How to Get Into Ketosis Fast
The low-carb, high-fat keto diet has been shown to improve body composition and increase endurance performance. But getting into ketosis is difficu...
Updated August 9, 2017
It's about time to start treating health...not just disease.
Episode 36 features Dr. Ted Achacoso, an exceptional polymath who has professionally trained in interventional neuroradiology, pharmacology, neurology, medical informatics, neuro-interventional radiology interventional endocrinology, nutritional medicine, and more. After spending years absorbing knowledge from different areas of medicine, Dr. Achacoso current mission now revolves around HOMe: "Health Optimization Medicine".
Health Optimization Medicine just does that: Optimize health. Sounds a lot like biohacking, right? Instead of waiting for a patient to develop a reason for medicine, Dr. Achacoso is aiming to swing the pendulum towards optimizing health by detecting and correcting imbalances in your body (hormones, nutrients, toxins, etc). By doing this and taking precautionary measures, this practice has the potential to not only prevent future disease but also bring you to your most optimal shape.
Geoffrey Woo and Dr. Achacoso discuss the reasoning and science behind the HOMe framework, the problem with the "incentive structure" the current health care system seems to have, and Dr. Achacoso's own hardcore biohacking regime!
Geoff: Hey, THINKERS. Welcome to this week's Thinking Podcast. This is your host, Geoffrey Woo. I'm excited to have Dr. Ted Achacoso here with us today. He goes by Dr. Ted, and he's built up quite an interesting framework and practice around anti-aging. Very similar to how we think about bio-hacking in terms of optimizing performance as opposed necessarily to just curing deficiencies as a therapeutic. Before diving too much into his theories, I'd like him to introduce himself and give his two cents on how he would describe his practice the best. Dr. Ted, welcome to our show.
Dr. Achacoso: Thank you for having me. My name is Dr. Ted Achacoso and eight years ago when I finished my training in anti-aging medicine and nutritional medicine in Paris, I was struck by the fact that we were still using the concepts of anti-aging medicine using hormones and nutritional medicine using nutrients to diagnose and treat disease. I said, "How come no one's focusing on health?" Alright? I created this little framework called Health Optimization Medicine, or HOMe for short. In fact, our slogan is, "Let's bring medicine HOMe." Where instead of diagnosing and treating diseases, why don't we detect and correct imbalances in the metabolome before you could actually see disease, or when a patient has disease already? Then you actually help hasten the process of healing. The question in my mind was ... I remember when I was a medical student, they used to ask me, "Okay, Dr. Ted, what's your disease management?" I'd like two questions actually to be asked of medical students, is what is your disease management? The second question is, what is your health management? That got me to looking at all of the different types of medicine: allopathic medicine, which is the way we practice medicine now, Western medicine. There's alternative medicine, complementary medicine, functional medicine, and these all diagnose and treat disease. The reason why there is this friction between functional medicine and illness medicine is because they diagnose and treat disease. I said, "Well, why don't we make it inclusive?" I said, "Why don't we have a framework that just detects and corrects imbalances?" Any side effects that you get from balancing is a beneficial side effect.
Geoff: I think that's interesting, actually. I mean, just to interject here, I think when the definition of medicine is diagnosis, treatment, prevention of disease, right? Disease is a very specific deficiency to norm. The definition of normal healthy is a very fuzzy, amorphous term, right? 100, 200 years ago, the average life span was 40, 50. Now it's 80. Even the definition of healthy has evolved over time. Dr. Achacoso: Yes. What I wanted to do is to be inclusive with illness medicine. I was there once. I mean, I'm a trained interventional neuroradiologist. I trained in pharmacology. I have training in neurology. So I said, "Why don't we have a definite set of ranges for what comprises as optimal levels for an individual?" Because if you diagnose and treat, you do tests, right? So ripping a page from the playbook, I said, "Well, okay, let's detect and correct imbalances." And the imbalances that we could readily measure now, which were not measurable about 25 years ago, is the metabolizer Kreb cycle, for example. Or your neurotransmitters. And all of these other metabolides, can be measured now. Unfortunately, we are still stuck with the things that we used to measure before. For example, clinical metabolomics is now 25 years old, and yet it hasn't found its way to medical schools. And doctors are actually afraid to get back to it, because they squeak by, by chemistry. It's like bad news. The things that you just used to memorize before, we can now measure them. But what I'm actually after, is not looking at the metabolides themselves, but what are the co-factors that actually influence them. And this is why I like measuring your micro-nutrients. For example, your levels of fat-soluble vitamins, your co-factors, like your CoQ10. High falabolic acid.
Geoff: So to help explain a little bit of details here. So the Kreb cycle is how our body generates, or how our mitochondria generate ATP, energy currency for cells. And there's a bunch of these pathways, co-factors, that are steps in terms of passing electrons through the proton gradient. So, yeah, there's multiple steps in the kreb cycle.
Dr. Achacoso: And that's the thing, is that we can geek-out on all of the details of that, but ultimately when a client is in front of me ... I call them clients because they're not sick, right? When a client is in front of you, you have to know what to give your client, right? So, I hate these advertisements that this vitamin is good for you, that vitamin is good for you, and you fight all over whatever mineral, why don't you just test for the levels? And you test for the levels and then when they're deficient then replace them. If there's too much, then take it out.
Geoff: Yeah, manipulate the biometrics, right?
Dr. Achacoso: Yeah, so, because we're heavy into quantification now, right? And these tests are now readily available, so we can do that. However, a big part of the whole process, especially for hormones for example, is that of course they're a part of your metabolome, which is heavily used for anti-aging, is that we have to establish the actual optimal ranges for this. And there are three ranges that have been proposed that I know, one that is used by Thierry Hertoghe, the pioneer in bioidentical hormone balancing. He's out from Brussels. And he was my mentor in this whole thing. And he uses the average value at 25 years old, okay? So the age range is between 29 and 30, sorry, 21 and 30 years old, right? You have to shift the values at that level. Then there's Mark Gordon who proposes a median value. And there's me proposing the 75th, the 50th to 75th percentile, from age 21 to 30. So this has to be established.
Geoff: So you're saying like above average of your demographic? Okay.
