September 18, 2018
I shifted awkwardly on the toilet seat, using one porcelain-planted hand to steady myself while I held a small paper collection device shaped like a hot dog tray (complete with red and white checkered squares) in the other hand. It had been ten minutes, and still not a single particle of fecal matter had materialized from my backside. I squirmed, grimaced, then finally managed to squeeze out a marble-sized speck of poo onto the tray.
A handful of brochures and poop-collecting instructions were splayed out on the bathroom floor in front of me, along with a small plastic storage container for my tiny turd. Based on the photograph on the tube, my deposit was large enough. I could now finish my duty in an actual, civilized toilet bowl, thank-you-very-much. With a sigh of relief, I dropped my sample into the tube and settled back on the toilet seat, slightly apprehensive about repeating this procedure on day two and day three, and wondering what my wife would think of the pre-paid Fed-Ex shipping bag full of my poop tubes laid neatly next to her homemade kimchi in the refrigerator.
Fact is, from sniffing peanut butter in an attempt to drip massive amounts of saliva into a tube for DNA analysis to spraying urine into a giant orange bucket I carried around for 24 hours for a University of Connecticut lab experiment on endurance athletes to giving a dizziness inducing nineteen full tubes of blood to the lab for a plasma longevity panel, in my quest to discover the best ways to self-quantify everything happening inside the human body, I’ve tested and tracked just about everything one could test and track.
Not a single day goes by that I’m not asked what the most important parameters to track would actually be if one wanted to fully analyze and optimize the performance of their body and brain. The fact is, in our modern era of “The Internet Of Things”, Web 2.0 and a dizzying number of self-quantification devices, it can be confusing and frustrating to figure out what’s to actually measure when it comes to blood, biomarkers, metrics and beyond – and even more confusing and frustrating to figure out what to actually do with all the data.
After testing, tracking and interpreting biometrics from self-quantification devices, along with blood, saliva, urine, hair and poop, I’ve found specific tests and tracking tools to give one the most bang for the buck without producing oodles and oodles of unnecessary data. And this article will explain just that: the 20% of self-quantification efforts that give 80% of the valuable data and results, and the best way to figure out exactly what is going on inside the body on a daily basis.
While there are literally hundreds of different blood, urine, and saliva measurements you could use to track recovery, and scientific advances are constantly making more and more test markers available, I’m going to share with you the best, most reliable indicators of proper recovery and the best tests for determining whether you are venturing into the land of nutrient depletion, gut issues, the wrong diet for you, overtraining or whether there are hidden missing components that can be optimized from a diet, lifestyle or supplement standpoint.
The 10 Best Blood Biomarkers To Test
When it comes to testing your blood, I’m a fan of paying the closest attention to the biomarkers that have been proven to be associated with the aging process. After all, if you can control for these blood values, you can be relatively confident that you’re going to not just be maintaining a reduced rate of biological aging, but also superior overall health. If you care at all about how well you’re doing in the longevity game, you’re curious how fast you’re aging, or you want to quantify the efficacy of your healthy eating and healthy living efforts, it’s worth paying attention to each of the following parameters.
1. RBC Magnesium
Red blood cell (RBC) magnesium is a mineral that can help predict important longevity markers such as insulin sensitivity and likelihood to be hospitalized whereas high levels of RBC magnesium can predict physical performance and potential for sarcopenia (muscle-wasting) as you age.
An RBC magnesium test can provide an earlier indicator of magnesium deficiency than a standard magnesium blood test. This is because when levels are low, the body will pull magnesium from the cells to keep blood levels normal. In this case, a magnesium blood test may show normal levels while an RBC magnesium test will give a far more accurate result.
During the first year of menopause, women lose on average 80% per year of their estrogens! This can result in a significantly accelerated decline in muscle mass and strength. Related to this loss of estrogens, which can of course cause subsequent decreases in physical function and the ability to be spry and supple as you age. Higher endogenous estrogen levels are associated with higher muscle strength and lower rates of fall-related limb fractures even after adjusting for bone mineral density. Estrogens can also stimulate muscle repair and regenerative processes, probably by acting as an antioxidant, thus limiting oxidative damage; acting as a membrane stabilizer by interacting with cell membrane phospholipids, and binding to estrogen receptors to govern the regulation of a number of downstream genes and molecular targets.
Estrogens also play a protective role against oxidative stress protection, and can participate in the antioxidant system because they can decrease the expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, an important source of superoxide radical, and can increase nitric oxide (NO) availability. In addition, estradiol activates mitogen-activated protein kinase and nuclear factor-κB signaling after binding to the estrogen receptor, and this stimulates the expression of mitochondrial antioxidant enzymes such as manganese superoxide dismutase and glutathione peroxidase, which results in reduced reactive oxygen species production of mitochondria (possibly contributing to the longer expected lifespan of women compared with men).
Estrogens also play a key role in the regulation of bone mass and strength by controlling the activity of bone-forming osteoblasts and inhibiting activity of bone-resorbing osteoclasts. Bone tissue is essential for structural support and locomotion in the vertebrae and critical for hematopoiesis (red blood cell production) as one ages. Bones also serve as an endocrine organ in the regulation of calcium homeostasis. Interestingly, when women are treated with exogenous estrogens, the decrease in bone mass and increase in bone turnover can be reversed, suggesting that estrogens have a potent bone protective effect. Here’s a great resource to see optimal estrogen (and testosterone) levels in men and women.
