Larry Smarr is one of the people who had a vision in the 1980s for a high-speed computer network that grew to become the Internet of today. So sharing data is important to him. Now he has found a new source of data that he believes has great potential if shared widely: information from his own body.
Actually, Smarr is just using himself as one example in the coming trend he sees in using information technology to regularly monitor wellness. I heard Smarr speak in Seattle last week when he joined a panel with biotech entrepreneur Leroy Hood and University of Washington computer science professor Ed Lazowska, at the OVP Tech Summit. This trio of visionaries all talked about how they see the healthcare system switching from a reactive mode that attempts to treat illness into a more data-driven science that is proactively geared toward keeping people healthy.
Smarr, the founding director of the California Institute for Telecommunications and Information Technology, is an early adopter of a lifestyle that attempts to create a “quantified self.” Every few months, he gives blood and has it analyzed for 30 or 40 measurements, which are stored in a spreadsheet to provide “biofeedback” on his state of wellness. This is still time-consuming and cumbersome, and nowhere near more futuristic visions of people giving daily pinpricks of blood that send their daily wellness data into a database stored in the cloud.
While many people are afraid that insurers will use genetic data to discriminate against them, Smarr is hopeful that people will want to openly share data on the quantified state of their wellness. This information could spread and create a positive form of peer pressure, as people will compete with their friends and family to improve their heart rate, blood pressure, triglycerides, etc. to a healthy balance. The data will be shared widely via social networking sites, and people will carry it around with them everywhere on their smartphones, Smarr predicts. (It should be noted that Smarr’s group at Calit2 gets federal research grants to study how people’s behavior changes in the new era of quantitative health.)
“The counter-revolution to obesity is centered here. People will be able to tune their bodies,” Smarr said.
I followed up directly with Smarr after the panel to ask him some more about his personal experience with becoming a “quantified self.” By looking at the data, and adjusting his diet and exercise accordingly, he’s already put together some impressive wellness statistics. Without going too deep into his medical file, here are some health statistics he volunteered:
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Here’s what he had to say about how he achieved those goals.
Xconomy: You talked about these early adopters who are taking deep quantitative measurements on their health, much more so than standing on a bathroom scale every day.
Larry Smarr: Although that’s not a bad start.
X: OK, but can you explain what you see happening with this group of scientists. What are they looking for?
LS: Well, it is a much larger group than just scientists. And it’s not just San Diego, but in Silicon Valley, too. There’s this whole site, the Quantified Self, which is the more extreme version.
For instance, I’m going in tomorrow to get the latest readouts from my last blood test that I’ll talk about with my doctor. The problem is we find that very few doctors are really knowledgeable enough about this new quantitative approach to be much help. It’s very frustrating. We just had a retreat at the [UCSD] School of Medicine, and this was a big topic. Patients are coming in with much more quantitative knowledge about the state of their body than the physicians have in the patient’s medical record. Also, the patient often knows more about the implications of the data than the physician does, because the physician hasn’t been trained to make inferences from this range of quantitative data.
X: What are you actually measuring yourself? You talked earlier about sodium and sugar, and how measuring these things somehow caused you to change your behavior.
LS: Let’s start with lipid (fat) sector. If you are worried about heart disease, there are a number of things to look at. First, there’s the LDL, “bad” cholesterol. Within LDL there are four different sub-sizes of lipids. The ones that are most worrisome are the ones small enough to actually get inside the walls of your blood vessels, and help start plaque to accumulate. The plaque tends to accumulate because of inflammation. There are a number of inflammation markers like high-sensitivity complex reactive protein, a generic marker, whose value tells you whether your body is in an inflamed state. If it is, the bad cholesterol can begin to deposit plaque and cause future problems like heart disease or stroke.
So you measure those things to see if a problem is beginning to occur. For instance, there’s a whole set of other chemicals that you can look at that involve your insulin-glucose system, which can tell you if you are in danger of being pre-diabetic. A significant fraction of our society is either diabetic or pre-diabetic. The test often involves fasting for 24 hours before you draw blood. Then there’s a whole set of issues with inorganic compounds, like sodium, potassium, all the way up through iron and your red blood cell system, whose major function is carrying oxygen-bound iron compounds. Then you can measure a half-dozen variables related to your thyroid function, measure all the different subtypes of red and white blood cells, and whether there are deviations in the numbers or shapes of those.
X: How does this work, do you give yourself a pinprick blood test every day?
LS: It’s not a pinprick. I use a combination approach for my tests. There are a certain number of these tests that the insurance company will pay for if the doctor asks for them. So I have a regular dialogue with my doctor, probably much more regular than most people would. Maybe every four to six months.
Additionally, I work with a private sector company, yourfuturehealth.com, which sub-contracts blood tests to local establishments. There are a dozen or more in San Diego that are just places you go to, just like you would in a hospital, and they take blood samples and send them off to a laboratory. The amount of blood varies anywhere from one vial to a maximum of a dozen vials that I have given at once.
X: How often do you do that?