Dr. Achacoso: Yes, yes. So if you have a 40 year old for example, or a 60 year old. Many of my clients are CEOs or having positions of power, so they're usually older. And you try to move their levels closer to the values between 21 and 30. However, the science of that is that yeah, you can detect the levels, you try to push it. But the art of it, is that all of these are network. You know, hormones are in network. You touch one, everything else moves. Nutrients are in a network. You raise the levels of vitamin E, and suddenly your anti-oxidant regeneration pathway gets fucked. Sorry, I'm ...
Geoff: Yeah, yeah, no. Let's keep it dynamic. No, I agree. The body wants to stay in homestasis. It's very hard to just shift one thing and not push everything ...
Dr. Achacoso: It's always in dynamic equilibrium. And that's systems of biology, right? Everything's in network. So the technique that I devised is actually network range shifting. Meaning the entire sub-network of, say hormones, the sub-network of nutrients, are moved down to the level when you were 21 to 30 years old. So that's the art of that, because you don't know what is going to move, right? And then ...
Geoff: I think what you bring up is interesting on the ranges, because if you look at the definitions today, the ranges are so broad.
Dr. Achacoso: Yes.
Geoff: And a lot of more forward-thinking practitioners are looking at it like, you're not clearly diabetic, or you're not clearly sick, but these are not optimal ranges, right?
Dr. Achacoso: This is actually very interesting. When I deliver lectures to doctors, especially in Asia, I do have a practice in Manila, I'm there 30 days every quarter. And it's really very interesting when they ask you, are these relevant to Filipinos. And I go, "How do you know that what you're using for your illness medicine patients are relevant for your patients?" So I attended this lecture once a few years ago, where this guy was expounding on laboratory values and where they came from. And he said, he tells this story about the thyroid hormones, right? He said it's the average of a thousand patients between age 3 to 94. So I am 55, really you're going to put me in those ranges? So there has to be that optimal range that has to be there. Alarmingly though, there was a study that was presented a couple of years ago. A very large cohort study of normal males and females, aged 21 to 30, in Europe, and already they're finding severe deficiencies in testosterone, menstrual abnormalities because of hormonal disturbances, and so on. And defining the roles of endocrine disruptors in the environment. And so where do we, we have to choose some range somewhere, right? So for me, the art of it is that yeah, you try to push it as close as possible to those ranges, but you stop when the patient says, or the client says, I really feel good at this range. And what's interesting is that prevention is always in hindsight. If no one bombed the world trade center then you'd never know that great lengths and effort that was put in order to prevent that bombing, right? Preventive health is the same way. I have a patient, for example, who says, "You know Dr. Ted, I've already been a year under your care, and I don't notice any difference." And I said, "You know, how many times have you got sick last year?" "About six times." This is before my care. He said, "About six times a year." I said, "How many times did you get sick last year?" He said, "Oh, my god, I never got sick last year." I said, "And that's the way this thing works." But on the other extreme, the other way of patients responding, is that "My god, my blood sugars are all normal. Dr. Ted, why don't you advertise your practice as something that can cure diabetes." Because I make no claims. That's a whole part of it. Is that there are no claims here. Any side effect that's beneficial is just a beneficial side-effect. So in that way, we're all inclusive. So you can refer, if you don't like the review of your doctor, if you don't want to review your biochemistry any more, you don't want to learn about metabolomics, epigenetics, gut mitabiota, mitochondria, exposomics, chrono-biology, evolutionary medicine, then you just refer the patient to us.
Geoff: From the mainstream, or I guess the typical medical establishment, I think it's always interesting that bifurcation around, "Okay, we only wanna treat the Zs and once you're in a healthy range, we don't wanna manipulate yourself. I mean why do you think that ... I'm sure you've gotten that sort of pushback.
Dr. Achacoso: You mean ...
Geoff: Because I think from an engineering perspective ...
Dr. Achacoso: Why fix what ain't broke, right?
Geoff: But if you look at the average norms, it is clearly broken, right? Like a third of Americans are pre-diabetic and diabetic. Obesity rates up in the right, I mean metabolic syndromes. So I think when we have different ... Usually we invite forward-thinking doctors on this program, and it just seems there's a lot of conservatism around not ... You know, "You're normal, we don't want to manipulate you." Why do you think that exists in the establishment?
Dr. Achacoso: Yes. Because that's how medicine is taught. You're essentially taught that these are the diseases, these are the pathologies, and you treat them. After that we don't care about you anymore.
Geoff: Yeah, we don't wanna touch you, right?
Dr. Achacoso: Don't wanna touch you anymore. But me being me, I, when I lecture, I actually accuse my colleagues of one thing. Because looking at it from a health perspective, makes you think a lot more of more moving parts. In fact, I just had an experience lately of having a joint client actually patient who was very wealthy, with chief of endocrinology of some major hospital. And came to my clinic and initially arms folded and just waiting for me to make my mistake. And then I showed that I take the entire the major hormones all of their levels and not just one organ. I take your cancer panel, I take your inflammatory panel. And then when he took a look at what I was doing, he said, "You do all of those tests." And I said, "Yeah, it's a network. Why don't you want to know all of the elements, all of the nodes in the network, and what's going to move?"
Geoff: Absolutely the bio-hacking way, right?
Dr. Achacoso: Yeah.
Geoff: You have to measure everything to understand how these things can be manipulated. If you're not measuring then it's just like you're just shooting in the dark.
Dr. Achacoso: Yeah, because the problem of the patient, this patient was salt wasting, right? So I wanted to give all those theorems which will retain the salt, right? And they said, "Why don't you just give a cortisol. It's gonna do the same thing." I said, "No. See, you didn't measure in the hospital, you didn't measure the cortisol levels. I did. And the cortisol is way up high."
Geoff: It would be high, right. You don't wanna be jacked up on cortisol.
Dr. Achacoso: Yeah. So suddenly it's like, yeah. And then they said, "Oh, you don't give any superficialogic doses, you don't give them as drugs?" "Yes, I use them as balancing agents. All you want to do is actually shift them to levels that are optimal for the patient, right?" So after that whole experience, he got friendlier. And I was leaving my clinic. I put my arm on his shoulder. He said, "come practice this thing with me." And he says, "No, no, no, no, no." He says, "I'm happy with my thyroid and my pancreas." And I said, "Why?" He said, "There's too many moving parts to think about. It's easier to think about it at an organ level." And that actually outlines difficulty of why many are do not like to practice this type of medicine. It's because you are forced to look inside the cell now. You're to look at networks. Whereas before you could just focus on the brain or the heart.
