A look at how to accurately quantify your cardiovascular fitness in order to optimize endurance sports or your cardiovascular health. Is VO2Max the gold standard? Are the metrics in the current “fitness trackers” useful for this goal?

In this episode we look at different ways to track fitness. Previously we have talked about VO2 max and Heart Rate Variability (HRV), along with the trackers (ex. Fitbits) which are used to quantify such physical activity markers.

This episode highlights difficulties and advances in translating physical activity data into meaningful information. We seek to understand what tracking fitness actually tells you about how fit you are? How is your fitness evolving due to training and other changes you are possibly making to your lifestyle? Ultimately, can we usefully quantify cardiovascular fitness yet?

Aiming to accurately capture this, our guest has developed his own approach to analyzing fitness and this is the main topic of this episode.

There is an opportunity.. to quantify what the fitness levels [are] that you can have. You can have feedback… from a health point of view, to see if exercise is having any impact.
– Marco Altini

Our guest is Marco Altini, a PhD Data scientist and entrepreneur working in the middle of the quantified self area. He has spent a lot of time working on heart rate, HRV, fitness, and physical activity analysis via wearable sensors.

Marco has published over 25 papers on the topic. He has a popular HRV4Training app, which is available on the iTunes store. I have used this app myself for over-training monitoring. So he has really done a lot of work in just this specific space.

If you’re in the quantified self community you probably know Marco already because a lot of his posts are widely circulated as these are normally rigorous and interesting. Today he heads up Data Science Activities at Bloom Technologies, where he is using technology and data to help women have healthier pregnancies. We also touch on that.

The episode highlights, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

What You’ll Learn

  • Marco’s research interests and the science behind personalized fitness (3:49).
  • Interpreting accelerometer, heart rate, or calorie meter device data (8:31).
  • Modeling physical activities and normalizing body data to accurately determine energy expenditure (9:54).
  • Using the VO2 max test as a marker for quantifying cardiorespiratory fitness (15:49).
  • The VO2 max test in tracking for performance or health benefits of exercise (19:24).
  • Interpreting VO2 max test results and the drawbacks of normalizing (25:13).
  • Using technology for normalizing results and improving accuracy of quantified fitness (25:54).
  • How to track individual fitness changes (30:23).
  • How Marco’s StayFit app works and distinguishing features from other similar apps (30:38).
  • Key points of analyzing energy expenditure as a fitness marker (33:44).
  • Because fitness improves over long periods, accurate tracking should aim at long – term benchmarks (37:14).
  • The complexity of the relationship between HRV and quantifying fitness levels (38:45).
  • How Marco tweaked his app to adapt measuring heart rate in overall fitness equations (42:28).
  • Normalizing fitness metrics and allowing for un-biased comparison between people (43:26).
  • The importance of context when considering what normalized fitness metrics actually mean for an individual’s results (44:12).
  • Comparing the advantages and limitations of tracking HRV vs. heart rate as fitness biomarkers (46:37).
  • Tracking HRV and fitness parameters in order to prevent pregnancy complications – a Bloom Technologies project (48:22) .
  • Discussing near-future market products and collaborations with major clinical research centers (51:54).
  • How to obtain more information on the topics of this episode (52:50).
  • How best to connect with our guest (53:36).
  • Marco’s recommendations for learning about cardio fitness (53:52).
  • Marco’s approach to tracking his body data on routine basis (54:34).
  • Caveats and useful insight into tracking HRV as a cardiovascular fitness parameter (55:45).
  • Marco’s number one recommendation for improving health, performance, and longevity (57:41).

Thank Marco Altini on Twitter for this interview.
Click Here to let him know you enjoyed the show!

Marco Altini (PhD), Bloom Technologies

Fitness Apps developed by Marco

  • HRV4Training: This app is useful for preventing over-training by measuring HRV and providing personalized feedback on your physical condition. Learn more on their website.
  • StayFit: This app from Marco is based on a novel method for quantifying cardio fitness, known as the Fitness Index developed by Marco Altini. Some of the research backing this up was just recently (after this interview took place) published in the Artificial Intelligence Journal here.
    Note: StayFit is not available on the Apple Store any longer. Marco has integrated the Fitness Index into his main app HRV4Training.

