’ll only want to speak to someone, but also because it’s cheap and accessible. So the experience of healthcare is quite radically different. I think there are some tests that definitely you should get done in a healthcare context that you just can’t do at home. And that’s absolutely the place for the healthcare industry.
Daniele: But really important point is that we are our own doctors. There are some conditions that it’s hard to control your risk of getting, but especially for the really major ones, including even cancer because there are many behavioral factors that affect cancer risk is, getting a physical is a bit like passing the exam, right? So no one just turns up for the exam without doing preparation. They study, people obviously don’t study which biomarkers the doctor will be taking. But the result you get on your annual physical is to a large extent, not entirely, but to a large extent the result of those behaviors that you are following in between your doctor’s visits.
Daniele: And this leads me to a second point which is, yeah, data tracking is obviously very important. I think it’s very important that it’s natural and not neurotic. People shouldn’t have to obsess over being healthy, because health is also holistic, it’s mental. It’s not just physical or biological. And that’s why we’re about giving people the most data with the least time, pain and cost. Well, with zero pain in our case, so that they can really be efficient in how they spend time on their health.
Daniele: But yes, we’re absolutely moving towards a more integrated approach. So we know we have access to genetic data, now we’re moving more to the world of epigenetics. Just because you have certain genes it doesn’t mean they necessarily express themselves. It hasn’t stopped people from maybe, as you hinted it earlier, selling diet programs based on your gene, which may or may not have a real basis in science.
Daniele: Then there’s also the gut biome. And this is also a very precious source of data. One really awesome startup in this area is Biomesense doing home based toilet, home toilet based microbiome analysis. So the poo side to our pee, right? And one of the issues in the microbiome space has been that people are again, providing lifestyle recommendations based on a microbiome screen. The problem is, the datasets they’re referencing are very limited, maybe 20 or 30 subjects in a study where very few samples are taken. Because it’s very hard to get study subjects to donate lots of poo for a test. It’s not pleasant to be able to do.
Daniele: The founder of this startup actually started it for that reason because he saw people essentially, he saw lack of good data in the microbiome space and wanted to solve that. So again, like genetic testing, hugely important data, lots of potential, but some quite important issues. Home blood testing, we also see what happened to thoroughness. There’s one type in us which is coming to the radar now called COR, C-O-R. If you type in, ‘know your COR’, you’ll find them.
Lee: Bob was a speaker at the 2016 event I did.
Daniele: I understand the company’s actually still alive. They actually raised money from a top BC about a year and a bit ago.
Lee: They did [crosstalk]
Daniele: But no one’s seen him really emerge yet, but that’s a very promising product. Because you get about five biomarkers with a single arm prick.
Lee: Yeah, when I saw your device, the physical picture of it somehow I was reminded of COR friend Bob Schmidt. He instantly came to me.
Daniele: I understand. Yeah, I see some similarities, the shape, the way the sample is loaded is very different.
Lee: I meant more as a device you can set in the bathroom and not [crosstalk 00:40:10].
Daniele: Oh yeah, I see. I would love to use both products. And then the devices that we have are easy to use. So one, for example, Naked Labs is a very exciting startup that has a body scale that scans you with a mirror, scans your body composition, so it’s not going to be as accurate, I think it’s called hydrostatic weighting. But basically where they… Yeah.
Lee: Yes. [crosstalk]
Daniele: But that’s something that could be done as a daily habit without much hassle, right? And then you have some very interesting breath testing companies like FoodMarble, where they are checking your gut response to foods, which is essentially how are you digesting certain foods based on, in this case, the nitrogen content of your breath. So I think it’s a very exciting space. There’re a number of challenges but…
Daniele: About four or so years ago, there was a very exciting site called CUE, C-U-E. And they’re still around. And they did amazing promo video for this home device that tests both blood and saliva, and it will test vitamin D and testosterone and all those things. And ended up raising a lot of money and basically making a single diagnostic test for Johnson & Johnson. So they were clearly a bit early for that consumer vision of effortless data at home.
Daniele: But I think we’re now a lot close to it. And obviously, that’s a movement that we’re leading as well. CUE had some setbacks. COR has some setbacks. We’ve had some setbacks in the past, but I really feel very, very excited now about where home and personalized health is going. Now we’re seeing the genetic space really evolving from classic genetics to epigenetics. Getting much more reliable insights, we’re seeing this shift from the microbiome industry to getting a higher quality data.
