The Ultimate Wish List Featuring Tools for “Quantified Self”

By Julie Gregory, Chief Health Liaison for Apollo Health

For all of the good little boys and girls looking for gadgets to help with the protocol, I’ve put together the ultimate wish list of tools that can help you monitor your health by quantifying various biomarkers to track your progress. I’ve specifically chosen products that are foundational to brain health. For organizational purposes, I’ve put each item into a category, but there’s considerable overlap in some as they offer a multitude of features. There’s no better gift than good health, and each of these recommendations will provide information that puts the power in your hands to enhance your overall health and cognition.

The shopping days till Christmas are dwindling down, and many of the manufacturers (not all) are offering deep discounts for the holiday season. (All prices were correct when published but are subject to change.)

Adequate oxygen is of paramount importance for a healthy brain. It’s no surprise that those with disordered breathing during sleep are at a much higher risk of developing dementia. Unfortunately, the vast majority of those affected with sleep apnea (periods of stopped breathing during sleep) are unaware that they have this condition. Thankfully, through continuous pulse oximetry performed at home, you can check your oxygen levels throughout the night, which may alert you to an issue you can address with your physician.

Oxygen Goal: Normal oxygen saturation is between 96 to 100%. You want your nighttime levels to be as close to your daytime levels as possible. Levels below 96%, especially for a sustained period, warrant further investigation with your physician. Levels will be lower for those living at high altitudes.

See several of my top picks for products specifically designed for this purpose. Neither requires nighttime electromagnetic frequency (EMF) exposure, only when downloading data via Bluetooth upon wakening. Apollo Health subscribers can learn much more about this topic by reading Is My Brain Getting Enough Oxygen?  

• EMAY Wireless Pulse Oximeter ($59)
  
  The EMAY oxygen monitor has an iPhone and Android-compatible app, provides continuous monitoring of pulse and oxygen saturation for up to 40 hours, and allows you to download a medical-grade oxygen report. This system uses a traditional fingertip clip that could become dislodged during sleeping. To take advantage of this discount price, you could use a small piece of non-sticky medical wrap (similar to that used by a phlebotomist)  to ensure that it stays in place throughout the night.
• Wellvue 02 Ring ($159 reflects $20 discount )
  
  The Wellness 02 Ring is registered with the FDA, has an iPhone and Android compatible app, and also offers free software so that you can download your report, with detailed analysis, to your personal computer to share with your physician. As the name indicates, the data is obtained through a comfortable ring with a built-in silent vibrating alarm that will notify you when you are experiencing either an abnormal heart rhythm or oxygen level.

Track Glucose

Continuing with foundational basics, it’s important to ensure that your brain has an adequate amount of fuel. There is a strong relationship between metabolic health and brain health. Those with insulin resistance, pre-diabetes, and diabetes have an impaired ability to effectively utilize glucose in their brains — an important risk factor for developing Alzheimer’s disease. The great news is that you have the power to easily track your glucose levels at home, enabling you to adjust your diet to optimize your numbers.

Fasting Glucose Goal:  In the morning (before taking any supplements, medication, or enjoying coffee or tea, your fasting glucose goal is 70 to 90 mg/dL or 3.9 to 5.0 mmol/L.)  

 My picks for measuring glucose include the two dual glucose/ketone meters described below, but I’m thrilled to announce that the FDA has finally approved several continuous glucose monitors (CGMs) that do not require a prescription. These can be helpful for anyone who isn’t meeting their glucose goal as they allow you to see the effect that various foods or beverages are having on your blood glucose in close to real-time, allowing you to make healthier choices. CGM uses a tiny needle-like sensor that is inserted under your skin (usually on your arm or abdomen) and transmits your glucose level to your smartphone. It’s very important to journal your meals (with times), stress level, and exercise while using CGM to better enable you to specifically identify factors that are causing glucose spikes. Continuous monitoring also enables you to track your glucose while you sleep and can alert you to hypoglycemic episodes. Apollo Health subscribers can log in for detailed information and instructions in Step One: Tracking Glucose.   

• Stelo by Dexcom This over-the-counter CGM provides reliable glucose readings with minimal lag. While sensors are designed to last up to 15 days, some reports suggest that up to 20% may not last the entire duration, and 10 percent may only last for 12 days. Stelo offers budget-friendly options with two pricing models: pay-as-you-go for $99 (two sensors) or a subscription plan for $89/month. The Stelo app integrates with your iPhone and Apple Health, providing basic glucose tracking without advanced analytics.