Tools & Tactics

Supplementation

  • Lypo-Spheric Vitamin CLiposome Encapsulated Vitamin C for Maximum Bioavailability; 0.2 fl oz. – 30 Packets | 1,000 mg Vitamin C Per Packet. Damien suggests taking this supplement in response to particularly low HRV test scores. As such, it can be used to prevent potential colds in a timely manner.

Tracking

Biomarkers

  • Maximal Oxygen Consumption (VO2 max): This marker reflects the ability of your circulatory-respiratory system to provide oxygen to your muscles for sustaining exercise. Research has confirmed that low cardiovascular fitness is associated with higher disease risk, including heart disease. A running VO2 max test is more indicative of cardiovascular fitness compared to a biking test which does not require you to carry your entire weight forward. We have previously discussed this marker in the context of wearable devices which estimate VO2 max with Troy Angrignon in Episode 24.
  • Heart Rate Variability (HRV): HRV is the measure of the change in the heart’s rhythm, measured as variations in para/sympathetic stimulation to the heart muscles. HRV is not an ideal marker for tracking fitness improvements because of day to day variability in results. Previously we covered HRV in the context of optimizing training in Episode 1 with Andrew Flatt, longevity in Episode 20 with Dr. Joon Yun. and using HRV to reduce stress in Episode 35 with Richard Gevirtz.
  • Heart Rate: The speed of the heartbeat – measured in beats per minute (bpm). Lower heart rate is associated with stronger cardiovascular ability. Marco recommends tracking resting or active heart rate for tracking overall cardiovascular fitness. Heart rate increases by 10-20 bpm during pregnancy – an important factor to consider when quantifying fitness or risk for pregnancy complications.

Lab Tests, Devices and Apps

  • Basis Peak: A watch functioning as a fitness and sleep tracker.
  • Moves: An exercise tracking app which can detect the type of exercise being performed.
  • FitBit: This company offers wearable devices which include cardiovascular fitness tracking. The FitBit Surge is a fitness watch that offers GPS tracking, heart rate monitor, all-day tracking, and sleep tracking. The FitBit Charge monitors physical activity and sleep quality.
  • Runkeeper: An app which tracks running, walking, cycling, workout, pace and weight and which also lets you manually enter the activity you are performing.
  • MyHeart Counts: A personalized tool that can help you measure daily activity, fitness, and cardiovascular risk developed at Stanford University.
  • Steps: A pedometer and activity tracker app with measures how far you walk and how many steps you take.

Other People, Books & Resources

Organizations

Full Interview Transcript

Click Here to Read Transcript
[03:49][Damien Blenkinsopp]: Now Marco, thanks so much for joining us on the show today.

[Marco Altini]: Thank you, my pleasure.

[Damien Blenkinsopp]: So I wanted to get first into a story about where you are at, and how you got into measuring fitness and looking at that specifically. What’s your background, and what’s your interest in this area?

[Marco Altini]: So basically I’ve been doing a PhD all around using wearable sensors to monitor energy expenditure. Well, let’s more say on their machine [04:12 check ‘machine landing’] aspects, so integrating multiple data streams [04:16 unclear] to accurate measurements of physical activity. Which is normally what we focus on is energy expenditure. So basically the intensity of the activity.

And taking a step back, let’s say most of the research in the field focused on the component of energy expenditure, which is due to physical activity, right? So body movement, because energy expenditure is actually composed of three elements. So we have diet induced thermogenesis, which is the energy expenditure we expend due to digestion, for example. And that’s something we consider as a sort of standard component, about 10 percent.

Then we have our basal metabolic rate, which is basically the calories we burn at rest. So if we take a bit of a simplistic view, this is what we would consume if we were not doing any activity. We lie in bed all day, and we still consume actually most of our energy which is due to this component. And then the third component is physical activity energy expenditure, which is the calories we burn when we move or exercise.

So by working a lot around this component and trying to estimate this more accurately using accelerometer and heart rate data, then I started focusing on aspects like personalization. Because when you use physiological data like heart rate to estimate energy expenditure you basically rely on parameters which are very well correlated with energy expenditure at the individual level. So for a single person, because of course heart rate is directly connected to oxygen uptake, which is also what we measure when we want to get the reference for energy expenditure.