3. High-sensitivity C-reactive protein
Over two dozen research studies have proven that baseline levels of the inflammatory marker C-reactive protein (CRP) in healthy men and women are highly predictive of future risk of cardiovascular ailments – including heart attack, diabetes, stroke, sudden cardiac death, and the development of peripheral arterial disease.
It has also been shown that CRP levels predict repeat coronary events among patients who already suffer from heart disease and that the outcome of patients immediately after a heart attack is tightly linked to CRP levels. Ultimately, individuals with excessive levels of CRP have a risk about two to three times higher than the risk of those with low, optimal levels.
In my opinion, a CRP test for inflammation, combined with a basic lipid panel, is the single, best way to evaluate your risk of heart disease. By eating a diet high in anti-inflammatory herbs, spices, and nutrients (especially turmeric and fish oil) and avoiding overtraining and excessive stress and toxin exposure, I personally try to keep my CRP below 0.5 and prefer to have it below 0.2.
4. Triglyceride:HDL Ratio
Also known as the “atherogenic index of plasma” (yep, that’s a mouthful), a high triglyceride:HDL ratio (meaning a high number of triglycerides relative to your HDL cholesterol) is also one of the best indicators of your risk for heart disease. This test also has the added benefit of also predicting lipoprotein particle size and insulin resistance, two other important markers for longevity. For example, in one study in elderly women, the triglyceride:HDL ratio predicted all-cause mortality (not only cardiovascular mortality but overall risk of dying from anything!).
There are of course a host of additional studies on this ratio, including this study that shows triglyceride/HDL ratio predicts coronary heart disease and cardiovascular disease risk mortality as well as or better than does full-blown metabolic syndrome. A ratio of 2 or under is good for your triglyceride:HDL ratio, and I’m a bigger fan of shooting for 1 or under. Above 4 is bad news bears.
5 & 6. Full Lipid Panel And Omega 3 Fatty Acids
An advanced cardiovascular and lipid panel goes beyond the typical cholesterol test to help uncover early risk factors for heart disease. Most people may not realize it, but a cholesterol test is important way before you feel old or sick. A basic lipid panel measures fats and fatty substances in the blood that indicate current and potential heart health, such as LDL, HDL, triglycerides and total cholesterol, while a full lipid panel goes far and beyond typical blood tests, and includes a particle size measurement.
Particle size is extraordinarily important because research has shown that small dense LDL cholesterol can be inflammatory and toxic to blood vessels and that a high level of Lipoprotein(a) indicates the most dangerous blood lipids. This Lp(a) is a specific type of small LDL cholesterol particle that inflames your blood and makes it “sticky”, and patients with Lp(a) are more prone to clotting. A comprehensive lipid panel can investigate the types of cholesterol particles in your blood and give you a far more accurate profile of your cardiovascular risk than standard cholesterol tests do.
In addition, the fatty acids present in your blood are worth examining because a higher proportion of omega-6 linoleic acid can result in lower longevity and predict earlier death and physical and cognitive decline. This is because linoleic acid can make red blood cells more susceptible to oxidative damage, which ages the cells and impairs their ability to deliver oxygen. In contrast, the more omega-3 fatty acid in the red blood cells, the lower your risk for colon cancer (and the higher the omega-6, the higher the risk for colon cancer). Older individuals with low levels of omega-3 fatty acids physically decline more quickly than older adults with higher levels. Low omega-3 fatty acid count also predicts smaller brain volume and cognitive decline, even in older adults who don’t possess any other symptoms of dementia.
Known as the saturation index, your stearic acid:oleic acid ratio is another important marker to check. Stearic acid is a saturated fat and oleic acid is a monounsaturated fat. A lower saturation index is linked to several aging-related diseases, including non-alcoholic fatty liver disease, prostate cancer, colon cancer and gallbladder cancer. When it comes to longevity, a higher amount of stearic acid is preferred.
7. Testosterone + Free Testosterone
Several reports published in medical literature have proven that low testosterone is associated with increased mortality. They include this study, which shows that low testosterone levels are associated with increased mortality in male veterans; this study, which shows that low testosterone is associated with increased mortality over a 20 year time span, independent of metabolic syndrome, diabetes, and prevalent cardiovascular disease (but attenuated by adjustment for IL-6 and C-reactive protein, making yet another case for keeping your inflammation low, especially if you have lower testosterone); and this report, which concludes that low testosterone may be even more dangerous than previously thought, and lead to a greater risk of death.
In that final report, men with low testosterone had a 33% greater death risk over their next 18 years of life compared with men who had higher testosterone. The study tracked nearly 800 men, 50 to 91 years old, living in California. Their testosterone level was measured at the beginning of the study, and their health was then tracked over the next 20 years. In addition, low testosterone can also drastically affect the quality of your life as you age, as symptoms reported by these men included decreased drive, erectile dysfunction, fatigue, loss of strength, decrease in bone density and decreased muscle mass. Also, these men tended to be overweight or obese, and at higher risk for cardiovascular disease and diabetes. Men with the lowest testosterone, below 241 total serum level, were 40% more likely to die!
You can delve into even more resources on the link between testosterone and longevity in this helpful article by Dr. Jeffrey Dach, which includes links to optimal testosterone levels.