Geoff: Yeah, the specialization of medicine.
Dr. Achacoso: Yeah. But then when you realize that they're all made up of cells with certain basic requirements. Then suddenly you're ...
Geoff: It's one body.
Dr. Achacoso: Yeah.
Geoff: Right? It's one system.
Dr. Achacoso: And there's a least common denominator by which they function. They require things. All of them have this, more or less the same structures. And there's just some specialization with the ...
Geoff: No absolutely. And they think like you know three, four, five years ago, when I was not as caught up to speed in bio-hacking, I would have been very skeptical. Because you just trust the typical medical establishment and then you realize, you look into it, you do your own research, you do your own reading. You talk to experts in this field. And it's like yeah, medicine in a lot of ways is very medieval in looking at the whole system as an inter-connected network. Very much how you talk about it. If you're just looking at the liver as ... Or as nuerology ... As one localized system, well there's so many ... There are diet effects. Diabetes which affects the liver, right? You're looking at the last effect, not the primal effect.
Dr. Achacoso: Yes. Well also the focus is always been in the entry of patients to health has always been through disease. And that's changing now, because there's a lot of new informations coming in. The media plays a large part.
Geoff: And I think also yeah people are more educated. The decentralization of information. People are looking at like "Hey we shouldn't be thinking about health only when we're sick. Let's be optimizing and becoming enhanced." Right? That's like the whole bio-hacker ethos. Okay, like we could all improve on this performance spectrum. It's not just like your sick, your healthy. It's really a spectrum.
Dr. Achacoso: It's a spectrum. Yeah. Health is a spectrum.
Geoff: Let's all be more to the healthy side. The enhanced side.
Dr. Achacoso: Yes. I have this definition of health that I actually like. It's very simple. Health equals A plus B plus C.
Dr. Achacoso: A is the absence of disease. And that's where the illness medicine doctors come in.
Dr. Achacoso: B is the balance between the catabolic processes and the anabolic processes in the body. According to C, the cycle of life of the organism.
Dr. Achacoso: So when you're young then you're geared more toward anabolism, like pediatric patients, right? And when you're older you're geared towards, more towards catabolism.
Geoff: Catabolism, yeah.
Dr. Achacoso: So what you wanna do is to balance that.
Geoff: Yeah. Anabolic is growing. Catabolic is breaking down.
Dr. Achacoso: Yeah. Essentially by evolutionary medicine as soon as we have our progeny evolution doesn't want to have to do with us anymore.
Geoff: Yeah, yeah.
Dr. Achacoso: But we have extended lifespans and so. So how do we live a high quality life?
Dr. Achacoso: And between quantity and quality people choose a higher quality to life all the time, right? I don't want to life in pain to 100 years.
Dr. Achacoso: If I can live 5 good years with high quality life, I'll take that, over 25 years of pain.
Geoff: And then let's get quality and quantity.
Dr. Achacoso: Yes.
Geoff: That's the ... Let's get both. I think one aspect I wanna dive into is metabolism.
Dr. Achacoso: Yes.
Geoff: So a lot of the emerging research around keytome bodies, kijac diets, low-carb high fat diets, caloric restriction
Dr. Achacoso: Mm-hmm (affirmative).
Geoff: That's been a big area of interest and research.
Dr. Achacoso: Mm-hmm (affirmative).
Geoff: You know one of our communities the WeFast is one of the largest online fasting communities.
Dr. Achacoso: Yes, yes.
Geoff: What have you ... I'm curious to get your opinion on that specific pathway.
Dr. Achacoso: I love it, but I also would like to say this. Before you do any diet, any fasting, any anything, please the technology now exists. Get your micro-nutrient levels assessed. Because before with any manipulation in your macro-nutrients, carbohydrates, proteins, and fats, or even caloric restriction, you are going to affect the micro-nutrients in your body. I mean, poor body.
Dr. Achacoso: There is the set of optimal for them that you should maintain before you start going on that fancy diet.
Geoff: Sure. Yeah.
Dr. Achacoso: Or this and that diet. And then for me in terms of as far as different diets are concerned, I really maintain it very simple. You manipulate your macro-nutrients according to your activity. So if you're going to do triathlon, etc. etc., you manipulate your carbohydrates. If you going to do bodybuilding you manipulate your proteins.
Dr. Achacoso: If you're going to do sit on your duff the whole day, then reduce your caloric intake, and burn fats instead.
Dr. Achacoso: It's cleaner fuel, right?
Dr. Achacoso: So for me personally I am on a 16 hour fast daily.
Dr. Achacoso: When I'm here in the United States, my first meal is at noon. And eating at 8 PM.
Dr. Achacoso: It's also the easiest way to get your patients or your clients to comply with any food requirements. Because they can manipulate their time, but not what they eat, right?
Dr. Achacoso: So this is my first advice, is actually, you know, I tell them, "You know, first the guilt, right?" You know humans are really so shameful as a species, because they have permission to eat from the time they wake up to the time that they sleep, right? So they think about that and they feel guilty, right? And then I said, "Why don't you try for 2 weeks reducing it to 14 hours?"
Dr. Achacoso: Then next two weeks, 12 hours. Next two weeks, 10 hours. Then the final two weeks, eight hours.
Geoff: Yeah, no, a 16, 8 fast, is not that hard. It's like skipping breakfast.
Dr. Achacoso: Yeah. Look, I am not asking you to change anything that you eat. You can dump everything else into that eight hour time period.
Dr. Achacoso: And then they ask me why. And I tell them, "Look ... Although the common analogy is that mitochondria are the batteries of your cell. They're actually your bacteria, right? I regard them more as kitchens that cook your food for you.
Dr. Achacoso: So they cook the food, they produce ATP. Now if you keep on putting food in there, it will never ... It's a self-cleaning oven. It will never clean itself up. It will throw up a lot of gunk and dirt and so on, and you never clean your kitchen. But if you remove food from it for a while, then it will regenerative itself.
Dr. Achacoso: It will clean itself, yes. Mitophagy. And it will produce you new batteries for the next day. So it's a lot better for you, right?
Dr. Achacoso: But for me, macro-nutrients have to be dictated by the activity that you have.
