Quantified Self: Come for a health check, stay for wellness


(Much of what I write here is informed by my casual exploration & concatenation of the work/research done by experts/professionals of the medical community— and is more of an observation from a layman’s view over the course of ~4 yrs, perhaps to record it as a longitudinal study on myself , or of my body’s mineral composition to be specific. Viewed from the perspective of “I write so I can read/examine them later”, its an attempt to journal the process as a note to self and is a work in progress. Oh, and it might not completely jibe with those who may or may not read this piece •‿•).


To test or not to test:

It all started with a tweet — when Mark Cuban ignited a firestorm by suggesting to his ~4.5M followers to consider blood tests every 3 months. Before he could even finish his thought process, internet mob was up in arms against this idea. Shots were fired. While some agreed that the era of quantified self/personalized medicine is upon us and thought that blood tests (in moderation) is not a bad thing, majority of his followers decided to take it out of context. Their reactions were punctuated by visceral undertone — to the point where he deleted his original tweets.

Although taking tests every 3 months is a bit too much, my understanding of his argument was that we should not wait till we are sick to get our blood tested, and that “blood work accomplishes nothing other than giving a personal baseline of information” — its to learn more about our body, that’s all. While a healthy skepticism ought to be promoted, outright criticism without understanding personal biases is counter productive. And its not like he is trying to somehow escape from the inevitable reality of life’s change agent. Far from it. He later added a comment which sums it up pretty well — “my crap shoot of life is just as random as anyone else’s”. Even those who take numerous tests, may be none the better for it. Thats life — arbitrary and beautiful at the same time.

Doctors and health experts, of course, have legitimate reasons to be concerned because it can create false positives/false negatives and can lead us to unnecessary expense/follow ups/stress etc. Important point is that we need to be careful not to treat it as a substitute for screening or diagnosing, nor it is a means to search for (or to prevent) a specific diseases. There are medications for that, and I doubt anyone is disputing it. In and of itself, these tests are not without merits. If anything, I find them (self initiated, not doctor prescribed) to be supplementary in their purpose.

(Mark agreed to do a Q&A, of sort, with added clarifications, a snippet is pasted below. You can find full text here.)

The tech sector will leave people better off at a lower cost. Moores law will have its day. But we are 5 years off from minimal impact. 10 years off from Marginal Impact. In 20 years we will all look back and think 2015 was a barbaric year of discovery.
To give perspective, we pioneered the Streaming Industry TWENTY YEARS AGO. And now we are finally seeing streaming becoming mainstream as a technology but it still cant scale to handle mega live events. HealthTech will continue to move forward quickly with lots of small wins. It will slow down when there is an inevitable recession in the next 20 years, then jump again afterwards.
In 30 years our kids/grandkids will ask if its true that there were drugstores where we all bought the same medications , no personalization at all, and there were warnings that the buyer may be the one unlucky schmuck that dies from what used to be called over the counter medication. We will have to admit that while unfortunate it was true. Which is why “one dose fits all ” medications were outlawed in 2040 :).

Know Thyself :

Which leads me to gist of my post. In the spirit of a mini-experimentation, around 2011/2012, I began to change what I ate by being conscious of the food choices I made — and, in the process, was curious to know how it regulated chemicals in my blood (and health in general). I wanted to base my choice of food more on biological and nutritional requirements, and less on convenience, habit, routine or abundance :-). Therefore, I completely stayed away from sugar (and its derivatives - coffee, desserts, sweet snacks, soda, fruit juices etc), transfats (fried stuff), red meat, most forms of carb (white rice, potato, pasta, noodles, cereals etc), all processed foods, dairy, almost all forms of alcohol (except occasional wine, of course). Instead, I mainly relied on vegetables, fruits (mostly low glycemic), nuts, eggs, chicken, fish, whole grains, legumes, water, & prebiotic/probiotic foods (kimchi, sauerkraut etc). Admittedly, its a bit of a hassle because it limits where/what you eat and scrutinizes habits of self control, but not an impossible task by any stretch. However, its ironic that in this day and age, one needs to make a willful effort to go back to the basics and eat what our ancestors have been eating for a long long time.

So, what follows is a list of tests I have taken over the past couple of years. Its not comprehensive by any means, but the ones that I have found helpful.