• Lingo by Abbott This is another over-the-counter CGM option that offers dependable glucose tracking for wellness purposes but may lack the clinical-grade precision needed for diabetes management. At $49 for a two-week sensor, Lingo is a cost-effective solution for those who need a basic option. Lingo is compatible with your iPhone but is currently not sharing data with Apple Health despite reports to the opposite. Android devices are not supported.

Track Ketones

If you’ve reliably been meeting your glucose goal above for a few weeks, it’s time to start checking ketones. No surprise, your brain needs adequate fuel to function at peak efficiency.  A neural fuel shortage — cerebral glucose hypometabolism — precedes and accompanies Alzheimer’s disease, and those of us with the ApoE4 allele exhibit this neural fuel shortfall as early as our third decade. For a deeper understanding, read “Why is Ketosis Important for Brain Health?” 

The great news is that ketones can offset this pathology, and we can easily measure them to monitor our progress. There are several methods of monitoring ketones: with blood from finger sticks that measures a ketone called beta-hydroxybutyrate (BHB), by breath (that measures acetone), or by urine (that measures acetoacetate). For reliability reasons, I highly recommend using blood ketones for optimal accuracy. Initially, it might seem scary to prick your finger, but I promise it gets easier over time and is actually quite painless. Once you’ve reached your ketone goal for several weeks, you needn’t test daily unless something feels different.

BHB Goal: This may be a bit different for everyone, with those more seriously affected needing higher levels, up to 4.0 mM. In general, you should aim to be at greater than 0.5 mM in the morning and try to get to 1.0 to 1.5 mM at some point during the day.    

See my top picks for measuring blood ketones below. Apollo Health subscribers can log in for detailed information and instructions in Step Two: Tracking Ketones.

• Precision Xtra Blood Glucose & Ketone Monitoring System ($27.50)
  
  This small handheld device uses a drop of blood obtained by a lancet (a pen-like instrument with a tiny spring-loaded needle on one end) to test your glucose and ketone levels (BHB) using separate strips. The Precision Xtra is considered the most accurate in its class, especially for low levels of BHB, and is widely available at many pharmacies and online. If you shop around for deals (through eBay), glucose strips can be found for between 30 to 40 cents, and ketone strips can be found for around 90 cents each. (You will be responsible for a small shipping charge, usually less than $5.)
• Keto Mojo (starts at $44.99, free shipping, includes ten glucose and ten ketone strips)


  
  This is a similar dual-system device that also measures glucose and ketones (BHB) through finger sticks. It also detects low levels of BHB and has a similar accuracy to the Precision Xtra above. The big bonus with this system is the less expensive strips. On the manufacturer’s website, you can purchase 60 of each (glucose and ketone strips) for $55.99, and you can find this deal here.                   

Track Exercise

Of all of the strategies that we recommend, exercise ranks amongst the highest because of the many benefits, which include increased blood circulation to the brain, upregulated brain-derived neurotrophic factor (often described as fertilizer for the brain), enhanced glymphatic drainage (which helps to clear amyloid-beta and tau from the brain), increased insulin sensitivity, reduced inflammation, improvement in sleep, mood, and much more.

Exercise Goal:  Look for opportunities to move and stay active throughout the day. Aim for at least 30 minutes of daily sustained aerobic activity, such as an outdoor walk interspersed with running, as you are able. We also recommend strength training 3 to 4 times per week.

Below, I’ll share some of my top picks for exercise trackers, some of which offer many additional features. Apollo Health subscribers can learn much about the benefits of exercise with detailed suggestions to protect cognition in our Exercise guide.

• Pedometer ($23.99)
  
  For those who eschew technology and Wi-Fi exposure but still want to track movement to stay motivated, consider this old-fashioned pedometer that tracks steps. It’s very accurate, easy to use, has a large display that’s easy to read, and can be clipped onto your clothing or worn on a lanyard. Try to work up to 10,000 steps a day, which roughly translates to five miles.
• Apple Watch (Starting at $ 249)
  All versions of the Apple Watch can sync to your iPhone via HealthKit and serve as an excellent fitness tracker. Still, I specifically recommend purchasing Series 6 or higher because of all of the bonus features that can help monitor your overall health to benefit cognition. (Those looking for a deal can find an older Series 6, starting around $149.)
  