Dr. Achacoso: And then what I'm strict about is always making sure that your micro-nutrients are optimal levels for whatever it is that you wanna do.
Geoff: Yeah, absolutely. I think that, I mean if you're just deficient, nutriently deficient, obviously if you were fasting, you're worsening that problem. I think in this day and age, most Americans, most people in general are over consuming rather than under-consuming, right?
Dr. Achacoso: Yeah.
Geoff: But yes, get the levels checked so you actually know what you're trying to do.
Dr. Achacoso: Yeah. And this the one thing that's nice, is that if their illness medicine doctor sees that, "Oh my god, it's been checked," and, "Oh my god, I fucking forgot the neboltis pathway." You say, "Go back to your doctor."
Dr. Achacoso: It's interesting, because sometimes I get calls here and these from doctors, "Dr. Ted," he said, "Your patient brought his test results to me." I said, "Well, I told him not to bring it to you." And it's just, "I don't know how to read this." I said, "Well, I don't how to read your tests in cardiology either." So I said, "Send the patient back to me." Right?
Dr. Achacoso: So it is a ... That's why it's a different specialty altogether. To be able to do that. And after you get the test results back, say you tested the metabolome for the hormones and nutrients. And what do you do? You have to deploy different agents of balancing, not just giving the supplements alone, but they help a lot because you know from my experience, I've been doing this eight years. From experience, your patients or your clients will never eat properly. That's number one assumption you have to make.
Geoff: Yeah, it's hard to put in person, right? It's hard.
Dr. Achacoso: Yeah, it's like, you show them all the ... "This is too much." I said, "Because you'll never eat properly. There's no guarantee." And then after that you have to take a look at the quality of your sleep. You have to take a look at their quality of their relationships with the family, the stress-levels, their work. You have to take a look at their gut health. You hae to look at mitochondrial health. You have to ... There was this patient suddenly developed anemia when he moved to another house. And this was a house that's surrounded by high tension wires and so on. And those are known to cause leukemia, right? Will you ask a patient to move? And it's an impossibility, right?
Dr. Achacoso: So these are the kinds of things that you have to deal with. Then you take a look at what epigenetic measures can you provide. Like for example, turmeric or curcumin and resveratrol, all these with epigenetic effects, how relevant are they to your balancing.
Dr. Achacoso: So I devised this three layers of balancing. First you balance them with bioidentical nutrients and hormones.
Dr. Achacoso: And the second layer would be ...
Geoff: So actually bioavailable. Because a lot of supplements like they don't get absorbed properly.
Dr. Achacoso: Yeah, bioidentical, bioavailable. And bioactive. It has to be in an active form. Like Thiamine Paraphosphate.
Dr. Achacoso: Or 5-methyltetrahydrofolate. You have give them the active form.
Geoff: For acid, right.
Dr. Achacoso: Yeah. Yeah. So ...
Geoff: You mentioned the gut microbiome, I think it's another area of interesting research. A lot of the data is preliminary, but a lot of researchers are excited about it.
Dr. Achacoso: Actually yes, I just brought a couple of patients of mine to Germany where the world's leading expert in adult fecal micro-biota transplant actually works. And this is it's very exciting because it's a one and done kind of thing. See in Europe, it's already approved for ulcerative colitis, IBS, IBD, right? And those are the only indications, but we're trying to establish research now, between Europe and Philippines, where we could examine, for example, it's utility in Alzheimer's, and depression, and Parkinson's.
Geoff: No, I mean, it might sound a little bit far fetched, but there's more gut bacteria, foreign cells, than human cells in our bodies.
Dr. Achacoso: Yes.
Geoff: So in a lot of ways, yeah, we're more bacteria than human.
Dr. Achacoso: Actually that was corrected sometime January of last year. When we say that, we're referring actually to the bacterial genome, right? But more or less our gut bacteria ...
Geoff: The actual count ...
Dr. Achacoso: The actual count is more one is to one.
Dr. Achacoso: But the genetic content outnumbers us.
Geoff: Okay, yeah. We'll look into the ... Yeah, I know it's a range between 1 to 10X, but yeah.
Dr. Achacoso: It's been perpetuated as such, but they did a recount. So when people ask me, it's the difference between knowing what micro-biota is versus what a microbiome. So when you're speaking of micro-biome, and just speaking of a genome, yes, that's true. But if you're speaking of a microbiota ...
Geoff: The cell count.
Dr. Achacoso: That's probably more of a, yes, more of a one to one kind of thing.
Geoff: But regardless, there's a lot of foreign, non-human cells floating around in our systems.
Dr. Achacoso: And not only that, a couple of years ago, I was thinking, I said, "Oh my god," I said, "I need to find out the communication system between prokaryotes and eukaryotes," right? So how do gut microbiota communicate with us. Or intestinal lining, or however. And I said, "If I am able to find that, then I would win my Nobel," right? And a friend of mine sends me this article that had the three Nobel laureates that were awarded in 2013 for exactly the same problem. Meaning they discovered the whole thing 10 years ago, because Nobel lags 10 years behind, right?
Geoff: It takes 10 years, yeah.
Dr. Achacoso: And it's micro RNA. They bud off via alter-membrane vesicles and then they deposit themselves into our intestinal cells. And they take charge of our genetic system. In fact, last year at Institute Pasteur, where the international society of microbiota conference was held, there was this fear that we think we're controlling ourselves, but actually this gut-bacteria they are in control.
Dr. Achacoso: And the founder of that in fact and inviting the founder of the world metamotic society, and the international society of micro-biota, it's just one person, to speak in Manila in September. And he suspects that there is actually communication between your endosymbiote, which is your mitochondria and your exosymbiote, which is your gut micro-biota.
Dr. Achacoso: And what I told him, "Marvin, it's micro RNA." He said, "No, it's too complex. It's probably something simpler than that." And I said, "It's micro RNA." But we'll see how the whole communication turns out.
Geoff: Yeah. That's interesting. I think, yeah, mitochondria. The theory of how they even exist, were that they were swallowed by a bigger cell. And that's how you got eukaryotes, right?
Dr. Achacoso: You know actually, I read a better version of that, that it's really originally not a symbiotic relationship.
Dr. Achacoso: The anaerobic bacterium, the proto-bacterium, that was in close proximity with what has become mitochondria actually possessed the klepto-gene. And the klepto-gene steals ATP from the mitochondria. So in the course ... It was more sinister than we thought.