Metabolic (blood) test via WellnessFX:

According to its website, WellnessFX gives “direct access to advanced biomarkers to measure cardiovascular, metabolic, hormonal, and nutritional health.” It includes lipid panel (cholesterol) test, and vital markers for liver, kidney, blood sugar, glucose, thyroid (TSH, T3, T4), cortisol, insulin, inflammation, hormones, blood count (RBC, WBC, Platelets), fatty acid (Omega-3, Omega-6), electrolytes (sodium, potassium, chloride), bone health (calcium), vitamins (D, D1, D2, B12, folic acid) in our blood stream. Blood is drawn at one of their partner labs, and within 8–10 days, results are made available via their mobile app. Great part of this is that I can retrieve previous test results and chart it via graphical display over time series. It also compares test results against standard (good) levels and provides generic recommendations. Here is an excellent video created by a WellnessFX user explaining his test results.

Its a yearly test and is a way for me to keep an eye on snapshot of internal workings of my body — again, not necessarily to prevent any disease or to look for one. However, if there is a significant deviation from normal, its a red flag for me to look into it more. Which, by the way, is how I found out that my Vitamin D level was lower than standard — and I needed to supplement it with prescription medicine.

NMR Lipid /VAP test:

Turns out, standard tests for blood cholesterol level does not mean much — unless its combined with a larger context w.r.t the size of LDL particles, number of LDL particles, ApoB, triglycerides, lipoprotein(a), c-reactive protein, and insulin sensitivity.

And there is now a growing understanding among medical community that one of the the most important indicators of cardiac risk is “actual number and/or size of LDL particles (LDL-P)” or ApoB level (as a proxy) in our blood — and it has less to do with the amount of “bad” cholesterol than they initially thought. Instead new research is pointing to sugar as the main culprit. Sugar, it seems, is the new tobacco — and it does not help that we are biologically hard wired to crave more of it. Dr. Robert Lustig, who has been sounding the alarm since mid 2000’s, has a great talk explaining all of this here (ff to 32min if you are pressed for time). And fortunately its getting the attention of mainstream, even from US Food and Drug Administration. It seems they have now proposed new guidelines recommending daily cap on sugar for the first time. (as a note to self, I had tweeted about Dr. Lustig’s talk back in 2010, sometimes its good to be early and right, ¯\_(ツ)_/¯…..).

Out of curiosity, over the course of last 4 years, I have probably combed through 90+ articles, blogs, talks, tweets, videos, research/academic papers, and one of the best resources on this is written by Dr. Peter Attia. He goes into considerable details on how cholesterol works, its health benefits and risks, how it ties into overall health and more (check it out at “Straight dope on cholesterol”, its the most comprehensive article, hands down).
 
And, for those who are from South Asian continent and reside in the SF bay area, Ssathi (Stanford South Asian Translational Heart Initiative) is running an interesting research project. They provide “a clinical and genetic evaluation of cardiovascular health and identification of any risk factors” — and their research is particularly catered towards people from South Asian countries. You can also volunteer for additional evaluations (includes a free MRI) and provide data for research purpose benefitting South Asian people. My experience has been great so far.

To recap, VAP/NMR tests normally include markers for c-reactive protein, insulin resistance, lipoprotein particle number, lipoprotein subfractions, standard lipid panel (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides), lipoprotein (a), qualitative assessment of LDL particle size, LDL-C, HDL-C, & VLDL-C.


Microbiome (Gut) test:

With the growing awareness on the human microbiome and its effect on health and diseases, there is an increasing interest in personal microbiome sequencing. People are curious what microbes are present in different parts of their body, how factors such as diet will affect the microbe composition, and how this affects their overall health. (the American Gut Project).
Microbial Selfie by Francois-Joseph Lapointe

One of the most fascinating new research that’s happening right now is with microbiomes (bacteria). Within the human body, it is estimated that there are as many (if not more) microbiomes as human cells — and majority (~30 trillion) of them live in our gut, mouth, skin and other mucosal surfaces of our bodies.

For the most part, our understanding of bacteria is that they cause diseases, but new research is opening up the possibilities of vital role these microbes play in betterment of our health — ranging from immunity to heart disease to brain health.

It also appears that our gut microbes produce a wide variety of neurotransmitters that influence our brains, and vice versa, much more than previously believed. There is evidence that many of our favorite foods are really the favorite foods of our gut microbes, which turn those foods into things that our bodies need and like. (Joichi Ito).

So, whenever we crave for something or feel hungry, its partly those gut bacteria signaling to our brain for reinforcements. Really interesting how these things work.

In 2011, I had randomly stumbled on an article where Dr. John F. Cryan and his team discovered bidirectional signaling (communication) between the gastrointestinal tract and the brain. It was right around that time when I was looking into probiotic supplements. I was so excited that I even (naively perhaps) sent a cold email to Dr. Cryan — in case he was looking for willing participants. His research suggested that probiotic strains can modulate various aspects of the microbiome-gut-brain axis. This was a ground breaking in its nature, to put it mildly.