  Let’s start with exercise. The Apple Watch will track more than 80 different types of exercises, from walking, running, cycling, and swimming to boxing and strength training. It uses built-in sensors such as GPS, an altimeter, an accelerometer, and a heart rate monitor to work out an accurate calorie burn and provides other metrics, including distance and pace. Series 6 and higher offers a fun “three rings” feature that is guaranteed to increase your daily movement. You’re challenged to close the rings each day; one measures calories, another measures brisk aerobic activity, and the final one tracks how many times you’ve stood up during the day. While not required, you may elect to use the Apple Fitness Plus app ($9.99 per month or $79.99 annually), which offers 12 different types of classes like strength training, high-intensity interval training (HIIT), core, meditation, yoga, Pilates, dance, kickboxing, cycling, treadmill, rowing and more that allows you to create a customized exercise schedule with personalized insights and recommendations.
  
  Additionally, the Series 6 and higher has included the ECG app, which can perform an electrocardiogram (which can quite accurately detect atrial fibrillation and other rhythm abnormalities), provides heart rate variability data, and has a built-in 24-hour, non-FDA-approved oxygen saturation monitor that provides average oxygenation with a high and low range. The Series 6 and higher also tracks sleep stages and enhances sleep by prompting you to enter a wind-down period and measures the time spent in bed and asleep. Wi-Fi needn’t be on during sleep and nighttime oxygenation tracking and is only necessary when downloading data in the morning.
  
  Series 6 and above has a surprisingly long battery life and an enormous selection of watch faces and bands, with a higher price tag for the more upscale choices. For the fashionistas, there are even oodles of compatible off-label bands so that you can switch up the appearance of your watch to match any outfit. All in all, if you’re searching for the one premium tracking device that “does it all,” this may be the gadget to put on your holiday list. Additionally, all Apple Watch data is seamlessly integrated into the ReCODE mobile app.
•  Google Pixel Watches and Fitbit Trackers (Starting at $199.99)
  Google acquired Fitbit in early 2021. Their impressive lineup now includes the Google Pixel Watches and a variety of Fitbit trackers, all of which can serve as excellent fitness trackers and more. However, some now require a premium subscription ($9.99 per month or $80 annually) to access enhanced features. The free basic Fitbit app tracks your activity levels, weight, sleep patterns, and nutritional intake. It also provides basic insights into your performance. Additionally, the free app includes introductory workout programs and exercises as well as introductory mindfulness sessions.  The subscription version offers access to over 150 guided workouts in video and audio formats from brands like barre3, Popsugar, and Yoga Studio by Gaiam. You can search for workouts by difficulty and choose a plan based on your goals. It also offers a Daily Readiness Score each morning to help you decide if you’re ready to work out or need to focus on recovery. Additionally, it will allow you to see your heart rate, calories burned, and Active Zone Minutes while viewing workout videos in the Fitbit app or casting to TV with personalized insights for runners to reduce the risk of injury. The Google Pixel Watches use the Fitbit app, which includes premium version features for six months.
   
  Given the importance of oxygen tracking, I’d advise you to only purchase a model that offers this bonus feature which is free with the basic Fitbit app. Some of the older models, including the Versa, Versa Lite Edition, and Versa 2 models, only collect 02 data when you use a SpO2 clock face, whereas, for the Inspire 3, Sense series, Versa 3, and Versa 4, you can install either a SpO2 clock face or the SpO2 app to collect SpO2 data. (Learn more here.)
    
  Fitbit data is seamlessly integrated into the ReCODE mobile app. Several versions of the Fitbit (including early Versa models) are being phased out and are no available at deep discounts (around $60). By combining the watch with a premium Fitbit subscription, bargain shoppers can get fitness tracking plus many other enhanced features at an amazing discount. 

Adequate quality sleep is another foundational strategy closely correlated with better cognition. Too little sleep affects overall health and leads to obesity, diabetes, heart disease, increased inflammation, and a weakened immune system. All of these conditions are bidirectional and also affect brain health. Additionally, our memories are solidified and consolidated while we sleep. New research has revealed that the glymphatic system, which clears waste, like amyloid-beta from the brain, works most effectively during deep sleep.

Sleep Goal: Your goal is to achieve 7 to 8 hours of quality restorative sleep every night.

Apollo Health subscribers can log into our Sleep guide for more information and detailed sleep hygiene tips. We encourage everyone to track their sleep quality and duration. Below I’ll share a few of my favorite sleep trackers.     