8. IGF-1 (Growth hormone surrogate)
I first discussed the link between a “sweet spot” for Insulin-Like Growth Factor I (IGF-I) in this article. In it, I summed up the writings of Dr. Rhonda Patrick on this matter, who said in a recent interview with the blood testing company WellnessFX:
…”in some cases there may exist a trade-off or a “faustian bargain” between longevity and performance. Optimizing for IGF-1, otherwise known as insulin-like growth factor-1, is one such case where more performance driven goals like maximizing growth and maintaining muscle and neurons may, to some degree, come at odds with ones desire for longevity.
The reason for this is that, aside from IGF-1’s more notorious role in building muscle, it has been shown to have some very interesting properties that haven’t entered mainstream dialogue as of yet: mice deprived of IGF-1 live longer…finding safe and effective ways to increase growth hormone and IGF-1 naturally, thereby, improving muscle and brain function while simultaneously preventing their atrophy seems like a no-brainer, who doesn’t want to be more fit and smarter – for longer?
Or is it longer? Mice, worms, and flies that are genetically engineered to be deficient in either growth hormone or IGF-1 live almost 50% longer than controls, which is a huge increase in lifespan. The converse has also shown to be also true: Overexpressing growth hormone by 100 to 1,000-fold in mice causes a 50% shorter lifespan, mainly due to kidney and liver dysfunction. The same results have been demonstrated in lower invertebrate species such as worms and flies, suggesting that this mechanism is evolutionarily conserved. Okay, admission here: either eliminating growth hormone or blasting it 1000-fold in mice is rather extreme…
…if you’re not quite convinced that the aging component to all of this is something that might also be relevant to humans consider this: polymorphisms (variations) in the gene that encodes for the IGF-1 receptor, which leads to decreased IGF-1 levels, have been associated with the longer lifespan found in centenarians.”
Ultimately, while the anecdote above sums things up pretty thoroughly, recommended levels of IGF can vary widely – but in a very eye-opening hormone replacement therapy podcast interview I conducted with anti-aging physician Dr. Richard Gaines, he recommended IGF-1 values between approximately 80 and 150 ng/ml.
Low fasting insulin can be a crucial market for longevity and indicates an important variable called “glycemic variability”, which is basically how often your blood sugar levels fluctuate throughout the day. In this article I wrote on blood sugar management, you learned about the extreme importance of glucose regulation and glycemic variability when it comes to longevity – and insulin is intimately tied to these variables.
For example, high fasting insulin levels are associated with a greater risk of cancer mortality. In addition, cancer patients who eat the highest amount of insulin-producing foods experience worsened cancer and increased overall mortality. Furthermore, high insulin levels can predict cancer mortality, even when controlling for confounding variables such as diabetes, obesity, and metabolic syndrome. In older adults with type 2 diabetes, the level of insulin use also predicts mortality.
The trick is not to eliminate insulin altogether, but to keep insulin levels within control. My friend Dr. Joseph Mercola recommends “a normal fasting blood insulin level…below 5, but ideally… below 3”.
10. Complete Blood Count w/ Differential
A complete blood count with differential, also known as a CBC, is often used as a broad screening test to determine an individual’s general health status. It can be used to screen for a wide range of conditions and diseases and to help diagnose various conditions, such as anemia, infection, inflammation, bleeding disorder or leukemia. The CBC is a panel of tests that evaluate the three types of cells that circulate in the blood, including:
Evaluation of white blood cells, the cells that are part of the body’s defense system against infections and cancer and also play a role in allergies and inflammation. White blood cell (WBC) count is a count of the total number of white blood cells in a person’s sample of blood and identifies and counts the number of the various types of white blood cells present (the five types include neutrophils, lymphocytes, monocytes, eosinophils, and basophils).
Evaluation of red blood cells, the cells that transport oxygen throughout the body. Red blood cell (RBC) count is a count of the actual number of red blood cells in a person’s sample of blood. Other factors in this part of the panel include hemoglobin, MCV, MCH, MCHC, RDW, MPV and PDW. Hemoglobin measures the total amount of the oxygen-carrying protein in the blood, which generally reflects the number of red blood cells in the blood. Hematocrit measures the percentage of a person’s total blood volume that consists of red blood cells. Mean corpuscular volume (MCV) is a measurement of the average size of a single red blood cell. Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of hemoglobin inside a single red blood cell. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin inside a single red blood cell. Red cell distribution width (RDW) is a calculation of the variation in the size of RBCs. The mean platelet volume (MPV) may be reported with a CBC. It is a calculation of the average size of platelets. Platelet distribution width (PDW) is also be reported with a CBC and reflects how uniform platelets are in size.
In the article “Which observations from the complete blood cell count predict mortality for hospitalized patients?”, it is reported that the most impressive predictors of mortality to be derived from a CBC are burr cells, nucleated red blood cells (NRBCs), and absolute lymphocytosis (an increase in the number of lymphocytes in the blood.). In the analysis, the first two (burr and NRBCs) were associated with mortality rates 8 to 10 times higher than that of the average admitted patient. There are anecdotal reports in the literature of burr cells being associated with “ominous prognosis” and more robust statistical analyses showing NRBCs to be associated with increased mortality. Lymphocytosis has also been reported as a mortality risk in patients, especially those with trauma and emergency medical conditions. The analysis shows that all 3 of these findings are strong independent predictors of mortality.
In addition, this article reports that men and women with above-normal white blood cell counts could face an increased risk of death at an earlier age, particularly from cardiovascular disease. People with normal white cell counts may not be out of danger since individuals on the high end of the normal range are also at increased risk of illness and death. Basically, the risk of cardiovascular mortality increases progressively with increasing white blood cell counts, and the increased risk of mortality associated with high white blood cell (counts) is maintained over 40 years of follow-up!
