The Brain as a Metabolic Monitor: Casey Halpern, MD, of SynchNeuro on Predicting Blood Sugar from Behind the Ear

[chimes] Hi, my name is Unity Stoakes, co-founder at StartUp Health, and today we have a Moonshot update with SyncNeuro. The co-founder Casey Halpern, Dr. Halpern, uh, is really blazing a trail as part of our Cardiometabolic Health Moonshot, so we're gonna get a full update on what they are bringing to the world with something really interesting. They're really pioneering a novel EEG-based wearable for glucose monitor that's non-invasive, it's affordable, and it's discreet.

So we're gonna learn all about what's going on at SyncNeuro. Stick around. [upbeat music] Dr. Halpern, Casey Halpern, just to set the stage, just to remind people, you guys are working on some r- really exciting stuff.

Tell us about SyncNeuro. How do you frame it to the world, and maybe share a little insight to the innovation that we're gonna dig into today. Thank you so much, Unity. Really kind words and great to, to be here and grateful to be supported by your Moonshot and StartUp Health.

The ability to use the brain and showcase the brain as a source of an enormous amount of information about our health, about our cardiometabolic health, and the, just the i- very idea that SyncNeuro is part of this cardiometabolic focus for me is, uh, I guess it's obvious, but I do recognize that the relationship might not be immediately obvious to people when it comes to trying to help people improve their health, specifically their metabolic health. And I've been, as a neurosurgeon, researching the link between the human brain and our body's metabolism for decades, and other neurosurgeons and neuroscientists have studied aspects of health in different ways through the brain and finding these incredible links between the brain's electrical activity and our body's rhythms.

Those rhythms, we use that term vaguely, but they can reflect things like sugar spikes or heart rate. And so the relationship for me is a clear link between the brain's rhythms and the body's rhythms, and SyncNeuro's just trying to bridge those two things, and in this case, doing so to help people improve their health and improve their sugar swings, focusing on people with prediabetes at risk for developing type 2 diabetes, and of course, trying to help people with type 2 diabetes be healthier as well.

And what's so interesting is we've all seen or heard about continuous glucose monitors, and what you guys are doing is it's not just a new form factor, but it's a complete rethink of the opportunity here, this connection between the brain and our glucose. Can you just share a little bit about what you're pioneering? Because as I understand it, and just to also I should say, we're so excited that StartUp Health, out of our T1D fund, our T1D Moonshot fund, which was funded by Helmsley Charitable Trust, is making an investment in SyncNeuro.

So we're so excited about that, but just to let everybody know in full disclosure, we are an investor in SyncNeuro, and we're just so excited because what you are doing with this novel EEG-based wearable, can you describe what it is? 'Cause it's not like I think most people think of as a traditional continuous glucose monitor that is invasive. You're doing something that's non-invasive. Exactly.

It's the, the holy grail of diabetes technology is the non-invasive glucose monitor, and so many different technologies have been tried over the last multiple decades. No one's really ever tried to leverage the brain, and our work started at Stanford when I was there practicing, and, uh, we made a, a number of serial discoveries linking the brain and the brain's electrical signals and the rhythms that can be detected using EEG technology to our body's metabolism. And everyone's afraid of neurosurgeons, and continuous glucose monitors are invasive.

Nobody likes the needle and nobody likes an incision. And I, for some reason, personally, I have no problem with an incision, but any time I get my blood drawn or if I wear a continuous glucose monitor, uh, a typical one at least, it makes me squeamish. And if I had a child with diabetes and he or she had to wear it, I... Of course, these are great technologies.

They provide an important readout, but they are limited in what they provide. And the brain can provide that, but also so much more, because that's just one important chemical or neurochemical that, that we need to manage in our health. But w- we're trying to give people multiple levers to pull, of not just their sugar swings, but also, uh, other aspects of their metabolic health. Sleep is a really important one.

I can't overstate that, how if we can get a better control of our sleep, our sugar swings would be better, we'd be healthier, we'd have more energy, we'd feel better. We would all be a healthier country. That's a hard thing to do, but it's in part hard because the information that we get from wearables, while helpful and often sometimes even elucidating, the help doesn't give us tools to make the sleep a better quality. We also, through the brain, can track physical activity and stress, and as we all know, managing our physical activity and our stress can significantly impact our health and specifically our blood sugar control.