Daniele: And then the last piece, of course, is how to bring this all together. And this is probably the challenge I see probably more in the tech industry space. So people who are less experts about the biomarker science, people who are really interested in the data, as well, who’s going to own this data and how to bring it all together. But probably the one person I would say, who I think really is a tremendous pioneer in this space is Professor Mike Snyder at Stanford. And he is the head of the Center for Genomics and Personalized Medicine. He is both a super legit researcher and also a legit biohacker. So I think even predicted his own early diagnosis, of Lyme’s disease by wearing seven wearable devices over six months or something ridiculous, but he does what’s called omics or integrative omics, which is combining genomics, metabolomics, microbiome testing, the biome of the skin, the mouth, not just the gut, and wearable data to try and go deeper and deeper still.
Daniele: So I think when I talked before about having these fully realized health analysing toilets to five to seven years, I really believe now that it’s not an exaggeration, that we are in our lifetime, I think it’s going to be a radical transformation of home health testing, and that’s not going to be just for biohackers. In the same way that you’ve seen Quantified Self. People used to talk about Quantified Self, they don’t anymore. They even stopped doing the conference. And that’s really because Quantified Self shifted towards this concept of biohacking, it’s more salesy, it’s more marketing. But biohacking really made the concept more accessible to people and it had a more holistic and emotional aspect. But I think that’s the third stage of evolution, which will be to the true mass mainstream health tracking. And probably a huge trend behind that is going to be healthy aging.
Daniele: That we’ve seen, excuse my lone dialog. But we’ve seen the athletes and the biohackers. And people typically in their 30s and 40s, maybe 20s really be on the leading edge of this health tracking. But I think that’s going to shift to the people who really have the deepest desire to be optimal, and the deepest desire to be young and healthy, and actually they have the most money, which is people who are aged 50, 60 and above. So I think that’s going to be a big transformation in the next 10 years.
Lee: I concur with everything you said. And you said a lot about it. I completely appreciate that. No, I love that. I appreciate it. And I’m so happy that we’re speaking for the first time. It’s great to hear it and it’s great to have a record button going so that others get value. I’ll pick up on a couple things you said there. I feel we could chat all day. And I know you’ve got a cough, so I’ll keep proceeding ahead. I’m surprised you know FoodMarble, did they come through HAX also?
Daniele: Yeah. So we are Alumni.
Lee: They’re an Irish company, they were planning on adding hydrogen. I’m just very surprised you know of them. [inaudible]
Daniele: Their products are their market. So kudos to them. I think the sensor itself is not too heavy duty. So they’ve managed to get the cost down to a good price and they have rave reviews, which is the most important thing. They have customers who love the product. And yes, they started with the nitrogen testing, but then moving on to the hydrogen testing, maybe it’s the other way around, I forget.
Daniele: And that’s really, I would also see them, I see them as being brothers in the same space because we are testing data from waste. We are testing data from the things that we have to produce from our own body, the saliva, the feces and also the breath.
Daniele: This is an interesting anecdote, Toto, the toilet company I mentioned, they actually spent some time trying to analyze fecal gas, essentially not really your fart but the air that comes to out of your posterior when you use the toilet to try and get insights.
Daniele: The other startup in, well SOSV is the fund that invested in us, I’ll say SOSV, they own IndieBio. Probably some of your listeners will have heard of IndieBio in SF. And also HAX which is based in Shenzhen and [inaudible] in UK. There is Cora. And Cora is very interesting because obviously you know what a CGM is, a continuous glucose monitor. And Cora is the first device I’ve seen that is a multi biomarker, continuous monitor. So they are testing glucose and lactate. Why is lactate important? Well it’s important for athletes. Through the lactate threshold, for example, essentially it’s the pushing your training intensity as far as you can without fatiguing yourself to improve your endurance.
Daniele: And they basically designed a system where they can have very small needles that are completely painless, and they can multiplex. So it’s not just glucose, they can have, I think up to four needles right now. And they’ve also innovated or made innovations in the manufacturing process to automate what was previously a manual process and was one of the major reasons for products like DexCom [CGM], for example, being very expensive. So I see FoodMarble, obviously ourselves and Biomesense or as it happens, SOSV startups, really pioneering in that space of data from waste. And then Cora being the next gen CGM, and then hopefully I really hope that COR comes to market and will be that blood lab test at home that we all really want. So yeah, that’s very exciting.
Lee: Yeah, it’s exciting. Yeah, FoodMarble do hydrogen today and they may have plans for methane [crosstalk 00:48:06].