So there you have it. Sure, you should certainly pay attention to qualitative, objective variables such as love, life, relationships, healthy food, fasting, grip strength and more – but also use modern science to track important internal variables and the biomarkers you’ve just discovered in this new Anti-Aging panel. The only blood test not included above, but that I still highly recommend if your goal is to track the biological aging process, is the “Teloyears” telomere test. You can learn more about that test here.
How To Test Your Hormones
Because hormone levels widely fluctuate throughout the day, the gold-standard method for testing your hormones is the DUTCH urine steroid hormone profile, which measures hormones and hormone metabolites (called conjugates) in a dried urine sample, and is performed via multiple measurements throughout the day – all from the comfort of your home. It is the most cutting-edge way to truly see what's going on when it comes to your hormones because it doesn't just measure hormones, but also something called “metabolites”, which are a measurement of hormone production and hormone breakdown.
Measuring both hormones and their metabolites can give you or your healthcare practitioner a much better overall picture of hormone production. For example, a DUTCH urine steroid hormone profile on someone with low salivary cortisol could show normal cortisol production, but high levels of metabolites. In other words, this would indicate that you are producing enough cortisol, but it's just getting broken down into its metabolites very quickly. There are also some metabolites that are important markers for cancer risk that can only be measured in urine. With serum (blood) and saliva hormone spot-testing, it's possible to track variations in hormone release throughout the day – and this is a great way to measure how your hormones change during a 24-hour period (your circadian rhythm).
In contrast, the standard 24-hour urine collection many physicians use reflects your total hormone output in a 24-hour period. But by using the DUTCH urine steroid test, you get the best of all worlds: blood, saliva and urinary results with just a urine collection. The DUTCH test measures the following:
-Progesterone metabolites (a-pregnanediol, b-pregnanediol)
-Androgen metabolites (DHEAS, etiocholanolone, androsterone, testosterone, 5a-DHT, 5a-androstanediol, 5b-androstanediol, epi-testosterone)
-Estrogen metabolites (estrone, estradiol, estriol, 2-OH-estrone, 4-OH-estrone, 16-OH-estrone, 2-Methoxy-estrone, 2-OH-estradiol)
Testing is easy. When you order the test kit here, you are sent a collection kit straight to your front door, and the kit includes five easy-to-use filter paper devices on which you urinate. You then use the enclosed pre-paid label to simply send it back to the lab. To learn more about the DUTCH test in great detail, take a listen to these two podcast episodes:
How To Test For Food Sensitivities
I prefer to use Cyrex Labs for food sensitivity testing because their tests are highly accurate, consistent, and based on the latest research and development in food sensitivity analysis. Versus outdated tests that test only one form of the food, Cyrex tests for multiple forms of foods (raw, cooked, processed, and combined foods). This is important because food proteins change when they are either cooked or processed. You might react deleteriously to a food only when it’s cooked but not raw, or vice versa. In addition, you may react to a food only when it’s in combination with other foods. Cyrex takes all of this into account and identifies foods that challenge your immune system so you can reduce the load on your immune system by minimizing exposure to those foods.
On your results, Cyrex gives three ranges of results: “normal,” “equivocal,” and “out of range”. “Normal” indicates an immune response within the accepted reference range, “equivocal” is one standard deviation away from a normal result, and “out of range” is two points of deviation from normal.
You should consider any “equivocal” result to be significant and worth addressing, and any “out of range” result to mean that a food is provoking a serious immune response. Even an equivocal result may mean you are just beginning to exhibit an immune reaction to a food, and short-term elimination of that food combined with addressing issues such as a leaky gut or other strategies you discover in my “How To Fix Your Gut” article here is a very good idea. If you test positive for immune sensitivity to many foods, you should remove only the ones you react most to (the “out of range” scores on the Cyrex panel), and begin a protocol to restore tolerance. After several weeks, you can test again, and if fewer foods come back positive, it’s a sign you are on the right track.
The Cyrex Array 10, also called the “Multiple Food Immune Reactivity Screen”, measures reactivity to 180 food antigens, including reactions to foods in cooked, raw, and/or modified forms. This can then help you customize which foods to eat and avoid. Of all the Cyrex panels, I consider it to give you the best bang for your buck when it comes to food sensitivity testing.
Another newer way to test for food allergies is by simply analyzing your entire microbiome, then choosing your foods based on your unique bacterial profile in your gut. Currently, the best way to do this is via a Viome complete microbiome panel. Since Viome is a bacterial, not an antibody test, if your pocketbook permits, I recommend testing with both Cyrex and Viome, and then eliminating any foods that are ranked as a high priority to avoid based on both tests. More on Viome below…
How To Test For Micronutrient Deficiencies
Sometimes you need to take deep dive into the smaller variables that a basic blood test doesn’t look into, such as amino acids, fatty acids, antioxidants, minerals, metabolites, enzymes, inflammatory markers and more. For this, you can use a special panel called an “ION Profile”, also known as a micronutrient blood test.
This test is a combination of advanced nutritional analyses that measure levels of organic acids, fatty acids, amino acids, vitamins, minerals and antioxidants. Over time, nutritional deficiencies of these compounds can cause a variety of chronic health conditions, and if you struggle with things like poor sleep, less-than-stellar workouts, brain fog, appetite cravings, sore joints, or any other “mysterious” issues, this profile can help to elucidate and discover micronutrients and other small components that other basic blood test simply can't discover.