Dr. Achacoso: It's not a cooperative thing. Like, "I wanna steal the energy from you, because you can produce ATP." But over time then we dropped the klepto-gene and stopped stealing the ATP from the mitochondria. And that's actually a interesting bit of evolutionary medicine. It's like, "Yeah, no, no, it's for your survival," right? So occasionally there's too much oxygen here, and I cannot process any of this. Or too little sugar that I cannot survive. So that was a mechanism that they had.
Geoff: Yeah, no, it's pretty interesting that.
Dr. Achacoso: Can I steal your ATP, right?
Geoff: Yeah, I mean it's interesting how like, yeah. You have like single cell creatures and somehow you start having organelles that are fairly complicated. Yeah, I mean, it's interesting, how all these things come together.
Dr. Achacoso: But what's fascinating for me is we communicate in this vast networks that are only beginning to get unraveled at this time.
Dr. Achacoso: And looking at, for example, now we know that there's a prokaryotic to eukaryotic communication, right?
Dr. Achacoso: And then it's also been shown that food itself have micro RNA that can effect the behavior of your own cells.
Dr. Achacoso: And therefore your entire behavior.
Dr. Achacoso: When I was teaching gut micro-biota five years ago, and no one would believe me at that time. When I was teaching this stuff, you went by the classic medical anatomy pathways, like "Yeah, it communicates with the brain via the vagas nerve, and via the hormone."
Geoff: Leptin, Acrellin.
Dr. Achacoso: Cortisol.
Dr. Achacoso: And ACTH. And by the immune system. But now there's direct evidence that they actually communicate directly with themselves.
Geoff: Like the banana's micro RNA is somehow ...
Dr. Achacoso: But then you ask a doctor, he said, "Do you know what micro RNA?", "You mean messenger RNA?", "No, no, micro RNA," "Uh, no." So these are kinds of things that we have to contend with now. But to be fair, for example, going back to the subject of mitochondria, which is the subject of bio-energetics. We did present it to medical schools, to be taught as a subject matter, way before, years ago. That's there's really no time to teach any of this stuff. It has to be at medicine 2.0. So what I've developed, developing right now, and the reason why I'm here in San Francisco, is that the framework of health optimization medicine that I started eight years ago ... You're in the business world, and you know that you have to have your two minute elevator speech, right?
Dr. Achacoso: I have even a shorter one than that. So illness medicine diagnoses and treats disease. Health optimization medicine detects and correct imbalances.
Dr. Achacoso: And right now it's at the level of the metabolome. It's because that's what we can measure. You can have people like Jack Cruise for example and so on, who would like to go down more to the biophysics level, the quantum level, but if you cannot pull the entire establishment of medicine down to the intercellular level, what more to this optogenetic and light switching and all this kind of stuff.
Geoff: I think metabalome's like a good place to start, because metabolism effects all downward processes. Like how our cells use and generate energy is so critical to so many pathways. So it seems like a reasonable place to have a foundation.
Dr. Achacoso: To start. And people ask me why the metabolome, and it's really very simple. Because genes can tell you what may happen, right?
Dr. Achacoso: It's not set in stone that they're going to activate. The proteome tells you what makes it happen. So you can take a look at all of the enzymes that can participate and so on. But the metabolome, tells you what is happening now. For example, me, my mother, oh sorry ... My MTHFR gene, the reductase is very much reducing activity. I got that by genetic testing.
Dr. Achacoso: However, by three previous metabolomic testings, my folate is always low and so is my B12, and so is my B6. They're all attached to one another, right?
Dr. Achacoso: So you know that there's probably something wrong with your gene, right? And even if you knew that your gene was reduced in activity, what do you do? You still give those anyway, so why not start with where you see what's actually happening, and can be immediately addressed, right?
Geoff: Interesting. Yeah.
Dr. Achacoso: So for me I know there's a lot of interesting genetics and so on, but I'm more focused on, yeah, there's the gene-library, but what influences its expression, right?
Dr. Achacoso: You know with the methylation mechanisms, for example, certain ...
Geoff: Yeah, I think there's actually a movement towards that, because I think there's interesting metabolic theories of cancer. By Tom Seyfried and
Dr. Achacoso: Yes. By Tom Seyfried. Yeah.
Geoff: He was on our show actually.
Dr. Achacoso: Yeah, I saw that.
Geoff: Yeah, so it was interesting. So I think there's absolutely like a movement towards like you know our genes get manipulated by environmental controls. Like epogenetics. These things are manipulated.
Dr. Achacoso: And now even by gut bacteria.
Dr. Achacoso: It's really quite interesting. But in my practice and in my advocacy of health optimization, I found out from among illness medicine doctors, there's only really two layers that you can count on. One are the new graduates, who have their license, they don't want to get into illness medicine, because they are active in looking and seeking out for this information. Bio-hackers and so on and so forth. Those people write me a lot. Medical students, like we want to ...
Geoff: They haven't gotten everything beaten out of them yet.
Dr. Achacoso: Yeah. That's why I'm starting a certification program in health optimization medicine, not only for doctors, but for practitioners.
Dr. Achacoso: Because my goal is to change the trajectory of medicine, just a little dent. Hoping that it could become the fluttering of the butterfly wings that causes the hurricane, right?
Geoff: Absolutely. I think there's a culture shift needed. Absolutely.
Dr. Achacoso: Yeah. So that's one layer. And they love it. And the other ones are those who are already established in their field. For example, one prominent neurologist said, "We used to say that Parkinson's disease and Alzheimer's disease are neurogenetic diseases. There's nothing we can do about them. And now Dr. Ted comes in here and says Sure you can do something about them. And isn't that wonderful. That there's actually a path for us that we can do. And they are inspired. And since they hold the ears of all these younger ones, it's the way that it can be evangelized. It's the way that we can ...
Geoff: Absolutely. Yeah, education.
Dr. Achacoso: However, those that are just started residency, or just starting their practice, they're death. There's no way to get them into this.
Geoff: Because they're just too plugged in.
Dr. Achacoso: Yes.
Geoff: They're just too busy just cranking out clinicals.
Dr. Achacoso: But the biggest untapped group are health coaches, fitness coaches, and so on and so forth. If you provide them with the proper training, why shouldn't they be able to balance your nutrients at least? They cannot prescribe hormones.