And so people with diabetes who obviously are fearful later in life of having a, a serious related medical event, they're really motivated to be healthier. But trying to get insurance coverage for a, a standard sort of Dexcom or Abbott device, th- this is a challenge. And even if they have insurance coverage, it's still very expensive and it's invasive. We've-Actually just done an ex- extensive amount of surveys.

We've tried to figure out what this population wants as we're building our wearable, and we're learning that they don't want something that's invasive. They want something that's affordable. They might need this the rest of their life or for many years, and so to sustain an invasive device like that is, is hard. At the same time, they, they also wanna know what they can do to get ahead of the problem.

They want to be proactive. This is not a population of people that has given up, so to speak. So we're trying to give them insights and tools, make them aware of the problem before it happens, and then giving them a personalized suggestion, a data-driven suggestion, to, to try to get ahead of that problem. And we can do that because we're a sort of a multimodal data platform.

If you only provide one metabolite, then you can only do that, but we can provide that metabolite by decoding the electrical brain rhythms. We detect them with our wearable behind the ear. You can barely see- So it, it's a wearable that's very discreet behind the ear. Yeah, that's right.

So think of it like, like a Band-Aid that sits behind your ear, a small Band-Aid, skin toned. There's always a little patch of skin that everybody has where there's no hair behind your ear. It sits comfortably right on the skull. Our sensor, which sits within that adhesed area, is an electrical rhythm detector, uh, an EEG technology, but it's miniaturized.

When people say EEG, they usually mean like a full array of electrodes around their scalp, and that's commonplace for people who are getting admitted to the hospital to survey their epilepsy or their seizures. Uh, also people that go to a sleep lab trying to diagnose a sleep disorder, uh, like REM sleep disorder or something like that. So those types of wearables can generate incredible information about our health. We've actually figured out that for what we're trying to do, we can actually detect the metabolic swings that Dexcom provides its users through in a very similar way, but all done with EEG technology, and we don't even need the full scalp.

Uh, and this is an advance that is made possible by recent development in AI that, that allows us to, to get a really robust signal from just behind the ear. So this is something people will wear, potentially even 24/7 for many years at a time. There are some tricks of the trade that have made this possible on the hardware side. It's - It does use an adhesive.

It's actually quite comfortable to wear. But a little tiny sensor sits behind your ear, and how do we make that work for people? Ours is flexible, so it contours to the shape of the skull, and externally it's soft, so you can sleep on it, doesn't hurt, doesn't pinch the ear at all. You can wear it with glasses, sunglasses, even a hearing aid.

And it provides the same glucose readings that Dexcom and Abbott's devices provide. We think that's really important. We've learned in our market research that our users wanna know their blood sugar level. They don't just want a range or the direction or trend they're going.

Of course, that can be helpful for people, but people really want that number. They know what those numbers represent, and we can help them achieve healthier numbers moving forward. In addition, it's not just the number. We, we really think it's important to give people insight into other aspects of their health, and we're starting with sleep.

We're starting with the standard health wearable pieces of data that people are accustomed to having, like heart rate, HRV. We have an accelerometer, obviously, we can provide steps. And then we can help people manage their physical activity and their other vital signs, which also play a critical part in our metabolism. I got this insight, and I credit Oura for this.

When I would eat dinner and if I ever had a dessert or a glass of wine with dinner, my sleep quality would go down, and my morning blood sugar, if I was checking it, would be worse. There, there, there was this clear pattern, and I'm really in tune with my health. I'm a bit of a health optimizer. I suspect there are people that do realize that.

I think there's people who don't realize it. And so we really wanna be able to kinda decode and deconstruct these data sets for people and help them figure out what they can do to wake up in the morning with a healthier blood sugar level. We know that's a really important sort of metric for health and for a future healthier life. What I love about what you're describing here and what you're innovating on is, you mentioned multimodal.