The Micronutrient Blood Test ION Profile from Genova includes functional deficiency marker testing for:
-Vitamins B1, B2, B3, B5, B6, B12 and Folic Acid
-Vitamins A, E, B-Carotene
How To Test The Gut
There are approximately 40 trillion microorganisms living in your gut. They help you digest your food, produce beneficial and harmful chemicals, control infections from pathogens, regulate your immune system, and even control your emotions (ever have a “gut feeling”?). These microorganisms – which make up your gut microbiome – have been implicated in maintaining optimal health, as well as contributing to many chronic conditions, including diabetes, obesity, Alzheimer's, Parkinson's, coronary artery disease, psoriasis, lupus, and autism. By taking care of your 40 trillion microbe friends, you can maximize your wellness and potentially prevent disease.
One way to actually figure out what’s going on with your gut bacteria is via a full sequencing of your gut microbiome using a service called Viome. Viome was born at the prestigious Los Alamos National Lab and originated from technology originally designed for national security. It is based on a complete sequencing of the gut microbiome based on a very small stool sample. Since every living organism produces RNA molecules from their DNA. By sequencing all of the RNA in your stool, Viome can identify and quantify all of the living microorganisms in your gut (bacteria, viruses, bacteriophages, archaea, fungi, yeast, parasites, and more) at the species and strain level.
While identifying the microorganisms in your gut is important, you can gain the most insight into your gut when you can also understand the function of those microorganisms (this is called “gut microbiome gene expression”). This is because the microbes in your gut produce thousands of chemicals, (called metabolites) that affect your overall wellness. Some of these microbial metabolites can be beneficial to your health, such as B vitamins and short chain fatty acids, while others can be detrimental, such as Trimethylamine N-oxide, or “TMAO”, which causes coronary artery disease. By analyzing the genes that your microbes express, Viome can identify which metabolites they produce – in other words, they can determine the role of these metabolites in your body's ecosystem. By following Viome's diet and lifestyle recommendations, you are then able to fine-tune the function of your gut microbiome to minimize the production of harmful metabolites and maximize the production of beneficial ones.
As I discuss in great detail here, every person is biochemically unique. As a result, every person processes macronutrients (fats, protein and carbohydrates) differently than others do. Because of this, as part of the “poop test kits” that they send you in the mail, Viome also sends you a special “nutritional challenge” shake to drink, followed by a series of measurements that you take which analyze your body’s response to determine how quickly you regain your balance and how you metabolize different macronutrients. When they combine the results of this nutritional challenge test with your poop test results, Viome can then provide your ideal macronutrient ratio and make dietary recommendations that are unique to you. When you sign up with Viome, you get an at-home kit delivered straight to your home, access to Viome's artificial intelligence engine, and a personalized plan with diet and nutrition recommendations delivered via an app. You also get a full list of microbes in your gut, which not only include bacteria, but also viruses, yeast, fungi, bacteriophages, and all other living microorganisms.
In addition to a Viome test for your complete gut microbiome analysis, I’m also a fan of the Genova 3 Day Gut Panel, since it allows you to determine, (which combines DNA Analysis, gas chromatography, mass spectrometry), microscopy, an enzyme immunoassay and colorimetry to test for the presence of enzymes, specific compounds, antibodies, hormones and many more substances in your gut. When it comes to going beyond the bacteria that Viome analyzes and also testing for yeast, fungus, parasites, etc. I consider this to be the gold standard for gut testing. It is a home stool collection test kit that is mailed to you, with the only drawback to it being that you must store your precious poo in the refrigerator for three consecutive days as you gather all the stool for the test, which may be shocking to any dinner guests that you have if you are not careful.
For more information on Viome, check out the podcast I recently conducted with their founder Naveen Jain, fresh off the presses just a few days ago at the time this article is being released.
How To Test Your Genes
You’re no doubt familiar with 23andme, the genetic testing service that can analyze your saliva, then give you detailed information on your ancestry, and certain genetic variables that affect your health. Problem is, even though I’m a big fan of getting a 23andme test, the good folks at 23andme only test for a limited number of genetic factors, and can only legally release a limited amount of health information, which means that you must download your raw data from 23andme (it is very easy to do this) and then upload that data to other websites that can give you much more actionable information than 23andme can.
As you discover in this podcast, Ben Lynch’s online genetic analysis service called “Strategene”, which analyzes your raw genetic data from 23andme for a host of different so-called “dirty genes”, is just one example of the useful information you can glean once you upload your raw genetic data to a third party analysis website.
DNAFit is another good service to upload your genetic data to, especially if you’re an active individual who wants to know more about how to exercise and how to eat. Using the power of genetic science, it is now possible to determine your response to a selection of key genetic markers associated with health fitness, nutrition and sporting performance. DNAFit provides in-depth analysis of up to 45 key genetic variants, allowing you to tailor your training and nutrition choices to play to your genetic advantage. The DNAFit Nutrigenetic report uses DNA information to provide information about individual response to carbohydrate and fats, detoxification (phase 1 and phase 2) ability, anti-oxidant capacity, omega-3 and vitamin B and D needs, salt, alcohol and caffeine sensitivity, lactose intolerance and celiac disease predisposition. The DNAFit Fitness report uses DNA information to provide information regarding power training vs. endurance genetics response, aerobic (VO2 Max) response, recovery profile and injury risk.