Dr. Achacoso: But for a health optimization practitioners, I call them hope. Home and hope. Health optimization medicine. Health optimization practitioner.
Dr. Achacoso: And there's a lot of them. I just had a software engineer lecture me in lipid bio-chemistry. And I said, "If this is the kind of passion that you see, why not have them certified?" Because they study. You make sure ...
Geoff: I mean that's gonna be a lot of instinctual pullback when doctors, they're like, "Hey, don't come on our turf."
Dr. Achacoso: Yeah.
Geoff: Right? But yeah. But I think, no matter what, people will be more educated. You just cannot the distribution of information.
Dr. Achacoso: No. And the thing is, actually, the illness medicine doctors don't want this turf.
Geoff: Right. Okay.
Dr. Achacoso: Because you have make use of the diagnostics that they have. Really do you really need an MRI every year? For your annual executive check up?
Dr. Achacoso: Do you really need a CT scan every year? You don't need this. But can you please get your, at least your nutrient metabolome tested once a year?
Geoff: Yeah, well you mentioned Alzheimer's and Parkinson's as potentially a metabolic syndrome?
Dr. Achacoso: Yeah.
Geoff: I'm curious what you mean by that, because I think there's a lot of interest around ketones as an interesting adjunct, at least been adjunct for those diseases, not a straight therapeutic. I mean some of the research and data we've look at is that perhaps Alzheimer's is a glucose uptake disfunction, rather than a ... I mean, obviously it's a complicated disease, but perhaps glucose is not being uptaken properly into the neurons, and therefore neurons are dying.
Dr. Achacoso: Mm-hmm (affirmative).
Geoff: But if you can feed neurons through alternate fuel source, like ketones, maybe you can rescue some of these cells. So I was interested in your perspective on that.
Dr. Achacoso: Actually, do you follow the work of Dale Bredesen at all? He's the one who reversed Alzheimer's by just using hormone nutrient balancing.
Dr. Achacoso: Yeah, he's serious neurologist. I mean with serious credentials.
Dr. Achacoso: And the time that he actually got popular was when he was able to reverse I think seven out of 10 patients.
Geoff: Yeah? Wow.
Dr. Achacoso: In various different states of Alzheimer's. And you look at his protocol, it's like vitamin optimization, and then hormone optimization, micro biota health, gut health, mitochondrial health. And you see it. And he's published the protocol.
Dr. Achacoso: And it's exactly what I've been doing, but not even for Alzheimer's patients, this is just for my regular clients.
Geoff: So you're saying that the side effects?
Dr. Achacoso: Yes, the side effects is that.
Dr. Achacoso: But the way I look at ... And he has very interesting publications on, for example, Alzheimer's. For example, the formation of the neurofibrillary tangles and the formation of the ...
Geoff: Plaque tile? Yeah.
Dr. Achacoso: Plaques and so on. Those are actually protective substances in the brain that are secreted out, and which we are not able to clear out, right?
Geoff: Right. Yeah, that's interesting research. Yeah. So basically people are like, "Oh, we've got to clear this plaque." But actually that is trying to protect.
Dr. Achacoso: Yeah.
Geoff: So it's interesting, what is the cause, what is the effect.
Dr. Achacoso: Yeah. And if you look at the ... I don't know, I think it's seven pillars of Aubrey de Gray in SENS Foundation, one of them is inability to clear out your trash from inside your cell.
Dr. Achacoso: And essentially if you take a look at what they're saying the same thing. It's just one of the mechanisms that's probably impaired in that. But then you take a look at Tom Seyfried's point of view on bio-energetics, or even the granddaddy of this all, the one from University of Pennsylvania, the one mapped mitochondrial eve. Wallace. Doug Wallace. He says, "Well, even if your whatever it is that you do, you still need energy to actually take out the trash."
Dr. Achacoso: "Continue regulation of division and all these other activities. They all need energy." So he says, "Bio-energetics takes primacy over this whole area." And they all have valid points of view. But for me, again, we have to come back to something that's clinical. So ultimately there's a client sitting in front, what the fuck do you do?
Dr. Achacoso: Or the client may be an athlete. The client may be a world leader. The client may be ... They have different needs. But the first thing you do is to make sure that at least for me in my practice, their hormones and nutrients are optimal. And they want instant results, right? Look, it took you how many years to get to this state? Why do you expect to get back to healthy overnight?
Geoff: Yeah. They've created damage. Or, yeah, they're pushing their epogenetics in a certain direction over a lifestyle of dozens of years.
Dr. Achacoso: Yes. And that just shows you how deeply ingrained we are with illness medicine, instant results, right?
Geoff: Yeah. Eat this pill and then you'll be fixed. Yeah.
Dr. Achacoso: And I've seen many colleagues, in the anti-aging field for example, first they started hormone treatments and so on and so forth, but it's slow. Yes, slow-going, but it's healthier. However ...
Geoff: You probably want it to be slow.
Dr. Achacoso: However, if they put an aesthetic medicine practice in there, with fillers and so on and so forth, that practice takes over. Because we're an instant gratification kind of species, right?
Geoff: That's a shame, yeah.
Dr. Achacoso: And kinds of questions I get sometimes in my lectures, like, "Dr. Ted, can you bank exercise the way you can bank certain things?" You can't, you have to do it continuously, right?
Geoff: Yeah. No, I think that's one of those things, where I think as a part of the shame of the current medical establishment, you don't, doctors don't make money to help people exercise.
Dr. Achacoso: Yes.
Geoff: You make money if you tell them to take this drug, right? Insurance bills and pays you on certain things that you optimize for. I don't think doctors go into it thinking "Hey, I'm doing this just for money." I think all doctors are doing it to benefit the patient, but if you're just ... The incentive structure's aligned for certain outcomes, then you're just gonna naturally gravitate towards it. The center of gravity is towards self, capitalism.
Dr. Achacoso: Yeah. That's really very interesting, because I trained under William Miyamoto who is the pioneer in medical informatics. Globally. He started the whole field, right? And I was in his lab for 11 years. And I did a lot of my artificial intelligence research there and so on and so forth. But we were the ones who started automating systems of hospitals, especially the VA and all of that stuff. And of course, the main thing that we were looking at was ICD book. International Classification of Diseases.