At the same time there are individual differences between people so you need to try to understand how to model this difference between people in a way that your energy expenditure estimate coming from heart rate is accurate. And while working around this, basically you’ll get the work on what is the problem of basically normalizing heart rate between individuals, which is directly connected to fitness.

Because everyone tends to know that lower heart rate means better fitness. This is true at rest but even during exercise, which is, as a matter of fact, the principle behind, for example, sub-maximal fitness tests.

So, people are brought to the gym and they do an exercise to a certain intensity, and then based on what their heart rate you get, basically a surrogate of their fitness level. And all of that came back as something that you need to account for also when you measure energy expenditure because the whole reason behind normalization is that our metabolic response to exercise is not affected by fitness.

So just as an example to clear this up, if we think about, let’s say two individuals which are the same in terms of age, body weight, body mass, pretty much the same anthropometric characteristics. Then when they do a certain activity, they consume the same energy. So it’s the same kilocalories per minute because that’s mainly driven by the type of activity and the body mass.

However, these two individuals could be having a very different fitness level. So let’s say that one is very fit and while doing this activity their heart rate is very low, and the other one is very unfit and the heart rate is much higher. Then if you use heart rate to estimate the energy expenditure, you would be over or under estimating for one of these people.

[Damien Blenkinsopp]: So the one with the fast heart rate is over estimating?

[Marco Altini]: Yes. If you have a higher heart rate and then you don’t take into account that there is a difference in fitness, then you will assume this person is consuming more energy because the heart rate is higher with respect to the average, let’s say.

But that’s not the case because actually metabolism is not affected by fitness and there have been quite a few studies looking both at rest and during exercise, and given basal metabolic rate the component of energy expenditure.

[08:31] [Damien Blenkinsopp]: So what we’re saying is there are a lot of devices out there right now which are attempting to assess how many calories you’re burning in addition to the steps. So when you’re looking at that, actually, it’s a bit more complicated than the standards currently use, right?

[Marco Altini]: Yeah, exactly. Especially manufactures which are using, providing sensors with heart rate. They like to claim that just because there is heart rate they will be more accurate. And let’s say that using heart rate certainly is already a step forward compared to accelerometers because you can, with minimal effort already take into account energy expenditure for many activities which don’t involve body movement. Right?

For example with accelerometers we have limitations even just biking, because you might have the accelerometer in a place where it doesn’t move when you do these activities. So by using heart rate you can solve, partially, these issues. Because of course your heart rate will increase.

It doesn’t matter if you don’t move if you are doing exercise which is intense and of course requires your heart to pump more oxygen to your muscles. At the same time, due to the fact that the relation with heart rate is very personal, then you need to be able to make an extra step and model that if you want your system to be accurate during intense physical exercise.

[09:54][Damien Blenkinsopp]: Great. So in terms of the tech out there currently, would it be safe to say that a lot of it’s either overestimating or underestimating based on these restrictions or are there devices or apps out there which have tackled this problem?

[Marco Altini]: So I think what we are starting to see a bit more is, for example in the context of even just monitors using, for example movement or steps, some of them are introducing something more around context. Which is important because when you use accelerometers this first instance were probably already in the late 70s, for sure in the early 80s.

The researchers started to develop the first equations to link accelerometer output and movement to energy expenditure. however some of the imitations there are that, for example, the relation between the accelerometer output and energy expenditure changes depending on the activity. So if you are walking or running there’s a different relation. If you are at rest, of course, there is no movement, and all of that.

Recently we started seeing even commercial devices which are able to detect activities. For example, I think the Basis watch is detecting a couple of activities. Even apps like the Moves app can detect activities.

So in general I would assume even though they don’t disclose the methods they use to estimate energy expenditure, I would assume the ones that are able to detect the activity, then what they do they use this table, it’s called the compendium of physical activities. Basically it’s a table where you have almost all possible activities you can think of, and for each of them there is a value of energy expenditure normalized by body weight that people are supposed to be expending while doing that activity.