You can listen to an example of how to interpret a genetic test like DNAFit and how I personally walk people through the results of their genetic analyses (in this case, obstacle course racing and Crossfit beast Hunter McIntyre) in the podcast episode “The Genetics Of A Beast Freak Of Nature“.
While Strategene and DNAFit are two of my favorite third-party services to which you can upload your 23andme data, you can view a host of other useful websites for analyzing your genetic data here. Finally, I'll soon be releasing a mind-blowing podcast on a new genetic test out of Canada that blows the amount of data you get from 23andme or DNAFit out of the water. Click here to subscribe to my newsletter so you're the first to find out when that podcast gets released.
How To Test Your Blood Glucose & Ketones
While a single blood test using an inexpensive blood glucose monitor from any drugstore or website such as Amazon can give you a static snapshot of your blood glucose levels, nothing beats a continuous blood glucose monitor for truly determining how your diet is affecting one of the most important parameters of your health and fitness: glycemic variability.
A continuous glucose monitoring system (CGM) is a system that does just what it sounds like: it monitors your blood sugar continuously, 24 hours a day. The data is transmitted from a sensor which is inserted right beneath your skin, and this is attached to a transmitter which sends the data to the receiver. You are then able to see your blood sugar at any point via a receiver or a phone app.
The basic way any CGM system works is via a tiny sensor inserted under the skin of your abdomen or on the back or your arm that is typically worn for 7-14 days (in my opinion, if you are eating your normal diet, you eat the same things regularly, and you test for two weeks, you’ll know everything you need to know about your blood glucose and can likely stop testing at that point unless you’re wearing the CGM for medical reasons). This sensor will be reading glucose levels in the interstitial fluid below your skin’s surface and is attached to a transmitter which sends the glucose level data wirelessly to an insulin pump (if a diabetic is using the CGM) or other receiver or smartphone app. This means that at any given time during the day or night, you can look at your device and see how your blood glucose level is trending, and even receive instant notifications if it gets too high or too low. The two most popular CGM’s – both of which I’ve experimented with and found to work well, especially when covered in kinesiotape or some kind of ace bandage for high-intensity workouts, races, swimming, sauna etc. – are the Dexcom Continuous Glucose Monitoring System and the Freestyle Libre. Admittedly, because of my highly active lifestyle, I was nervous about using a continuous blood glucose monitor due to my fears that it would constantly become detached from my body, become water damaged, or that the extremely small needle that is inserted between the CGM and the skin would become bent. However, as long as I am careful to tape the CGM prior to intense physical activity, it seems to stay attached and continue to take good readings. I'd especially recommend the more expensive but far more accurate Dexcom G6 model, which also requires a physician's prescription but is well worth it if you can get your hands on one.
In addition to blood glucose, it can be very insightful to measure your ketone levels, which are reflective of how efficiently you are burning fat, or how efficiently you are producing energy, even in the absence of high blood glucose levels. Assuming you do not possess genes that would make you respond deleteriously to a high-fat, low-carb diet, ketosis can be a powerful nutrition approach to use switch your metabolism to prioritizing the use of fat as a fuel, while also increasing cognitive and physical performance (incidentally, even if you’re not achieving ketosis via a high-fat, low-carb diet, you can still amp up ketone production by intermittent fasting or engaging in other forms of calorie or carbohydrate restriction). Many people just assume that if they are “low carb” or fasting they are in ketosis, but it can be useful, especially if you’re just getting used to a new diet or supplement and trying to determine whether or not it increases ketone production.
There are a host of methods to measure ketones, but my current tool of choice and the one that currently sits on my office desk is the Levl device for measuring ketones, which is based on a simple breath measurement that not only tells you ketones, but with pretty good precision fills you in on exactly how much fat you're burning each day based on an algorithmic approximation from your breath ketone values. Just like a CGM beats constant finger needle pricks for blood glucose, the LEVL beats the pants off repeatedly conducting blood ketone evaluations.
How To Track Your Readiness For Stress
No one can perform at their best 24/7/365, because both mental and physical readiness varies from day to day. This means some days are perfect for challenging your body and mind, and other days should be focused on easy, restorative, relaxing activities. Ideally, this is something that should be quantified and tracked. As a very sleek and efficient way to test the body’s recovery status and overall wellness without the need for imprecise subjective evaluation, time-consuming questionnaires or extensive testing, and with the use of one simple piece of hardware – the Oura ring – I’m now using the Readiness score as one of the only key “daily metrics” I glance at (the other is sleep, and occasionally blood glucose and ketones during periods of trying new diets, foods or supplements). The Readiness score allows me to answer important questions, such as:
-Is my nervous system ready to take on the day?
-Should I take it easy today in my workouts or go all out?
-How much stress can I handle today?
-Should I get extra sleep tonight, or a nap today?
-Have recent lifestyle or environmental changes significantly affected me?
All of these questions can be quickly answered if I can simply wake up each day and glance at my Readiness score, which indicates how recovered I am and how well my body is responding to the demands of daily life. If daily stress load and recovery are in balance, then usually the Readiness is high. I use the same method with the clients and athletes I coach to give me intelligent data that educates me on exactly how to structure their training for the week – even occasionally pushing the athletes in training through low periods of Readiness followed by big bouts of recovery so that they can super-compensate and bounce back even stronger (a training method called “periodization”).