Daniele: They’re testing cows while they’re at it.
Lee: Yeah. Because a lot of people have, for example, small intestinal bacterial overgrowth, so you could potentially use it in that setting. So, this home health monitoring instantly, you could also include the likes of Alexa, Amazon Alexa, voice biomarkers comes to mind and an Alexa that also gathers data from these devices that you mentioned, including your own.
Lee: The whole biohacker thing to me seeing, how could I put it? To me, it’s an indicator of the future we’ve already arrived at. Quantified Self I think goes back to 2008 and then it led to what became Fitbit. One of the founders used to go to, was one of the early people at Quantified Self and it led to the fitness trackers et cetera. And I think that Quantified Self in my opinion has passed its time. And I think the now of it is quantified health, wellness and aging, that’s where we’re aiming now. And by health often people mean disease but we actually mean health. It’s amazing how little we know about measurements of health except for some fitness like VO2 Max or HRV but it’s very limited. Our measurements of health if we had a planet, it’s just like checking two cities, so to speak.
Lee: So we’re quite limited in the resolution of measuring health. So for that reason, and a number of other reasons I won’t go into this point. I renamed this podcast and relaunched it as Quantified Health Wellness and Aging and you’re actually the first guest under that new naming.
Lee: And also, I’ve created a LinkedIn group, which will be live later today or tomorrow, which is for industry professionals, and it’s quantifying health, wellness and aging. So it’s interesting that you brought it up. So biohacking is the, you can see the wishes to take control of our health because of the chronic disease burden, of obesity, of people feeling crap, of people having brain fog, et cetera. We’re under constant bombardment, like with toxic loads, et cetera. And the orthodox healthcare isn’t taking care of subclinical issues, and it’s letting people blindly walk over decades into horrible diseases and decreased healthspan. So and people are learning that health isn’t binary, they can upgrade their health, feel better have more energy, even if they currently do think they’re well, there’s even higher levels.
Lee: So I appreciate by the term biohacking in meaning, “Hey, we’re trying to take control of our health” It’s promoting a distributed, decentralized, preventative health care. And we’re adding optimization because healthcare doesn’t include optimization services in its paradigm. But this hasn’t became networked yet. And I think this is, in fact I know this is where we’re going. Instead of just being isolated individuals having meetups it becomes sort of distributed in the network and quantification is the currency of that. And then when you begin to see that, it’s just an explosive picture that’s never ending value.
Daniele: Yeah, I think I would largely agree with many things you say. I mean biohacking is, it takes me back to the point about personalization of health, that there’s a health aspect to biohacking and they say, like a physical health, and there’s a psychology aspect. So people come to biohacking or they come by hacking for different reasons. Some people come because of a previous condition that really made them feel, “I really need to do some of my body.”
Daniele: Some people feel that they couldn’t get the help they wanted from the medical system. I think it’s very important that we, in my opinion, that we try not to blame at least the doctors. I think we have extremely broken USA healthcare insurance system. I think the most important innovation you probably need is single payer or something similar to that rather than say private health insurance. I probably would offend some people for saying that. But-
Lee: You’ve upset a lot of Republicans.
Daniele: I know. But what I mean is doctors are our friends, that they are there to help us and I think most people who go into the profession really want to care for patients. Incidentally, while we’re talking about insurance, the irony is that private insurance is actually still a form of socialism. I’m not a socialist, but it’s socialized in the sense that by paying premiums you are paying for other people who get sick. So it’s… I’ll stop there.
Daniele: But yes. So I think it’s really… I see quite a lot in the keto, also all related spaces, people saying well many influencers lie to us, they lied to us you can’t trust your doctors, some influencers say, “Well trust me, buy my products.” And there’s some truth in that. But people ultimately are responsible for their own health and doctors are ultimately there to help you. I think it’s important you have good care through a good price.
Daniele: But I think biohacking as a concept probably was really born in the US because there was such a neglect of health and at the same time, it’s almost like an extreme that was produced in response to that in the same way that you have gym culture really grew up in the US, right? The body beautiful in such a big way.
Daniele: But now what we’re having is, having come from that very niche perspective of Quantified Self, then to biohacking. Really what I think we’re seeing is most exciting it’s going to be just a normal, mainstream culture of health and wellness. But what is definitely true is in the biohacking space because wellness is a more ambiguous concept. And it’s also state of mind that some people make very good money by simply making people feel good about themselves, and that’s great. But it’s not necessarily scientific what they’re doing either. So I think there’s always that tension that when you see the traditional medical industry, things can also be more scientifically rigorous, although it’s obviously been shown that many research papers and can also be biased or inaccurate. There’s more rigor, but there’s obviously less care for the total person and the pre patient.