It's a new form factor, but it's really powering way beyond just glucose. It's more of an integrated, holistic lens on your health, and I love that you're integrating fully with s- sleep as a key thing because that's impacting so, so many other things to our brain health, to our metabolism, to our whole wellbeing. What other types of impact on our health do you see this enabling me to be able to track? Stress, I would imagine, integrating in with my diet you framed here.

It's quite powerful in how many different touchpoints it has into the lens of our health. I appreciate you saying that, and I completely agree. The form factor is new. We think people are really excited about the brain these days, and this - the timing is right.

Other potential functionalities that we can offer, really the answer is endless, but what are we focusing on now? So obviously to help people with their blood sugar, just speaking very practically, providing a sensor that could be more affordable and non-invasive, super important, truly allow a technology like this to scale to the... This is a massive population of people that have blood sugar problems and health optimizers, many millions of people. An, an invasive, very expensive device can't really scale like that.

For type one diabetes, these are probably sufficient. But in any case, we think, we still think we can do better. Now, going past that, and what can we do? First of all, while we do sleep, what does that exactly mean?

So we're gonna give people insight into their sleep quality. We're gonna track behaviors during the day and their sleep-related behaviors that seem to lead to better quality night's sleep, so that we can actually give people a personalized algorithm during their day to try to have a better night's sleep every day. In addition, that sleep period is so critical because of its link to metabolism.Another core feature of ours, one that we got great feedback on in our market research, is the ability of the brain to predict and be proactive and provide a sort of a forecast, like a weather forecast in the morning.

I still wake up in the morning and look at my phone to get the weather forecast for the day, just in case it changed from the night before. [laughs] And what we can do is pool the sleep data from the prior night. Remember I mentioned earlier, if you have a little wine and you don't sleep as well, your morning blood sugar's on average gonna be a lot higher. It turns out we can actually provide people with a forecast for their day based off their night's sleep, and we can give them data-driven guidance, personalized data guidance, on what they can do that day to get ahead of that spike before it happens.

Or on average, they're gonna have higher spikes throughout the day. What can they do throughout that day to try to reverse that? And that's gonna be related to physical activity, de-stressing behaviors, food choices, and we can figure out over time what foods don't lead to a big sort of sugar spike in an individual. This is not just related to glycemic index.

It's related to how people are metabolizing their food, how fast they're eating their food. And some foods, when you say you're gonna have a bag of nuts, what does that exactly mean? Because if you pay attention, there's high fructose corn syrup poured all over these nuts, and canola oil, and all these things that are just refined and, uh, and unhealthy that could be causing spikes in places you wouldn't expect it. Really getting granular like that is gonna be really important.

We're gonna have an automated food diary through a partnership with January AI and building our own technologies around this as well to try to be the sort of messenger of solutions to the problems before they happen. That's really part of our brand, really part of our culture, is not telling people that they just made a mistake. We want to get ahead. You're helping them prevent the problem before it becomes a problem.

That's exactly right. You mentioned a key word here a, a few minutes ago, AI, and you've been working on this innovation for many years. And I know AI is really integrated in, but what is the new species of AI made possible for your innovation and is bringing to life with what you're doing in a way that maybe when you started building just wouldn't have been possible? We get feedback from neuroscientists all the time like, "Really?

EEG can do that? Isn't the signal pretty noisy?" And the answer is yeah. I mean, [laughs] the signal is noisy, and 20 years ago we probably didn't have sophisticated AI tools.

This is machine learning that we're doing. Machine learning is not new as a method, but some of the machine learning tools that we have right now are very new and related to some of these new sort of advancements that we've had. I'm not a signal processor, so I never get too sophisticated when it comes down to exactly the, what that methodology is. But because of those new tools, we can track people over time with these longitudinal, you know, 24/7 multi-day data sets to really get a handle and kind of get the signal despite the noise.

It is a noisy signal, but there's great brain data there. We just now see it. Yeah. That's what I'm so excited about, is what used to be noise- Yeah...

a few years ago, or even a year ago- Yeah... you can now pull out invaluable signal because of AI, and that's just opening up a whole new world of opportunity to... It's like the beautiful part now is the noise because you're able to find the value in it. Yeah.

It's quite extraordinary. What's coming up for you? I know you're been doing a lot of surveys, a lot of studies. There's, you're validating.

