Towards a new era of health research and patient empowerment
“Know thyself” – inscription on the way to the oracle at Delphi.
Once upon a time, healthcare providers and even researchers were mostly limited to getting only snapshots of what was going on inside patients and research participants. For the most part, blood tests and hi-tech scans just tell you what was going on when the blood or scan was taken.
Think about it, you go to your doctor and get your blood pressure and a blood sample taken. The blood pressure is a little high, but blood pressure changes all the time. Why was yours high, and is that the rule for you or the exception for you? We don’t know that from a single measurement, or even a couple of them. We do know that how your blood pressure changes, and when it is high matters1-3, and having this information would likely result in safer more effective management.
Let’s take the blood test and say that it shows your blood glucose (sugar) is high, but what foods and meals have the biggest effect? You can just look up some average responses online and work it out right? No, that’s not what the latest research is showing us. Work into the area of precision nutrition is telling us that individuals can vary a lot in terms of how they respond to the same foods4,6. I’m not saying you can’t make some educated guesses based on something like glycaemic index, but we can do better.
Enter continuous glucose monitoring, or ‘CGM”. This involves wearing a large coin-sized device on your arm that regularly measures your blood glucose. Originally developed to help people with diabetes and who take insulin to control it, this technology is now used in research to discover how individuals react to their chosen diet and lifestyle2-4. Some people are also choosing to use it to optimise, or ‘biohack’ their diet, exercise, sleep, and other lifestyle habits, and if not optimise, then at least work out the most important things to change. They are doing this by not only recording their blood glucose but also tracking diet, sleep, and exercise, usually with nothing more than their smartphone.
Technologies like continuous glucose monitors are moving us away from relying on static snapshots, and moving us to getting videos of our dynamic physiology. Not only that, but with some good design, and a little willingness to learn, we’re moving away from relying almost exclusively on professionals, such as medical doctors, to interpret a bunch of test results, and instead getting valuable personal health-related information that we can use to inform our own decisions. Now I think that is empowering.
I’m not predicting that technology will replace health professionals, but it will augment them. The right technology will make it that much easier for professionals to know their patients’ or clients’ unique requirements, and spot when these change. Accurate information can help build the foundation of a true partnership in health and beyond that, optimal performance.
People are already using technology to work out what works for them even when no one else had the answers. A great site to check out is www.quantifiedself.com where you can watch short talks by people who have tracked their: menstrual cycle against creativity, blood chemistry response to different meals and activities, blood oxygen levels while climbing Mount Everest, running without eating as someone with type 1 diabetes, migraines to help manage them, or symptoms to help with diagnosis of difficult to diagnose conditions. The BioDesign Lab and many others are simply making the technology better, more comprehensive, easier, and cheaper.
If you’re a health and/or performance professional, or a researcher, current and emerging technologies represent the foundations of fundamental shift in how you work. Wearable technologies allow a fresh look at human physiology. Seeing how individuals respond to food, exercise, sleep conditions, or stressors will no longer require expensive equipment in artificial environments that make the researchers among us forever question but does this apply in the real World? and the practitioners among us wonder will this therapy work for my patient/client? Or is this therapy/approach working for my patient/client? Monitoring outcomes will no longer be something done every 6-12 months because of a lack of time, skill, or financial resource.
We are now entering an era where collecting laboratory quality information is possible, or soon will be, while people go about their lives. With cloud computing and the right systems, we can visualise health or disease unfolding as the continuous and interrelated processes that they are, and intervene when most appropriate rather than when things get bad enough for patients/clients to come and see us, or when some arbitrary period of time has passed and a ‘checkup’ is due.
For researchers, the technology means we can/will get more information from more people in less time, and probably at lower cost. This makes it much easier to understand the sometimes subtle but important differences between people with the same condition. It actually gets us closer to seeing people as individuals, which they are, rather than simply research participants meeting criteria x.
The change we are seeing is in effect allowing all of us to be more like researchers. It enables you as the patient/client to be a citizen scientist who can, preferably under some professional guidance, take much greater ownership of your health by being able to see how what you are doing is affecting you now, and in the short-run. The idea of course being that if something isn’t working, you can change it, and immediately start seeing the effects of that change.
The promise of precision medicine was to base treatments on people’s genes, but the right consumer technology will allow us to leap-frog precision medicine and get to true personalised medicine. For example, we already know there are changes in the functioning of the nervous system that researchers can detect many years before someone is diagnosed with a disease such as type 2 diabetes or has a heart attack or stroke7, and I’m not talking about cholesterol or blood pressure. But the measures currently available in everyday medical practice are mostly limited to blood tests, and only the less expensive less specific ones.
Researchers and clinicians will soon be able to gather the information that can be used to diagnose disease before it manifests, and have more accurate diagnoses when the disease is already present. Very early detection maximises the possibility of prevention at minimum cost and effort. Whereas accurate profiling of the patient, along with real-time monitoring, will reduce the need for trial and error. And very importantly, when researchers are using the same technology that is available to everyone, what is learned in research can be applied to practice much more rapidly than it currently is.
Advancements in how all this new information is processed, e.g. machine learning, will mean the information can be combined and connections identified that have so far remained hidden. To (mis)quote Marcel Proust, The real voyage of discovery consists not in seeing new sights, but in looking with new eyes; reliable wearable technologies will give us those new eyes.
I started with another quote, Know thyself because it most succinctly captures the power of wearable technologies to change our lives; they make the hidden visible, and with the right software, they make the complex understandable, so that we can know ourselves like never before and, if we choose, become the best selves we can be as a result.
- Li, Z., Snieder, H., Harshfield, G. A., Treiber, F. A., & Wang, X. (2009). A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood. Hypertension Research : Official Journal of the Japanese Society of Hypertension, 32(5), 404–410. http://doi.org/10.1038/hr.2009.32
- Chen, S.-W., Wang, Y.-K., Dou, R.-H., Xie, X.-Y., Hu, Y.-B., Ding, N., et al. (2020). Characteristics of the 24-h ambulatory blood pressure monitoring in patients with Parkinson's disease - the SFC BP multicentre study in China. Journal of Hypertension, 38(11), 2270–2278. http://doi.org/10.1097/HJH.0000000000002536
- Fan, H., Onakpoya, I. J., & Heneghan, C. J. (2020). 24-h ambulatory blood pressure versus clinic blood pressure as predictors of cardiovascular risk: a systematic review and meta-analysis of prospective studies. Journal of Hypertension, 38(11), 2084–2094. http://doi.org/10.1097/HJH.0000000000002500
- Zeevi, D., Korem, T., Zmora, N., Israeli, D., Rothschild, D., Weinberger, A., et al. (2015). Personalized Nutrition by Prediction of Glycemic Responses. Cell, 163(5), 1079–1094. http://doi.org/10.1016/j.cell.2015.11.001
- Mendes-Soares, H., Raveh-Sadka, T., Azulay, S., Ben-Shlomo, Y., Cohen, Y., Ofek, T., et al. (2019). Model of personalized postprandial glycemic response to food developed for an Israeli cohort predicts responses in Midwestern American individuals. American Journal of Clinical Nutrition, 110(1), 63–75. http://doi.org/10.1093/ajcn/nqz028
- Fabricatore, A. N., Ebbeling, C. B., Wadden, T. A., & Ludwig, D. S. (2011). Continuous glucose monitoring to assess the ecologic validity of dietary glycemic index and glycemic load. The American Journal of Clinical Nutrition. http://doi.org/10.3945/ajcn.111.020354