Dr. Achacoso: And the whole reason for that is not really to classify diseases, but to provide insurance companies this labels on how much to bill. Frostbite is classified as a disease and so is pregnancy classified as a disease.
Geoff: Whoa, okay.
Dr. Achacoso: It's part of the international classification of diseases. And initially I said, "Oh, nice. I'm an illness medicine doctor. I could actually take a look at all of this list of diseases and ..."
Geoff: Get a sense of how much money I could make?
Dr. Achacoso: And then now you say, "Oh my god, this exists, just for, really the main purpose is for you to be able to bill your patients." You have to put a particular number. Those freaking codes that you have to put in, because they correspond to a certain monetary value.
Geoff: Yeah, so I think it's if the incentive's lined up in that way. If you come in with the greatest of intentions, but that's how you pay your bills, it's hard to, yeah. So I think you really need to break out of that framework to I think optimize for health outcomes as opposed to just treating it like a local symptom.
Dr. Achacoso: Yeah. Well, when I looked at it I looked at the international classification of diseases, and then I looked at the chart of how much each one cost. You take it out of the book and then plug in what your hospital says.
Dr. Achacoso: "Holy shit," I said, "I feel like a prostitute. For each service that I provide it's like ... "
Geoff: That's funny. Yeah. That's funny. This is the bonus feature. What do you think of the interesting areas of science? I mean, obviously it looks like you've pretty broad perspective on some of those exciting areas we covered. Metabolomics. We talked a little bit about micro-biome. Interesting research around psychedelics or neutropics, around certain cognitive functions.
Dr. Achacoso: Yes.
Geoff: What is the most exciting, interesting field for you as you see evolving with the push of clinical research and all of that?
Dr. Achacoso: You know, we discussed a little bit, what I monitor are developments of course in metabolomics and then in symbiote science, which is micro-biota and mitochondria. In exposomics, which is your toxic exposures and your exposure to infections like Lyme disease and stuff. Developments in chronobiology, you know, your sleeping cycle and stuff. And developments in evolutionary medicine, like should you go paleo or not?
Dr. Achacoso: Developments in epigenetics. How can you manipulate the genes without actually doing a CRISPR CAS9 on your genes.
Geoff: That's real biohacking. That's actually sort of carving up your DNA.
Dr. Achacoso: I actually a bought an entire, and it's in my ...
Geoff: Apparently there was the first human embryo was implanted with a CRISPR'd genome. This is coming out of the news like yesterday.
Dr. Achacoso: Oh really? Before that the Chinese, right? The thalocymia gene. But for me personally, I have to confess, before coming here this morning, "pppt", I micro-dosed with LSD.
Dr. Achacoso: Yeah.
Dr. Achacoso: And then I had my, I have to confess this, right? You have brilliant listeners. I had ... I'm very sensitive to nicotine, so I had a milligram of nicotine.
Dr. Achacoso: Some caffeine. Probably equivalent to 120 milligrams.
Geoff: Okay, like a cup of coffee.
Dr. Achacoso: Yeah. A cup of coffee. And then, since I'm on a three hour time zone difference, and I just returned from Manila actually, week before last, so I'm not really fully in my element yet.
Dr. Achacoso: I took a very low dose, like a 1/4 tab of modafinil. So I am all over the place.
Geoff: So you've got real stack going on. Yeah, you got some modafinil.
Dr. Achacoso: I think where the developments are that should be monitored and should be allowed to get studied are actually the use of all of this scheduled substances ...
Dr. Achacoso: That have a lot of neurotropic value.
Dr. Achacoso: And for example, take a look for example, the use of dimethyltryptamine in the treatment of alcoholism or treatment of addictions.
Geoff: Yeah. Or ketamine, interesting data for depression.
Dr. Achacoso: Yeah, for depression.
Geoff: Psilocybin as well for depression.
Dr. Achacoso: And LSD for ... There was just a study that they finished in Switzerland for those with terminal cancers or certain death ...
Geoff: Or MDMA for PTSD. Yeah, no, it's interesting.
Dr. Achacoso: To remove ... So I think there is ... We know a lot about these things already.
Dr. Achacoso: And we know that people are using them.
Dr. Achacoso: We have data on them. Why don't we just go and take a look? Because we know how to protect ourselves. The definition of a neurotropic for me, is first it must be neuro protective before it's neuro-enhancing, right?
Dr. Achacoso: So we now have stacks. So yeah, we can have a neuro-protective stack, so now let's put in some neuro-enhancing stack in there.
Dr. Achacoso: A lot of people are afraid of nicotine for example, because of the wrong information about the addiction. So there has to be ...
Geoff: Yeah, no, I think nicotine's interesting, right? The smoke is the damaging part.
Dr. Achacoso: Yeah.
Geoff: Nicotine itself is maybe ...
Dr. Achacoso: Did you read that study where they tried to get the rats addicted to nicotine, and they couldn't. But then they dissolved the smoke in the water and then the rats kept on ...
Geoff: Drinking the smoky water?
Dr. Achacoso: The smoky water.
Dr. Achacoso: So, it's those kinds of things, they are in the public awareness, but there has to be a massive re-education.
Geoff: Absolutely. I think you're hitting a broader just social awareness, where if we're just aliens looking at the substance regulation, it's fairly arbitrary, right? You look at side effect profiles and then addictiveness and then legality. Alcohol, tobacco, they kill a ton of people every single. They're A okay to use.
Dr. Achacoso: Yeah.
Geoff: And then you have compounds that have very ... That haven't killed anyone.
Dr. Achacoso: Yeah.
Geoff: Or killed very few people, and they're very, very illegal. If you have ... If we're just a bio-hacker or just a scientist looking at this space, we'd be like, "The regulation doesn't really make sense, in terms of risk to society, and then why they're legal or not legal." And that's not even moral judgment or ethical judgment, just like looking at data. These things kill people and it's legal. And these things don't kill people, they're illegal. What's going on here?
Dr. Achacoso: Look, this is really interesting you say that, because even in my practice, where of course what you wanna first is you balance the metabolome, right? And your layers will be first used by bioidentical hormones and nutrients, or bioactive and bioavailable. Then second you use phytoseuticals, [inaudible 00:50:53], for bacteriophages and bacteria, right? And your third level is the drugs.