In conclusion, the discovery and the explosive progress in the characterization of the gut microbiome have initiated a paradigm shift not only in medicine, but also in the basic and clinical domains of neuroscience. To understand the magnitude of this paradigm shift, the reader has to be reminded of the powerful grip of Descartes’ separation of mind/brain on the one side (religion, psychiatry) and body on the other side (medicine) that has dominated Western science and medicine for hundreds of years.
Not only is the concept of gut-microbiome-brain interactions in health and disease paradigm breaking, the emerging data-driven, analytical methodologies that are required to pursue the integration of massive amounts of data are equally revolutionary. — The Journal of Neuroscience

There are many ways to learn and explore microbiome living inside our body. I have been using uBiome to sequence and to understand the microbial diversity. There is also an open-source science project by the American Gut/UC San Diego. To be honest, I wasn’t sure what to make out of their test results. Its interesting data to look at, and it shows how my microbiome compares to others. It also provides info on different types and percentage of microbes in my gut and cross-references our data with those living with traditional lifestyles. Because this area is still nascent, I am trying this out of curiosity than anything else.

Personal Genomics (Biotech 2.0 revolution):

Fairy DNA — Stuart Caie

23andMe:

23andMe, a personal genomics and biotechnology company, is “the first and only genetic service available directly to consumers that includes reports that meet FDA standards”. It was founded on the premise that consumers should be able to acquire info about genetic make-up of their DNA without much hassle and that it can speed up medical research by collecting genetic data from the consumers through their system. I happen to be 102,113th customer out of 1 million (and counting) who opted to genotype their DNA (#humblebragalert).

One of its test results tracked down some fun ancestry discoveries such as I have distant (5th) cousins in China, or I am 2.6% closer to Neanderthal than I thought (so what I am a caveman? #blessed)? Although there are obvious factors (life style, environment) external to heredity, it also provides interesting/random tidbits such as level of predisposition to traits for sweet taste preference, bitter taste perception, freckling, obesity, likely to be a sprinter or long-distance runner, smoking, etc.

Perhaps the most important aspect of 23andMe is that it analyzes genetic variants, whether they are recessive or carriers, mutations in the gene etc. However, since most of the results describes (or compares) study findings observed in people who descended from European ancestry (meaning, their results apply to people of European ancestry and cannot yet estimate risk for those with South Asian roots), it was limited in its scope and I have not yet been able to fully take advantage of their research data. I will however continue to contribute and participate in their research — hoping that my data can add to existing pool of info collected for South Asian population.

Harvard Personal Genome Project (PGP):

Harvard Personal Genome Project is “designed to create public scientific resources that everyone can access by bringing together genomic, environmental, and human trait data donated by its participants.” The project is dedicated to creating repository of human health data and, in turn, to accelerate human health researches around the world. It was initiated by Harvard University’s George M. Church (who also helped create Human Genome Project back in 1975).

While 23andMe covers 0.03% of the genome, PGP Harvard offers significantly more coverage (90–100% of the genome, approximately 3 billion of base pairs). However, in order to enroll, participants first have to complete eligibility screening/questionnaire, go through identity verification process and pass an entrance exam. I am currently half way through their entrance exam portion and hope to examine my genetic and trait information via Veritas Genetics — who is collaborating with PGP on sub-$1,000 genome sequencing. Will expound on it at a later date and time.

The Human Genome Project (HGP) was one of the great feats of exploration in history — an inward voyage of discovery rather than an outward exploration of the planet or the cosmos; an international research effort to sequence and map all of the genes — together known as the genome — of members of our species, Homo sapiens. — The National Human Genome Research Institute.

Past, present and the future (is here) :

Taken all in all, no test is 100% accurate. Our body, we all know, is a complex system — where various organs have to co-ordinate just the right way to give it a life. Not unlike a bicycle (in its simplest form), that needs its lever and wheels to move in the right way to function. Therefore, my goals for doing these tests are to keep an eye on snapshot of internal workings of my body and to keep myself honest if only for wellness — & nothing more. I am not trying to convince myself of additional examinations either. Human nature being what it is, we would otherwise confirm bias our way into finding causes for concern. And as one can imagine, its easy to deflate correlation with causation — which shows how challenging it is to fully understand these things.

Finally, there has been unbelievable number of advancements in human health and biology in last couple of years and its only about to accelerate even more, insofar as we take a longer view of time. The future of medicine is already here, and its going to be more and more personalized. If I were to take a guess, in 10–20 years, personalized medicine will just be called medicine. After all, if medicines are not personal, then what is it?

p.s. because its a work in progress thing, some of the salient points I have made are malleable and are weakly held. In other words, if the facts change, I will happily change my mind :-)


TEDMED 2013