It’s true that the current state of your body and mind can give you subtle hints about your readiness. For example, are you relaxed or tense? Is your mind crystal clear or covered in fog? Do you feel healthy or a bit under the weather? But these are mainly subjective evaluations of your readiness. An objective evaluation is also important, which is why getting a personal Readiness score is something I very quickly do each morning by glancing at the smartphone app that connects to the Oura ring.
The Readiness score ranges from 0–100%, and is based on specific metrics tracked with the Oura ring, specifically:
Previous Night’s Sleep: How well you slept the night before has a big impact on your Readiness Score. A general rule of thumb is that the previous night’s “sleep score” should be above 85% or at the high end of your normal range if you’re planning to subject your body to stress or do something that calls for maximum physical or mental performance.
Sleep Balance: Sleep Balance is based on a longer-term view of your sleep patterns. The Oura ring compares the past two weeks of your sleep duration to your long-term sleep history and the amount of sleep time recommended for people in your age group.
Previous Day’s Activity: The Oura ring keeps track of your previous day’s load and guides you accordingly. This means your Readiness score may be slightly lower if you have trained intensively in the past 24 hours, although if your RHR (see below) is normal and your HRV (see below) is still high, your Readiness score may not be as low as you think.
Body Temperature: Knowing the variations in your night-time body temperature helps you to detect early signs of impending sickness or a need to rest, and for women, the specific stages of the menstrual cycle (for example, studies have shown that females should schedule the majority of their highest intensity training to correlate to the first half of the menstrual cycle.)
Resting Heart Rate (RHR): RHR is a reliable and scientifically proven measurement for establishing overall sleep quality, recovery and health. Usually, an RHR on the lower side indicates good fitness, but an exceptionally high or low resting heart rate can be a sign that you need more recovery. For more on RHR, check out this fascinating article on the big data that Fitbit just released on the link between RHR, exercise, longevity and much more.
Recovery Index: The timing of your lowest RHR is also of significance and tells you how well your body is in recovering from the previous day’s load. Recovery Index is one indicator of this balance: it indicates how long it takes for your RHR to stabilize and reach its lowest point. An indicator of good readiness is if your lowest RHR happens earlier in the night (a rule of thumb is at least six hours prior to waking). For instance, eating a heavy meal, drinking alcohol, or exercising too close to bedtime can postpone the timing because they all speed up your metabolism and elevate your RHR, which in turn delays your recovery, increases your sleep needs and lowers your Readiness score.
Heart Rate Variability (HRV): Your HRV reflects the small time gap between your heartbeats, and in an ideal recovery scenario, this gap isn’t identical all the time and has mild beat-to-beat fluctuations. HRV is a measurement of the variation in the time interval between heartbeats. Both researchers and practitioners consider HRV to be a good measure of your readiness status, as it can indicate stress and fatigue levels on your body. Generally speaking, when you’re fit, relaxed and recovered, your HRV is higher. When your body is recovering from stress or strenuous exercise, your HRV is lower. The Oura ring app shows your average HRV (from 5-minute samples measured during the whole night), and your nightly HRV curve.
All these variables are then tracked by the Oura ring and used to generate your daily Readiness Score. A general rule of thumb is that if your Readiness Score is above 85%, you’re ready to meet the day’s more stressful physical and mental challenges, and if it’s below 70%, you might want to consider concentrating more on recovery.
How To Track Your Sleep
What is the right amount of sleep for me?
How fast did I fall asleep?
Did I go through a normal series of sleep stages during the night?
How do I know if I’m sleeping well?
How do I measure sleep?
Until this new era of self-quantification came upon us, outside sleep laboratories, it was very difficult to answer questions like this and to track sleep objectively.
The problem with sleep monitoring is that traditionally, most people outside sleep clinics didn’t have tools with which to track sleep accurately. Without a measuring device, you cannot really know whether you have had enough deep or REM sleep. In addition, it can be tough to remember how well you slept, say, a couple weeks ago, or to generate realistic trends of how your sleep trends along with your diet, your supplements, and your exercise. This is important because, as you learned above, your “sleep history” can have a significant effect on your Readiness score. In addition, it’s easy to misinterpret sleep quality: having a feeling that you slept like a log doesn’t necessarily mean that your sleep was actually restorative, and training through a low Readiness score or a low sleep score can cause an impending injury or illness to rear its ugly head, even if you subjectively felt as though you were ready for stress. I’ve seen this happen over and over again in both myself and in clients and athletes I train who decided to simply listen to their body, vs. listening to the body but also using better self-quantification through science.
If you don’t know what your sleep quality is, you cannot act proactively. In the very worst case this can lead to a situation where you start to learn more about your sleep only after you’ve developed some sort of a sleeping disorder such as severe sleep apnea or insomnia, and need to consult a sleep clinic or find yourself addicted to sleep supplements or medications. Even if you do go to a professional sleep clinic or sleep lab, you’re usually only there for a night or two of sleep analysis, and the sleep tracking devices there can be quite uncomfortable to wear, thus giving you inaccurate data (go ahead: just try to get a normal night of sleep in a lab with a bunch of electrodes attached to your head).