• Oura Ring (starting at $249)
  
  What appears to be a simple (albeit masculine-looking) ring is actually a high-tech device that offers accurate sleep tracking along with a host of additional features that make it very attractive for protecting cognitive health. Let’s start with the sleep-tracking features. Via the corresponding iPhone or Android app, the Oura Ring delivers a comprehensive sleep report that includes your total sleep time, your total time in bed (which reveals your sleep efficiency), your sleep stages (light sleep, deep sleep, and REM), and totals all metric together for a nightly sleep score. Additionally, it can help you determine your chronotype, or your body’s natural sleep-wake preferences, and provide insight into hormonal factors that can affect your sleep. A recent study compared the Oura Ring (Gen 3), Fitbit (Sense 2), and Apple Watch (Series 8) for sleep tracking, and the Oura Ring was found to be 5% more accurate than Apple Watch and 10% more accurate than Fitbit in four-stage sleep classification.
  
  It also monitors your temperature, heart rate, heart rate variability, blood oxygen, activity, daytime stress, cardiovascular age, cardio capacity (VO2 Max), and more.  Unfortunately, only very basic features are offered for free. To access full features, you need a subscription, which costs $5.99 per month or $69.99 per year. You get one month free with your purchase. The Oura Ring has a long battery life, is water-resistant, very comfortable to wear, and all data seamlessly integrates with the ReCODE mobile app.       
• Apple Watch (Starting at $ 249)
  
  Series 6 (starting at $149) and higher can serve as decent sleep trackers measuring sleep stages, even breaking down how much time you spend in each stage: rapid eye movement (REM), core, and deep sleep. While they may be slightly less accurate than the Oura Ring, they come in second place for accuracy and do not require a subscription for sleep tracking and all other metrics. See above for additional features.
• Google Pixel Watches and Fitbit Trackers (Starting at $199.99)
  
  All Google Pixel Watches and all newer Fitbit Trackers (that have heart rate monitors) can track sleep cycles, including the stages of light, deep, and REM sleep. Even better, this information is all freely available on the basic Fitbit app, but the Fitbit Premium subscription will allow you to access more detailed insights like a “Sleep Profile” with a deeper analysis of your sleep patterns. See above for additional features.

We know that stress is unavoidable and, in the short term, can actually be a positive reaction, offering protection from harm when faced with a real threat. But, too often, we’re faced with chronic, severe, and unresolved stress that can have a devastating impact on cognition. Stress is inevitable, and we can best protect our cognition by learning to change our reaction to it by adopting regular stress management practices and integrating healthier habits into our daily lives.

Stress Management Goal: Build an effective stress management practice into your daily routine.

Apollo Health subscribers can read our Stress guide for detailed information on multiple options for stress management habits and tools, including mindfulness, meditation, and much more. For those who struggle to adopt a daily practice, see the recommendations below that can both enhance your application and provide feedback to help confirm that you’re on the right path and provide motivation to continue.    

• HeartMath Inner Balance ($134.25, reflects 25% off until 12/31/24)
  
  If you like data and are motivated by immediate feedback, the HeartMath Inner Balance system may be a good stress management tool for you. HeartMath is based upon the science of coherence that occurs when there is a state of harmony between your heart rhythm and your brain/nervous system. Your heartbeat speeds up and slows down all the time (this is called heart rate variability or HRV), and you may see that measurement on your wearable devices. HRV can be a marker of your autonomic health, whereas coherence measures your heart rate pattern. Higher coherence between the heart and brain is associated with a host of measurable health benefits, including reduced stress, improved sleep, increased energy, and more.
  
  HeartMath works by using either a wired or Bluetooth earlobe clip that transmits your real-time data to an iPhone or Android app on your smartphone or tablet. Android users also have the option to use the latest sensor, Inner Balance Coherence Plus, which offers an enhanced experience along with lifetime access to the HeartMath app. (While Bluetooth versions are available, we recommend the wired versions above to reduce EMF exposure.) The apps provide a variety of unique exercises based on a foundation of heart-focused breathing that helps you build your coherence. As you do the exercises, you receive visual feedback, allowing you to see your level of coherence change in real time as you practice. They recommend using it three to five times per day to measure and track your progress over time.
• Apollo Neuro ($349.99, but be on the lookout for an updated holiday deal)
  
  The Apollo Neuro wearable device uses vibrations to help manage stress and increase focus. It works by sending vibrations to signal safety to the brain and interrupt the “fight or flight “response. It’s designed to rebalance the nervous system and improve HRV. Most people opt to wear it on their wrists or ankles. It comes with a free app that allows you to choose between multiple modes: relax, focus, sleep, and recover.
  
