Chris Kresser: Do not trust it at all is my answer there. I see alpha-hydroxybutyrate elevated on nearly every patient that I test, including patients who have extremely zero other markers for insulin resistance including myself. Now my fasting insulin is usually between 2 and 4. My fasting leptin is below 2. My blood sugar is typically in the 70s or low 80s. I have no evidence whatsoever of any insulin resistance or blood sugar dysregulation, but my alpha-hydroxybutyrate on the True Health panel consistently comes back slightly elevated. As far as I can tell from the research I’ve done, it’s not really anything to be concerned about. However, if it’s occurring within a larger pattern of signs and symptoms and symptoms of insulin and leptin resistance, then, of course, you would consider that separately.