What are some of the things you can share and talk about? And there's a lot of maybe listeners, I don't know if you have any asks of the ecosystem on how they can support maybe some of the research and studies that you're working on. I appreciate that. I, this company came from my research, and that kind of culture of basic science and discovery is very much part of what we're doing, and it's allowing us to leverage the great advancements of modern day, but also create those advancements ourselves.

So that's something we're very proud of. Some of the specifics I can't get into too much, but right now what's actively happening at the company is a sort of a internal validation. We have a, a working prototype, which is really exciting. When I last spoke with Startup Health, we were raising money to try to get a working prototype.

[laughs] And yeah, we worked with a prototype manufacturer. We did some internally. We, despite best efforts, we, we learned we really got to do this ourselves, and it's funny because we figured that out, but when I talk to very successful founders or listen to their podcasts, I learn that there's a little bit of a common theme, that in some ways you got to delegate sometimes to other people, to other companies. But if you can do it yourself, it's probably better that way.

There's a lot of reasons for that. Might just be human nature and human tendencies. But we figured that out ourselves the hard way. The good news is we're, it's working now, and, uh, we're doing sort of an alpha where all of the employees in the company are wearing it.

Great feedback, great... We're all very skeptic-type scientists and our biggest critics. In the next couple of weeks we will be launching our algorithm training, and what does that mean? So this is basically an IRB-approved human clinical trial.

But in the end, it really is just algorithm training. Uh, we just are putting a sensor on human patients, and so we have to call it a study. There's really no endpoint other than feasibility and usability feedback and accuracy. But the accuracy is all about training.

We anticipate hundreds of individuals will be needed, but I'll tell you, we achieved accuracy that was nearly matching Dexcom to accuracy with just about 20 subjects, and what that speaks to is the sort of robustness of the signal in the human brain. This is not exceptional. This is typical. This is just our human biology.

This brain functionality has been there our whole evolution. It probably allowed humans to evolve and keep us alive when food wasn't readily available. The brain had to know there were periods of food scarcity and how to keep us alive and orchestrate our metabolism, maybe to slow down in those periods of time. We don't have that problem as much anymore, at least in most parts of this country, but, but that function is still there, and we see it, and despite the noise, we can capture it.

Once this training is done, we will - We don't think that's gonna take long, probably three to six months. We will be, uh, applying for a IDE, investigational device exemption, through the FDA.Try to get 510[k] over-the-counter clearance. There w- will be a day where we want to take this technology to dose insulin and guide medication management of diabetes.

But at first, we see a great need in just helping people improve their lifestyle and be healthier. And there's a lot of companies focused on Type 1 right now. We really see an opportunity in people with prediabetes who are really motivated not to develop diabetes. You asked me earlier, what else are we doing?

I'll tell you, like, when I talk to people with prediabetes and diabetes, the ones that are really motivated, these are people who are just trying to be healthier and figure out, "What can I do?" And they're told by doctors th- they're not sick enough for the doctor to worry about them, or they really just can't get in to see an endocrinologist because it's not that person's fault, they just don't have the bandwidth or the capacity in their clinic. And there's 40, 50 million people like this, so how can you accommodate this?

We have to put that type of medical strategy, preventative medicine, in the hands of the users. The issue is right now, our hands, we don't have any knowledge as to what's going on in our bodies, and the, the medical system's not really set up like that. So that's our vision here, is to really put preventative medicine in our own hands. And then once we get this right, I consider this chapter one, maybe chapter one, chapter two, or a long chapter one, we'll see.

But there's chapter two, three, four. What does that look like? And that relates to people with diabetes. Why are they so eager to get better?

They don't want to have a stroke. They don't want to have a heart attack. They're at risk for all of these serious medical complications that people have with or without diabetes, and the brain is a phenomenal conduit to understanding our brain-cardiac axis. It's not just gut-brain communication.

The brain communicates with our whole body, so being able to play a role in other health areas is very much on our radar and will probably be part of our sort of relatively immediate fundraising that we're doing. I just, I love your chapter one, too, because it will help so many people. Focusing on prediabetes, people [laughs] with diabetes. This just opens up just a massive, uh, opportunity to help a lot of people.