LS: I give a blood sample on average, every three to six months.
X: When did you start doing this?
LS: Around three years ago, when I realized from a lot of reading that if my goal was to become even healthier than I am, I needed to keep track of my numbers so I could tune myself.
X: You decided at the first of the year, you wanted to lose weight, and ever since you’ve been losing about a pound a week. What was it in the information that you’ve been gathering that’s enabled you to change your behavior and help you lose weight?
LS: What I’ve talked about so far is the internal state of your body. But on a daily basis, you feed your body. Food contains some of the most powerful chemicals we introduce into our bodies. They can impact much of our hormone and endocrine systems. Analyzing that food intake is critical to understanding how that food changes the state of your body, with weight, for instance, being a very crude metric.
So every morning I get on the scale naked, same scale, get a number, and record it in a spreadsheet. That way I know how I’m doing. Then I analyze all the food I’m eating. Not just the caloric content, but also the three major subcategories: protein, fat, and carbohydrate. Within the protein sector, is it lean protein? Within the fat sector, how much of it is Omega-3 long chain fatty acids? How much is Omega-6? Within the carbohydrate group, you don’t want food with a high glycemic index, you want low glycemic index. You want lots of fruits and vegetables. Then you calculate what fraction of your caloric intake are you getting from each of these sectors. After that, you have to worry about things like how much fiber you are getting. And how much hidden sugar is in there, how much sodium? To lose weight, you need a caloric deficit. All I did was reduce my caloric intake, by 10 or 20 percent, mainly by portion control, but also by looking at the amount of fat, because fat has over twice the calories per gram as proteins or carbs. Then I increased my aerobic exercise by 10 or 20 percent, trying to get at least five hours a week of aerobic exercise. Then you have a caloric deficit, and your body sheds weight.
X: How much have you lost?
LS: Since I came here [San Diego] in 2000, I had lost about 20 pounds and had been pretty level at that weight. But then I noticed that over the past six months, I was creeping back up. So after my New Year’s resolution I have lost about 20 pounds since January 1.
X: What was most surprising to you, when you started quantifying your diet? I imagine that some of this might be generalizable to a lot of people who eat similar foods.
LS: If you don’t get quantitative, you’re lost. Your illusion of whether you’re eating a lot or a little of something isn’t accurate. So what I do is occasionally sit down, and spend hours and hours of time making comprehensive measurements. Working with guidance from my doctor, I took 12 days randomly, when I knew I would be at home, and created a food intake spreadsheet. I recorded how many grams or how many teaspoons of everything that went into my mouth. Then you go on-line to the USDA. They have a great database, in which you can translate the grams of carrots, or that many teaspoons of olive oil, into the grams of fat, carbohydrates and protein, but also grams of sugar, fiber, sodium, and all the vitamins. Then after 12 days you take an average daily food intake and look at the total calories, the percentage that were from protein, fat, and carbohydrate, whether you are getting enough fiber, etc. The next stage I will take that database for these 12 days and spend a few hours looking across the vitamin sector intake to get an idea where I’m under and over the recommended allowance. These numbers might indicate that I need supplements, for instance.
But the point is, trust your instruments. You cannot fly blind and have a good outcome.
X: It sounds like a lot of work. And not something the average American will want to do. What needs to happen before people start thinking more quantitatively about their wellness?
LS: If you look at the obesity epidemic in America, it’s clear that a lot of people don’t want to do work when it comes to measuring their nutrition, and look what happens. If you’re not going to take personal responsibility for the state of your body, then you may well end up with a body that is much less healthy than it could be.
There are a few simple rules. Stop eating sugar and drinking soft drinks. Stop eating refined flour. Both of these spike your glucose-insulin system. Because they are “flash energy” sources, your blood detects it has enough glucose and your brain tells your body to store everything else in your stomach in fat cells for the future. Then in a short time the flash source of glucose is gone and your brain tells you that you need more food. It’s a vicious cycle. Those two things are, I would say, about 80 percent of the problem. Second, cut your portions down by a factor of two. If you do those things, you have given yourself a chance to get control back of your body. Then you can begin to read and learn about the types of food you are eating. But those are the most important rules to get you started.
X: Having gone through this experience, has anybody in your family or close circle of friends looked at this and said, “Hey, Larry, what you’re doing seems to be working. I want to do that too.”
LS: Absolutely. That’s probably the thing I find most satisfying. There’s a radiating social network of health. It emanates from everybody I see taking this quantitative approach. A few years ago, I felt really isolated out there. But now I’m actually considered pretty conservative about my approach. My more advanced friends ask how come I’m not using all the new techniques, like wearing monitors 24/7 that record a wide range of your body’s parameters. But the good thing is that there is a national movement of people working on having a healthier lifestyle, eating real food and not so much of it, getting exercise, and managing stress. The key issue is that it’s not about losing weight. That’s just the crudest possible measure. It’s creating a healthy body, and moving from a sickness paradigm to a wellness paradigm. That will transform the whole healthcare industry.
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