Daniele: One thing I really noticed when I go to healthcare and med tech conferences, I do less now, is two things. People talk about quality of care, not access to care. And secondly, they talk about treatment rather than prevention. And I think what I would like to see is more scientific rigor and objectivity in the wellness industry, but a lot more empathy and compassion in the medical industry. And I think if those two come together, it’s a very exciting future.
Lee: Again, I concur and find your views laudable. And, again, we have a nice matchup here. I’m not only concerned about healthcare not being data-driven, and often having, well, mostly having clinical practices stated to be on average, 17 years behind clinical research, which is quite alarming. But I’ve been working for a number of years in what we call the wellness industry. And I’ve come to see that it’s a wild west, and I feel pretty bad because I know a lot of products and services offered just are not worth the money being charged. I’ll leave it at that and just say the wellness market is like the wild west.
Lee: And for example, you picked up on my hint of genetic testing for diet is bullshit. Some other tests also I won’t go into there because I appreciate the businesses they’re trying to build and how they’re trying to get somewhere. So that’s also why I’m interested in quantification, isn’t just because healthcare – i.e. this reactive system that waits for you to get sick first and doesn’t do optimization. But it’s because the wellness market itself is often misleading.
Lee: Once we start quantifying, then we have a currency that operates across the entire system and it will fuse with InsurTech and FinTech. So amazingly exciting, but I don’t want to jump too ahead in future. I do need to ask you some questions before I lose you. So you also, in this Body Coach, you also have electrolytes like magnesium, and I must cover magnesium with you because magnesium is, I think I’ve held the same opinion for five years. It’s a number one thing I believe most people should be taken and you should be taken out quite a lot and in a number of forums. Let me just quote Dr. Norman Shealy to you. “Every known illness is associated with a magnesium deficiency. Magnesium is the most critical mineral required for electrical stability of every human, every cell in the human body and magnesium deficiency may be responsible for more diseases and many other nutrients. And yet many of these illnesses Americans have they’re needlessly suffering and they’re getting given drugs could actually be cured with magnesium supplementation”. So do you want to talk about the electrolytes first, your device can-
Daniele: Sure. So there are four ones right now, sodium, potassium, magnesium, calcium. We don’t test things like zinc, for example, because it’s not super elaborate in urine. It’s best to test things like the zinc in feces. But for these four, they’re very important and they all play different roles. But it’s commonly said, people are told, “What’s your salt intake? Don’t have your salt intake too high.” And there’s some truth in that, but the picture is a bit more nuanced. Sodium or, salt is sodium chloride, is really, really important for many, many body functions.
Daniele: One thing I learned recently actually is that sodium is used by the body to transport glucose into cells. So when you consume carbohydrates, you may know that your body releases insulin and insulin causes the body to retain sodium. A major reason for this is it needs that sodium to get the glucose into the cells. So if you have a high carb, low fat, low salt diet, it’s a terrible combination because you have that huge insulin in stimulation, low sodium availability to process that glucose and honestly low fat which is not good for your hormonal health.
Daniele: But sodium certainly has a very important relationship with potassium. Most of your sodium is contained in your blood. And most of your potassium is contained outside the blood, which means in the cells and in the fluid between cells and organs, the interstitial fluid. And the ions, these sodium and potassium ions can be exchanged between these different compartments pushed back and forward through something called the sodium potassium pump. And that pump is powered by magnesium. So if you have high salt and low potassium you can suffer from elevated blood pressure, why?
Daniele: Because in your body water moves to the area of highest electrolyte concentration. It does that in order to reduce the concentration of electrolytes. If you have high sodium and you have low potassium, generally speaking more water will move into the area where the sodium is to reduce that concentration relative to the concentration of potassium and that area is primarily the blood. Blood volume increases, blood pressure increases. Obviously other factors are involved but that’s a pretty good general rule.
Daniele: And magnesium is a very important factor in powering the pump that causes ions to be exchanged back and forth between those two compartments and essentially for electrolyte balance. So if you have even a reasonable amount of potassium in your diet and you have low magnesium, some people can experience high blood pressure symptoms as a result. So it’s really, really critical.