It probably comes as no surprise to you that I also swear by the Oura ring as an my favorite accurate but unobtrusive sleep tracking device: it doesn’t disturb sleep, but with highly accurate sensors quietly measures body signals such as resting heart rate (RHR), heart rate variability (HRV), respiration rate, body temperature, and movement during sleep, along with tracking all your sleep cycles. You can then grab your sleep metrics in easy-to-read format and visualizations from the smartphone app, along with guidance on what the different metrics mean, and on ways to improve your sleep quality within time. Oura uses the following parameters to calculate your Sleep score:
Total Sleep: This contributor shows you the total amount of sleep you achieved the previous night, including light, REM and deep sleep. It’s important to realize that the total time you spent in bed does not necessarily equate with the amount of total sleep.
Efficiency: Put simply, efficiency means the percentage of time you spent sleeping while in bed. The longer the time sleeping, the more efficient your sleep was. In general, a sleep efficiency score of 85% or above shows that you fell asleep quickly enough (in less than 20 minutes) and didn’t wake up too often during the night.
Disturbances: Disturbances are the other side of the efficiency coin, and inform you as to the total time you spent awake. Disturbances such as wake-ups, get-ups and restless time during your sleep can have a big influence on your sleep quality, resulting in less restorative sleep. For example, this can be one of the primary reasons behind daytime sleepiness. Obviously, many things can cause your sleep to be interrupted, but variables such as stress, noise, sleep companions, light, room temperature, infections, drinking too much (alcohol or even water) so that you pee during the night, or later evening activities (exercise, screentime, heavy meals) are on the list of potential suspects.
REM Sleep: As you learned in this article on sleep, REM is short for rapid eye movement. This is the stage of your sleep that is associated with dreaming, but also with memory consolidation, learning and creativity. It ideally makes up about 20-25% of your total sleep time but tends to decrease with age.
Deep Sleep: Deep sleep, or NREM sleep, is considered the most restorative and rejuvenating stage of sleep. This is the stage where your muscle repair and growth takes place, your body is relaxed, blood pressure is lower, and it’s also harder to wake you up. The amount of deep sleep varies between nights and individuals, but on average, adults should spend 15-20% of their total sleep time in deep sleep. This percentage also tends to decrease with age. Basic, simple practices such as daily physical activity, and avoidance of practices such as heavy meals and alcohol before bedtime (or long naps and caffeine in the afternoon), can all increase your amount of deep sleep, as can following all the sleep hygiene tips you learned in my last big article on sleep, such as sleeping in a cool, dark room with limited sound interruptions.
Sleep Latency: This is the amount of time it takes for you to fall to sleep. Sleep latency is highly variable, but a rule of thumb is that it shouldn’t take you more than 15-20 minutes to fall asleep. There are many reasons that might lead to your sleep latency to decrease, including exposure to too much blue light at night, and a later dinner and/or alcohol too close to bedtime. Bear in mind that also dozing off in less than 5 minutes can often indicate that you are sleep deprived or that you haven’t slept enough the previous night.
Sleep Timing: As you also learned in my last big sleep article, every human has a biological clock aligned to day and night cycles. All of our essential biological processes such as body temperature, hormone releases and hunger operate on 24-hour cycles known as the circadian rhythms. As you also learned in that article, there are significant differences in our rhythms: some of us are more morning-oriented, some are evening people, and others are somewhere in-between. Regardless of the orientation, however, having a consistency in your rhythm and your sleep timing (e.g. I’m personally to bed approximately 10pm most nights and up approximately 6am most mornings) is important. In addition, having the midpoint of your sleep somewhere between midnight and 3am is preferred from a sleep quality point of view.
Collectively, each of the parameters above is used by the Oura ring to calculate your daily Sleep score. The score ranges from 0-100%, and as a rule of thumb: the higher it is, the better, more restorative sleep you have had.
If all this testing sounds a bit overwhelming, then please realize that the goal is not to spend each day hunched over a tube while spitting saliva, filling beakers full of blood in a laboratory or pooping into a tray every time you use the bathroom. In contrast, a simple and ideal self-quantification scenario would look like this:
-DNA test such as 23andme: once in a lifetime
-Comprehensive blood panel such as the Greenfield Longevity Panel for men or for women: once per year
-Microbiome test such as Viome: once per year or whenever the gut seems to significantly change in function or health.
-Food allergy test such as Cyrex: once per year or whenever the gut seems to significantly change in function or health.
–3 Day Gut test: once per year (or, similar to the Viome test, whenever symptoms arise)
–Readiness and sleep tracking: daily
–Ketones and glucose testing: optional, but to be performed ideally on a daily basis when adopting a new based diet or when attempting to evaluate which food groups cause glycemic variability or a rise/fall in ketones
–Micronutrient test: optional, but to be performed if concerned about energy levels, health issues, or wanting to “dial in” supplementation and diet protocol even more thoroughly.
So now it’s time to start self-quantifying. Sure, you don’t have to buy a fancy $10,000 full-spectrum blood test from a Longevity Institute, but considering how inexpensive and accessible DNA testing is, it can be a perfect place to start. So invest in yourself. This week, consider ordering a DNA test. If you’ve already gotten one, open up your results, look at your disease risks, and see what proactive thing you can do for them. For example, if you have a higher than normal risk of prostate cancer, you can start getting more lycopene from a fresh tomato every day. Or if you have a high risk of type II diabetes, you can begin saving any carbohydrates that you eat for after an exercise session, when your when your blood sugar levels won’t be as prone to fluctuation. You get the idea. DNA testing is probably one of the less expensive and more informative tests that you learned about in this article.
Do you have questions, thoughts or feedback for me about testing, tracking or self-quantification? Leave your comments below and I will reply!