So these devices are probably mapping the activity they recognize to this level of energy expenditure. This method [11:53 unclear] like four or five years ago, to be much better than using accelerometers without context. But it’s even better than combining heart rate and accelerometers, if you don’t take extra measures like modeling context or normalizing heart rate.

So just putting together accelerometers and heart rate is not able to outperform methods where you use only accelerometer data. But with a bit more of machine learning to be able to recognize what activity is being performed, and then map that to an energy expenditure level.

[Damien Blenkinsopp]: Right. It sounds like if you have the heart rate, and you have the anthropometric data ñ what’s your weight and age and so on — and if you have the accelerometer data showing the movement, and you have an algorithm which categorizes what kind of activity it is based on the accelerometer, what’s that showing.

Which, I know isn’t always correct, based on my experience. So sometimes, for instance, I was wearing the Basis and it would say I’m on a bike where I never got on a bike. So it isn’t quite perfect yet, but we’ll assume that’s getting better. And maybe it’s already better.

Then what they’re doing is they’re looking at the activity and they’re saying, ìWell for this type of activity this heart rate is standard for this kind of fitness, and this heart rate is standard for this kind of fitness.î Is that how it works? Or is it a more basic thing right now?

[Marco Altini]: I think step zero would be simply to map it to known values, regardless of your heart rate. Let’s say, an app without heart rate, like the Moves app. So you just have the activity type, and you map that energy expenditure. Yes, like the average energy expenditure for that activity for a person.

So you are walking, and of course you can walk at many different speeds, so maybe that’s not known by the app. But still you would assume that for the average walking speed for the average person, you would consume this many calories. And when you detect walking you just map it to that and then based on other characteristics you input, like your body weight, you scale that by your body size, basically.

And then if you do a bit of more advanced work, let’s say, and you want to develop your own model for a specific activity. Let’s say you have the Basis, and at Basis they have a couple more physiological parameters together with movement, then it could develop there on regression models by collecting reference data.

So normally we do that with indirect calorie measure. So that’s a device which is a physical mouthpiece, where you breathe and it’s measuring O2 and CO2 counts. So, you compare the O2 and CO2 in body sheets, and that’s basically energy expenditure. So by having people performing different activities wearing the Basis watch, while you measure these reference calorie meter data, then you can see how all these valuables change depending on the activity.

And then you can map, let’s say heart rate changes and movement changes, the energy expenditure for a specific activity. I don’t know if they are doing that, because that would require to do all the tests with a calorie meter. I would assume, considering that they have all that physiological data that they did also this kind of development. While maybe all the other devices which are simply accelerometers, they might have simply used the values from the compendium of physical activity.

Basically the compendium of physical activity is what you use also when you, let’s say you use an app for tracking your workout, like Runkeeper, that let’s you also manually enter the activity. So maybe one day you didn’t have your phone and you want to enter it manually, then it will also estimate your energy expenditure. And that’s basically just a lookup from this table. And then it’s just scaled by your body size and for the amount of time you did the exercise.

[15:49][Damien Blenkinsopp]: Okay great. So what we’re talking about here is physical activity level, right? These are different version of it. There’s energy expenditure, and there’s Steps, which is currently what’s on the market. All these devices are looking at quantifying our physical activity level.

I guess the question is is that what people really want in terms of the end game? Because you’ve got this app out which is trying to get at something which you feel is a bit closer to the end goal of what you want to measure.

[Marco Altini]: Yes, so while I was doing research here on energy expenditure and the more I looked close to the whole personalization story, basically I was thinking what is a way to quantify not only what activity you do, right, the amount of exercise, the Steps, but also what the impact of this activity on your health, if there is any.

So this is a process in which we try to move from quantifying physical behavior to quantifying physical activity related health markers. And one of these markers, which is probably the most important one, is cardiorespiratory fitness.

[Damien Blenkinsopp]: That’s kind of well-known. That’s been the standard for a long time, in terms of quantifying fitness. But it’s only been done in laboratory contexts, as I understand it.