What's, what does a realistic timeline look i, if all things go your way, where I could walk into a CVS or Walgreens or Walmart and maybe over the counter get one of these. And I'm the type of person who I would, from time to time, I wear an invasive continuous glucose monitor because I- Me too... I really wanna know, and I do that a couple times a year. But now if I had the opportunity to go get Sync Neuro pop a sticker behind my ear, I'd wear it all the time.

W- when can I get access to this outside of the study? Yeah. Is this a few years down the line? What's realistic with how- Soon...

how the world works? It'll be soon. So assuming fundraising efforts go according to plan, and that's really, that, in this market, this day and age, that, that part of it has been a struggle. And Helmsley helped us out recently presumably 'cause they believe in us, and we've never paused operations at the company, not once.

So we're very grateful, 'cause we know a lot of great companies out there are also struggling with fundraising in this market. But assuming there's no issue with fundraising, uh, I would anticipate our sort of commercial launch to be late 2027, early 2028. I don't think that's overly ambitious. This is a over-the-counter 510[k] type process through the FDA, and we understand the type of clinical trial they will need in order to kind of give us that clearance.

We're not gonna start that trial until our algorithm training and our algorithm is showing the accuracy that we know it will need to get that clearance. So we know what we have to do to get there, and where we are, we're very well positioned to, to do that. We're always ready for curve balls and the aches and pains of building hardware and software and reaching your early adopters. But early 2028, I think is a conservative estimate.

That's so exciting. We're at the dawn of the neurotech revolution, and the angle that you're coming at this is just quite extraordinary. And I mentioned we, out of our T1D Moonshot fund, StartUp Health is so excited to invest, and one of the reasons, one of the many reasons, is we've watched you execute. As you mentioned a few moments ago, you raised an angel round.

You didn't even have a prototype. You built the prototype. You just continued to take the science to the next level, to the next level, to the next level, and I think execution is... Once you know there's science there, it's all about bringing it to market, and we're just so excited to see the progress that you continually make.

You've got an amazing team- Yeah... and amazing science behind it, and we need to get this out to the world. So hopefully other investors... Are you still fundraising now?

What can you talk about? You- you need to just thank you for the kind words, and the team is everything, right? Couldn't do this without our team, and like Emily Murra, my co-founder and president, just, what a kind person. But she i- inspires people and works so hard, and you know, she's compiled an incredible team at the company on, on the R&D side.

I, I couldn't be prouder or more inspired. So that helps me with fundraising, because the things that I feel are possible, they deliver on. And we have a great relationship where there's bidirectional communication, so I understand the feasibility, I understand the constraints, and then we fundraise around what we know is possible. The, yes, so we closed on the angel round.

Raised a little over $3 million there, and then we moved into this priced round. Boomerang Ventures led this round, and recently Overwater Ventures joined in. This is in our seed round. It's a $10 million pre-money priced round.

Overwater is a co-lead. Stanford University Ventures also joined in, so we have some institutional investor representation. Great advisors, by the way, that come with that. People that really pressure test what we're doing and have experience and success having had done it in the past.

And I'm sure as investors, they've seen failures too, so we learn a lot from them. We are at about three and a half million of our five million goal. That goal is critical. If we don't get to that goal, we have to slow down operations, and that's something we've never had to do.

I don't intend to. Oh, you're gonna get there. Th- this- Yeah... innovation's too important.

It, it's- I agree... so there's no doubt in my mind. People go to Sync Neuro. Is it...

And Casey Halpern, Dr. Halpern, should they reach out to you, Emily, either? Where, where should we send people? All of the above works.

All of the above works. We're on LinkedIn. You can go to our website, sync- www.syncneuro.

com. But yeah, we welcome any help, any support, any ideas. W- w- we want criticism too. We think that we've got something really special here to offer people with diabetes or brewing diabetes, but we're also, our ears are open to feedback, and we want to learn from people.

We want to learn from the users. Anybody that has any feedback for us, we're on LinkedIn. Please do message us there, and thank you so much for the support. Last question, and 'cause I know you think about this a lot, which is walk us into the future and chapters one, two, three, four, et cetera.