Dr. Achacoso: So when you're looking at a client. Okay, now you're micro-nutrient optimized, now you're hormonally optimized, what's your next level to give? Especially for example for enhancing cognitive function, right? So you're at the third level already, which is the level of the drugs.
Dr. Achacoso: So why should I give them something that I know is not going to work versus something that I know from all of these decades of experience, and working with them ... Like, for example, MDMA, or LSD, and psilocybin, etc., etc. Why don't I find ways to make them work?
Dr. Achacoso: Because we already know that they have some ...
Geoff: Yeah, there's definitely some, at least pre-clinical evidence, right? And it's a shame that they're scheduled and there's not more clinical research on it.
Dr. Achacoso: Yes, yes. So where are we to go, right?
Dr. Achacoso: Even in, for example, when I balance neuro-transmitters, I do not balance the neuro-transmitters first. First you balance everything that's needed by all the cells in the body. And then you take a look at the neurotransmitters. Okay, this ... You see that the metabolites of garba, metabolites of dopamine are down, and so on. And then you consider, amino acid therapy, boosting that, or give them a phytoceutical like micunapruiens, three times a week, to boost their dopamine and stuff like that. And then after that where do you go really?
Dr. Achacoso: You can only hack so much in that level. And I've been hacking for so many years now. And you tailor, of course you tailor, custom dose everything to what you need, right? But there's always this thing that you're actually looking for that sweet spot, which cannot be achieved by just these things alone. You have to ...
Geoff: I see them as all levers. They're all tools to get you into an optimal performing zone, right? It's a shame or I think it's just a disservice to not at least explore all possible levers to manipulate our own performance. Before we wrap up here I wanna get a sense of, yeah, what are the most exciting projects that you personally are looking forward to? I know you said you're out to do some lectures. What are some of the things that our listeners can do to follow and get updates from you?
Dr. Achacoso: Actually majority of my time is right now being spent in Asia, because right now I'm building there the first metabolimics laboratory for South East Asia.
Geoff: Okay, it's like a full out lab?
Dr. Achacoso: Yeah, there's less than 10 of those in the world. And the research lab is completed and then now we're looking at the commercialization phase of it.
Geoff: Interesting. So this is measuring all the co-factors and stuff?
Dr. Achacoso: Yeah, the co-factors, vitamins, etc. The other projects I have of course are building mitochondria laboratory and a gut microbiote laboratory. Gut microbiote is of course a different animal altogether. But I just want to be able to put out there all the tools that are necessary for you to be able to practice health optimization medicine, right? So you have laboratories here in the United States, there are laboratories in Europe, and there's practical none in Asia. So that's where I had these laboratories made. And of course the company that I started there is called Bio-balance. But we cannot produce our supplements over there because of the quality control for the ingredients, so they're still made for us here in the United States, in Vermont. And then it's air-shipped, so they don't get cooked in the shipping.
Dr. Achacoso: So what I'm doing right now is just putting in all the pieces together for someone to be able to practice health optimization medicine. There's your diagnostics and here are your therapeutics, like in illness medicine. So here are your detectors and here are you balancers. So that's what I'm doing now.
Geoff: Outputs and inputs.
Dr. Achacoso: Yes. And so what I'm doing right now, you will hear more and more from health optimization medicine organizations soon. We're establishing this as a non-profit organization that will provide the certification course for health optimization medicine and health optimization practice.
Dr. Achacoso: And then the other side to that is providing actually a turn-key system for you to be able to practice the health optimization. Because now I finish certification, now what, right?
Dr. Achacoso: So then you can plug in the laboratories ...
Geoff: So like mini Dr. Ted's running around, spreading the hope ...
Dr. Achacoso: Or better than me, because they're ...
Geoff: I mean hopefully, right? That's how things progress. You want your students to be better.
Dr. Achacoso: Yes. But my real hope are actually the health optimization practitioners, because the reason why I'm doing this really is you can already see that illness medicine is marching and about to fall down a cliff. Why can't we do a minor course correction? By just putting in a core practice in there. Which should be part of the spectrum anyway, which is health optimization. And then you do functional medicine, on the side which they do diagnosis and treatment of disease. Sorry. And then illness medicine. I spoke in fact with about 20 functional medicine doctors in the Philippines before I came here, and I was able to convince them, that, "Hey, you know the core of your practice should be health optimization rather than functional medicine, so that you don't fight with other doctors." But they saw that it's part of a spectrum. If you're using the same functional tests anyway, so why don't you first balance what's needed before you actually address the disease? And then from there, if you still need illness medicine, of course, they're great at accidents and all of this acute stuff, then apply them. There is place for everyone.
Dr. Achacoso: But let's supply the missing piece. Hopefully we're able to provide the first module on health optimization by the end of this year. Hopefully the software is another time, by that time on metabolomics. And then there are going to be six other modules from there.
Geoff: Yeah, no, very exciting. We would love to keep in touch and get that update, and help distribute the message. I think this is a really fun free-flowing conversation. I mean we touched upon a lot from bio-energetics and the mitochondria to micro-dosing LSD. Appreciate your time.
Dr. Achacoso: I hope that effect is not from ... This is my normal, it's not from my stack.
Geoff: Oh yeah, no. I can tell. I mean but I think that's what I think spirits and innovation, creativity, we need in this space. I think look at the macro trends. 1/6 of American GDP is going to healthcare and no one's really happy with it. So I think there needs to be sort of kicks and turns and punches into the system to see, "Hey, can we improve this system?" Every system can be improved, so let's all work together to improve the broader system up here. And change the culture around that system.
Dr. Achacoso: And actually more than that, I think change to consciousness around it.
Dr. Achacoso: If we can change the consciousness around it, to something that's more of genuine compassion.
Dr. Achacoso: Rather than, we're driven by a lot of the capitalism and all of that. That's fine. But at this day and age, when we know a lot more about ourselves, why don't we infuse the proper compassion into all of these practices?
Dr. Achacoso: And the first compassion should be towards ourselves, right? Like look at us, what's happening to us. So if we're able to do that, then raise consciousness, and raise awareness, then we would have done our jobs.
Geoff: Absolutely. Hey, thanks Dr. Ted.
Dr. Achacoso: Alright, thank you.
Geoff: Cheers! And as always follow us on iTunes, Google Play, SoundCloud, and YouTube. As always, thanks so much for joining us and see you next time. Cheers.
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