• Muse 2 ($199)
  
  If you struggle with a wandering mind during meditation, the Muse 2 headband may help to act as your personal meditation coach. Using advanced EEG brain sensors, it can detect your brain activity and provide you with real-time feedback in the form of gentle audio sounds through your headphones. When your mind is calm and settled, you hear peaceful weather. As your focus drifts, you’ll hear stormy weather that cues you to bring your attention back to your breath. While this device can be used without a subscription fee, by subscribing ($12.99 per month), you’ll get access to a larger library of guided meditations, expert-led programs, and detailed post-session reports.

The science is very clear that heart health and brain health are inextricably linked. A healthy, well-functioning circulatory system is vital to deliver much-needed blood to the brain. Research clearly shows that poor cardiovascular health, with age, can contribute to cognitive decline. All of the strategies outlined in the Bredesen protocol, combined with regular biomarker screenings, will enhance and improve heart health. 

Heart Health Goal: To maintain healthy blood pressure, normal sinus wave rhythm, and pulse wave velocity.

There are multiple aspects of heart health, including hypertension (elevated blood pressure), irregular heart rhythm (atrial fibrillation), and poor pulse wave velocity (measures the elasticity of your arteries) that are associated with cognitive decline that can be quantified and measured at home to help you monitor your heart health.

• Omron Platinum Blood Pressure Monitor ($89.99)
  
  The Omron Platinum is a top-rated pick for accuracy by Consumer Reports. This device has an irregular heartbeat detector, a BP risk category indicator, and a data averaging function. It allows multiple users to store readings separately and includes a one-size-fits-most cuff. It also has the ability to sync to the Omron Connect app via Bluetooth. Research indicates that hypertension is a risk factor for dementia. By regularly monitoring your blood pressure, you can make an adjustment to your regimen and follow up with your physician as needed. When synced with the accompanying app and HealthKit, it will enable you to integrate your blood pressure data with the ReCODE mobile app.
• KardiaMobile ($69.99, discounted $10 for the holidays)
  
  The KardiaMobile is an FDA-cleared device that, when synced with its accompanying app, allows you to turn your phone into a clinical-grade personal EKG monitor. It captures a medical-grade EKG in 30 seconds, anywhere, anytime, and can detect atrial fibrillation, bradycardia, tachycardia, or a normal heart rhythm. You can store your EKGs on your phone and email them to your physician as needed. If you have an Apple Watch Series 6 or higher, the Google Pixel Watch, or some versions of the Fitbit, they can perform the same function and are all integrated with the ReCODE mobile app. 
• iHeart Wellness Monitor ($99)
  
  The iHeart Wellness Monitor device clips onto your fingertip and displays a variety of health measures depending upon which app you use it with. Five different apps (iPhone and Android compatible) are included, but my favorite for heart health is the Internal Age app that measures aortic stiffness (pulse wave velocity). The results are reported as “biological age” determined by an algorithm based on an age referenced dataset. The goal is to have a result that is equal to or younger than your actual age. Results from iHeart correlate closely with the SphygmoCor system, the gold standard for measuring pulse wave velocity.  Poor pulse wave velocity is a significant risk factor for future cardiovascular disease and dementia. It’s an excellent way to monitor the effect that the protocol is having on your heart health.
  
  Using the same clip, you can also download the iHeart Brain app to measure your orthostatic health, vital for optimal brain health.  This app tracks blood pressure changes in response to standing up from a seated position. Generally, the healthier you are, the faster your brain responds to changes in blood pressure when you stand up. This app reports this information as a “Readiness Score.” Your goal is to score as close to 100 as possible.
  
  Another helpful app is the iHeart HRV app that measures heart rate variability; a higher HRV (with a top score of 100) indicates a healthy autonomic nervous system, with a good balance between the sympathetic and parasympathetic branches, which allows your body to adapt to different situations and perform at its best.      

By embracing technology and building the habit of “quantifying self,” we can begin to track and tweak all of the parameters necessary for healthy cognition for years to come. Many of these products will provide data directly to the ReCODE mobile app (available at the App Store) as long as you download the app that accompanies the product and regularly download your data as you collect it. Any product that is compatible with Apple’s HealthKit will provide data to the ReCODE mobile app.  For those who aren’t Apollo Health subscribers, please see Dr. Bredesen’s most recent book, “The End of Alzheimer’s Program,” for detailed information on all of the strategies to enhance and protect cognition.