Daniele: Calcium is also really important. So people typically think of calcium as being something you consume to keep your bones and your teeth strong, and that’s true. But calcium also has another very important role, which is it helps what’s called smooth muscle, but basically muscle tissue relax.
Daniele: So when you, sorry to talk a dark conversation, when you die, we talk about rigor mortis. Where your muscles become stiff, it actually takes energy and electrolytes to make your muscles soft, they’re not naturally soft. So if you have elevated blood pressure or elevated blood volume, I should say, having a good amount of calcium in the diet is very helpful to avoid your blood vessels being too stiff and getting them to flex to withstand that pressure.
Daniele: So, these four have a very important relationship. Also, high sodium displaces calcium, it pushes calcium out. So, really you want a good amount of sodium, a good amount of potassium relative to sodium, ideally the same amount or more and then enough magnesium and calcium. And these four and harmony are going to produce the best results in terms of obviously physical performance, blood pressure, general health nurse function. And also even things like body composition.
Daniele: Sodium is a great, like insulin as well, is a great retainer of water. So typically, people who have high sodium intake and low potassium can experience least temporary water retention and increasing potassium intake can help with losing some of that retained water. So it really, really is critical not just think about your salt intake, but actually all four of these together in the right amount.
Lee: I’ve been looking at this for the past couple years on and off of nutrient balancing. And beginning with mineral wheels, and lately I’ve progressed on to hair mineral analysis, because I’m concerned about the balance. And the short of it is, it’s more of an art. And there is no definite hard guides of ways of measuring, ways of doing ratios and ways of knowing they’re in harmony that at least I can see it still very practitioner led and guessing and playing. So maybe your device can help people to achieve that balance. I don’t know how, if it is possible.
Lee: So if we take magnesium, most people measure magnesium in the blood. Blood only has one percent [of total magnesium]. And the standard test, I don’t know why, but the standard one I see doctors run is useless. It’s only a test of, can you keep homeostasis of magnesium in your blood? And most is stored in your bones something like 60 plus percent. Obviously it will pull from it, so it’s pointless. And so you can test magnesium RBC, intracellular, that’s why I test and I find it useful. I’m doing a lot of magnesium dumping I noticed it’s often low and I don’t know if that’s because of toxic load, from amalgams.
Lee: But Carolyn Dean, who I’m sure you’ve heard of, the author of Magnesium Miracle actually mentions a third type of testing which uses urine, I think it’s 24 hour collection. So I’m not sure what your device offers. If I understood right, that you need 24 hours to [inaudible 01:06:16].
Daniele: So it’s true that in clinical practice, when people want to assess electrolyte intake with what you might call gold standard accuracy, so the most accurate way of assessing magnesium intake of any bio fluid is a 24 hour urine collection. What I can say is that regular spot measurements of magnesium also provide an actionable measure. So it’s not gold standard compared to 24 our collection, but, and you can see it again in sodium potassium studies as well, that when people take a single spot measurement of say sodium alone, it’s not a very useful biomarker. When they combine that with sodium and potassium and creatinine, it becomes better and pretty good. And when they take that on a periodic basis, it becomes a lot better.
Daniele: So, in an ideal world, we would get gold standard measurements of all our biomarkers all the time. That’s not going to happen. Practically speaking in terms of technology and cost. So what we do is, for each thing we want to track, we try and find the best trade off in terms of money, time and pain to get the best overall picture, and that’s what we offer. Yeah.
Lee: Yeah. And if we had time, I would have picked up on integrative omics and began to challenge it from a cost perspective, long term it looks great. But I see we only have a couple minutes left and I’m really worried that I don’t honor your time. So first of all I’d like to, definitely need to ask when’s the device becoming available, how much would it cost? How much do the strips cost? Because this is more of a subscription I guess.
Daniele: Of course. So, as you suggest the description is the main part for us. So we’re looking at $20 a month, give or take, which would give someone at least one test a week, if not two. We will have a clearer sense of the final cost once we finished our design from manufacturing, which probably I would say is nearby around June. We should have a much clearer picture of the final price.
Daniele: The main, really unit, the test tick reader, which can test a range of different testings, it can also be used by more than one person. So it’s designed that urine can never go inside, everything stays on the chip in the test stick, that’s looking at being $100, give or take. We’re really interested in a lot of people being able to use this on a regular basis rather than a small group of people doing biohackers being the only ones who really use them.
Lee: How do I get one before anybody else?