Talk about the impact that, that Sync Neuro's made you and the team and Sync Neuro and this innovation, and how it's impacted people's everyday lives who, as we've seen, there's a lot of people with diabetes and obesity issues, and these are sleep challenges, stress challenges, mental health challenges. What impact have you guys brought forward to the world because of what you're creating here? A very brief sort of, not a non-sequitur, but I, I just wanna comment. Your comment about seeing into the future, I...

There's something a- about futurists, like founders of companies that have created something that everybody told them was impossible, and they did it anyway, [laughs] and they probably didn't do it to spite that person, but maybe that person, the opportunity to prove them wrong was motivating. But at the same time, they just believed that what they were saying was possible, and they made it possible. So I, I don't know yet if I'm a futurist. I certainly aspire to be.

I think as a neurosurgeon, being able to anticipate things for your patients, to give them a safe surgery and a safe outcome, is really important, so I, I definitely have some of that training in me. But we're putting it to the test here as, as an entrepreneur, and in any case, I, I find that very inspiring. It's something I try to aspire to, to be a futurist. So I, I'll see if I can answer your question.

We'll see if I'm right one day. One, one quick thing. You're better than a futurist because you're bringing the future to now. [laughs] That's exactly right.

We li- I live in the future. That's exactly what I usually tell people. [laughs] Come join me in the future. There we go.

In some ways I think that, so... I would say that, and we talked about it a little bit earlier, and it's really nice to be able to focus on it, the ability to give people insight into their health and put them in charge, put them in the steering wheel, allow them to know what they could do to be healthier. You hear doctors and p- people tell patients all the time, "You just have to eat healthier or get better sleep or stop stressing out." This is not easy to do.

When, when people say this is easy, that's almost, it's almost insulting. It's insulting to me, and I don't suffer from obesity, but trying to be healthier, and these aren't easy things in our society, especially when we are ambitious and we work and we have to take care of our families and ourselves. These aren't easy things to have. We need tools to do it, and these tools have to be readily available, affordable, accessible, maybe even fun and even cool.

And so I do think that taking care of yourself needs to be cool, and I'm not sure it is quite there yet, although there's definitely traction moving in that direction. I see a, a future now i- in the present, in some ways, that people aren't flooding the emergency rooms with complaints related to diabetes and obesity and going to their primary care doctor with these problems. I would say that these are problems they can solve, but they can solve them only when they have the information more immediately at their disposal, and also in real time, and that's something we're trying to solve for.

And if we can do that, then also our primary care physicians are focused on more advanced problems and actually practicing preventative care, not being so reactionary, or not ordering tests all the time that we don't need. W- w- we're just clogging the system. Our ERs aren't overflooded. The amount of people that go to the ER with these types of problems, and they have to go because they can be emergencies.

But if we can actually help people get ahead of that, and that's what people want. They don't wanna be in doctor's offices. It's like they don't want to be there, but they kinda have to be, uh, until something like this is available to them. And credit Dexcom and Abbott for putting glucose monitors out there.

It's clearly a helpful technology, but now we have to scale it, and in order to scale it, you really have to reinvent it, so to speak, and also listen to the user and understand what they're looking for. And it's the sort of multimodal, multi-lever strategy that allows them to be proactive, to live a healthier life, and I guess that's the future that we're trying to create. I love it. Yeah.

And I, you sparked an idea on how, maybe you already thought of this, to make them really cool, these stickers. Just a cool tattoo, and I can every day of the week put a different cool tattoo behind my ear, and I can change it out any time I want and have- Absolutely... the coolest tattoo there is. Oh, absolutely.

It's a little bit of brand development, brand awareness, making it cool, helping people join a community of partners. Remember, it's machine learning, and so the more people that join our community, the more accurate we are. And obviously we're not gonna launch until we're certainly accurate enough, but it could always be better. And then we can grow into other indications, and all of the users can help each other be healthier.

That's the kind of community, that's the kind of world I wanna live in. Casey, thank you, and the whole team over at Sync Neuro, for everything you're doing. And- Thank you... we're grateful to be partners with you.

Thank you. Oh, we're grateful as well. Thank you so much for having me. What a great opportunity.

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