Loosing weight, the journey to get fitter & healthier, even managing chronic diseases like diabetes. They all start with lifestyle changes.

Behaviour change is hard.

Tracking weight can help, but its not motivating on a day-by-day basis and its not all that useful as a health indicator.

Tracking physical fitness is hard. Tracking overall ‘health’ is harder still.

What we need are biomarkers we can easily track and get instant feedback. Realtime feedback motivates us when we’re doing well and allows us to quickly course correct when we’re off-track.

In the last few years with the wearables, sleep trackers and cheaper self-monitoring tools, monitoring our health has never been easier.

With more data, we get better understandings of our bodies. We get instant feedback on how we’re progressing. We can see what foods or exercises impact our body positively or negatively. How a holiday can impact our health or stress levels.

We can even tell when we’re sick before we even feel any symptoms.

Measuring What Matters

What gets measured gets managed, but even more important to that is we’re measuring the right metric.

For health & fitness, weight is useful over longer periods, but in the short term not so much. Exercise or diet won’t impact it meaningfully immediately and its not always clear why it jumps up & down.

Tracking steps can be motivational, but it doesn’t track gym workouts, pizzas eaten or overall heath & fitness.

Tracking cholesterol is controversial with many doctors saying they’re not a useful measure of overall health.

None of these give us instant feedback on what we’re doing well right now, and give us early warning when we’re going off track.

What *IS* useful however is resting heart rate, Heart Rate Variability (HRV), blood glucose and blood biomarkers of health.

The latest in wearable technology can easily do the first two, blood glucose is cheap & simple to test and blood biomarker tests are getting more and more accessible.

Biomarkers that Matter

Resting Heart Rate

Resting heart rate is a good metric to start tracking fitness & overall health. Its a good indicator of day-on-day stress, diet and alcohol consumption, stress levels. Long term trends are a great indicator of cardiac fitness.

We can see improvements in our resting heart rate very quickly. Moving to a clean diet, reducing alcohol and improving stress levels will show up within 24-48 hours.

Below is 4 months of my resting heart rate data.

The trends & spikes are:

Ketogenic diet in May, trend down

Holiday in June, trend up due to poor diet & lack of exercise

Spikes are due to alcohol, stress and hard workouts

Resting heart rate tracking is very easy to take, most heart rate wearables now have this — the Fitbit HR, Jawbone Up, Apple iWatch, or sleep sensors like the Beddit. For cheaper still ways, it can be done with apps and heart rate straps like the Polar H7.

Heart Rate Variability (HRV)

HRV is a more accurate indicator of stress on the body than resting heart rate. It’ll go down when stressed, ill, exercising heavily or on a poor diet. It’ll go up as we get fitter, clean up our diet and reduces stress in our lives.

Below is 4 months of my HRV data.

Some of the HRV patterns above are:

Highest spike is the day after coming off ketogenic diet

Low spikes generally alcohol or stress related.

Low dip end of May was related to changing jobs and travel

Trend up during June while on holidays, and again from end of August when everything was settling down

More details on HRV here.

Blood Glucose

Elevated blood glucose over time can indicate pre-diabetes and poor diet. Tracking blood glucose over time can give us a much better sense of what foods cause insulin spikes and are ultimately very bad for our long term health.

4 months of blood glucose data

Patterns in above are:

The downward trend in May was due to a ketogenic diet

Upward trend in June from holidays — poor diet & lack of exercise

In general theres a fairly good match with the resting heart rate, although alcohol does’t impact glucose levels too much.

Note, blood glucose of 5.5 is entering pre-diabetic numbers. High glucose also impacts a range of other health issues like inflammation, and general poor health. I wasn’t aware of this issue before, but its been the most motivational biomarker for me to change my lifestyle.

Blood Biomarkers

If there was one other metric that we could track as well as above in terms of usefulness it would be for inflammation, so C-Reactive protein (CRP) and Fibrinogen.

Inflammation in the body is an indicator for chronic low level diseases or illnesses, cardiovascular disease, diabetes and general health.

Exercise, clean diet and reduced stress levels all lower inflammation levels.

For a use case of how useful this is, Larry Smarr in the US Quantified Self was able to diagnose himself with Crohns disease before he had any physical symptoms. His talks online just show how far we can go with hacking our health with Quantified Self tools.

Many companies now provide wellness checks that test for inflammation among other biomarkers — Inside Tracker in the US for instance.

Soon theres even home testing devices like the Cor blood testing device. This app connected device that can test for inflammation & other biomarkers within 5 minutes.

Biomarkers Compared

Health Hacking

When we see in real time how healthy our body is at a more deeper level, we can try new diets & behaviours and see quickly how our body reacts. These fast turn around experiments — like sprints in agile methodologies — allow us to learn more about ourselves & improve health quickly:

Removing processed foods improves all metrics

A morning walk in the sunshine will lower blood sugar, reduce stress levels & improve HRV

Reducing or removing alcohol will remove spikes

Getting enough sleep will improve HRV and reduces inflammation

Acupuncture improves HRV and reduces inflammation

Many others — including standing desks, exercise, keeping hydrated during the day, Omega3 supplements

We also start to learn at a deeper level what foods are bad for us. Its very easy to make that connection when we see say our resting heart rate & HRV off the morning after that pizza. Its not so easy when we just wake up feeling terrible.

When tracking more meaningful metrics in our body we learn a huge amount more about our health. How to improve it and how we can reduce the number of bad days.

Self tracking gives us much more self-ownership over our own health.

Further Reading

Diet Suggestions

Mark Hyman has an excellent 10 day ‘detox autoimmune’ diet on his website.

Dave Asprey has a great series of recommendations for his ‘Bulletproof diet’ plan. His book is excellent as well.

Chris Kressers 14four plan covers diet, stress, sleep & movement.

Resting Heart Rate

Jawbone & resting heart rate

Fitbit & resting heart rate

Separate article on Wearables on resting heart rate.

Heart Rate Variability

Blood Glucose

Mark Hyman talks extensively about diabetes, insulin resistance & the health implications. Here he talks about reversing pre-diabetes.

Great podcast episode on the Quantified Body about blood glucose & ketogenic diets.

Inflammation Markers