Daniele: Of course, I’m happy obviously, of course to priorities for the beta list. What we’re doing is, we’re expecting to go on sale in Q4 this year. So something around October, November. Hardware infamously takes time. But we’ve reached the stage now we feel pretty confident about that deadline. And then I’m going to be doing in person demos in Q2 this year. And then I expect to have a beta program in Q3 this year. This is for a period about three to four months, maybe five, we will have a number of devices in circulation.
Daniele: Some with individual end users, some influencers, some with me here as well. So if people go to our website at B-I-S-U-.-B-I-O, that’s bisu.bio. There’s a mailing list you can sign up for there, we will send you one email a month unless you’re opting to get additional content. And you can just be in the loop until that’s available. So we’re sorry to keep people waiting. It’s been a long journey for us. But we’re very excited about this year, if you happen to be in the US if you’re in SF, LA, New York, Austin or Seattle, we’ll be, New York is New York at Hudson Yards, by the way, we’ll be in Beta stores, that’s B-A-T-A from roughly mid March. So keep an eye out. You can see the device in person, you can play with it, you can see the app as well. So that’s an opportunity to get up close to the device and have a feel for it even before it’s on the beta program.
Lee: I appreciate that. I’m going to throw in two questions, spend a few seconds on them, that’s what we have left. But I have to throw them in. Quick, the future roadmap. And secondly, you made a statement I saw online of chronic diseases, self caused and self treated. So just future roadmap and your statement of chronic disease, self caused and self treated.
Daniele: Yeah. So future map is launching this year with the diet test stick, and then I can’t disclose the names, but we are progressing a number of collaborations that should result in new test sticks being launched this year. Some just buy us, some co branded for things like oral health, baby health, pet urine testing and so on. That this product is going to evolve from initially for people who maybe say keto dieters or athletes, for example, or marathon runners, and from that initial segment to something for the whole family’s health. And then based on this data, we can provide, not push, but provide relevant products and services. So one can be food delivery, or potentially supplements or medicine or a consultation with a doctor, a dentist, a vet or a personal trainer.
Daniele: And the app experience will also change eventually. Right now it’s slightly more on the biohacker side, it probably if you look at Oura Ring, you’ll see some similarities of the design. That’s going to change to probably a basically a chat interface that you would speak to bisu. Maybe it’s verbally, maybe just through the app, like chatting with a doctor. And that’s really the vision for the product, that we’ll be an advisor in your home, who knows maybe integrate with Alexa one day.
Daniele: About the statement I said, Yes, I said was the effect of that chronic disease is self caused and self treated. I want to make it very clear. I’m not accusing anyone of being negligent about their health. Our bodies are complex. People have different circumstances, personal, financial, knowledge wise. No one should be made to feel ashamed of themselves for their health condition. But what I mean is, is that according to the CDC, so the Center for Disease Control in the US, half of disease risk is down to lifestyle behaviors. So your genetics is important, your healthcare is important, your environment is important. But by far the largest single factor is what is happening in your daily life. What you eat, how much you sleep, how much stress you have, do you smoke tobacco, how much alcohol do you drink? These are the key factors.
Daniele: And our aim is not to shame or blame people, we really don’t believe in that. But our aim is to empower people and to actually give them the tools they need to understand what’s going on with their body. So that’s what we’re about.
Lee: The chip measures eight biomarkers simultaneously.
Daniele: Currently yes. We’re aiming eventually to increase that to 10. It’s more of a trade off between the amount of sample that’s sucked in and the size of the agents themselves. So we’re expecting we can probably get that to 10 by the end of the year, once we get closer to the mass manufacturing device. But for now it’s eight and we’re very happy with that. But probably 10 would be the maximum. That’s very standard. That’s the number you get on a standard clinical urine test trip, so we would not be limited in that respect.
Lee: Daniel, I greatly appreciate your time. There’s so many more questions I’d love to ask you. And every time you talk it raises more questions, I’d love to ask you. So hopefully we’ll come back on another time. And I wish to thank you for your time, your passion, I look forward to this product. I’m going to email you to see how I can get on the beta list for it. And once again, thank you so much for your time and hopefully come on another time. I can ask how you went from Japanese studies into this business.
Daniele: Very much appreciated. My pleasure as well. I appreciate you reaching out and I think next time I should be fun to share some experiment, share some data gathering, share some stories of people who use the product and ideally yourself as well. I think that would be a really nice evolution that will make it even more real for people who are listening.
Lee: Looking forward to it.
Daniele: Thank you so much.
Lee: Take care.