[Marco Altini]: Exactly. So far, as you say, it’s been really, I think 20 or 30 years that we know for sure that all these studies show that low level of cardiorespiratory fitness is indicative of higher risk of getting different sort of diseases. And even in general of just what is called [17:24 check – all cause mortitus], so you’re just most likely to live less if you have a low level of fitness.

And what is interesting here is that it is true even when it’s basically controlled by physical activity or body size. So it means that it doesn’t matter even if you are obese or if you have less levels of activity, but as long as your cardiorespiratory fitness is higher, you tend to be protected with respect of these other issues.

And indeed we know that. The research community at least is well aware of the importance of cardiorespiratory fitness, but in the general population I think we still lack awareness of this. Mainly because, as you say, there are basically no tools. So the way this is measured is in laboratory conditions. The reference is called VO2 max test.

And while VO2 is the oxygen volume and this is called VO2 max basically because the way the test works is that you get people either to do a treadmill test or a biking test in which they bike around until exhaustion. So you increase the intensity of the exercise every 5 minutes or so. And basically there is a point in which an individual is still able to keep it going at that intensity, just a bit before you drop. And then your oxygen sort of plateaus, and that’s your VO2 max.

[Damien Blenkinsopp]: What does that signify? Is that the moment when you switch to anaerobic, or what does it signify physiologically?

[Marco Altini]: Well, there is really the moment in which you cannot take any oxygen anymore. You need to stop. You cannot take any more intense activity, so that’s the max oxygen you can take.

[Damien Blenkinsopp]: Right. So it’s like your maximum ability to metabolize…

[Marco Altini]: It’s the ability of your circulatory-respiratory system to provide oxygen to your muscles for sustaining exercise.

[Damien Blenkinsopp]: Great, great.

[19:24] So showing that efficiency and when people are looking at that list, let’s talk a little bit about the decisions.

Typically when you have these meters when people are using these activity tracking meters for, whether it’s biking and running and so on, typically they want to improve something. They either want to lose weight, sometimes, or they want to improve their fitness. Or they want to improve their health.

So you’ve talked a little just there about cardiorespiratory fitness, we say that that has a protective effect against heart disease, which is one of the biggest killers. And also, if our cardio fitness is better, is more efficient, then we’re probably going to be able to run further, and run faster.

We’re going to be able to perform better, which is also something that we want. Whereas the Steps and the energy expenditure is hard to understand how that reflects either of those two cases, kind of like the use cases: health or better performance.

And with Steps and energy expenditure, you can tell that you’ve done more in terms of quantity but you can’t really tell if it’s going to give you more performance or you’ve actually got health benefits.

[Marco Altini]: Yeah.

So I think there is an opportunity in trying to quantify what is the fitness levels that you can have. You can have feedback for the ones that are interested just from a health point of view, to see if exercise is having any impact. You can have, actually even for professionals it would be, they do the VO2 max test and they know their actual cardiorespiratory fitness level, but still you cannot do that that often and it takes time.

[Damien Blenkinsopp]: It’s expensive, I think it’s like 300 dollars or something. Because I looked up, when I was in the US recently I was going to do one in San Diego and they had a gym that was actually providing it. Sometimes you can go to laboratory health centers or sometimes some advanced gyms will have the equipment to do this.

[Marco Altini]: Yes. I think there are a few limitations around the VO2 max test, apart from the cost.

Certainly you need some medical supervision and you need, again, the calorie meter to measure the oxygen. It requires a level of infrastructure. And apart from that, I think sometimes it’s even tricky to interpret the result. Because VO2 max is normally reported normalized by body weight. So you need to provide people with an easier way to understand their fitness level.

So you have these tables where basically different levels are divided by gender and by age. So if you are a person of a certain age and you’re male, and then you have your VO2 max result and it would soon [21:53 unclear]. Okay?

But however, these tables are not organized by body weight. Only by gender and age, since the results are normalized. However, the exercise type you use to acquire the VO2 max data is not part of those tables. And that has a great influence on oxygen consumption.

Because even just when you normally measure energy expenditure, even if you’re doing an activity which is weight bearing, you literally carry your weight around, like when you walk around, then the link between oxygen consumption and body weight is much stronger compared to when you just bike. Especially for stationary biking in the gym your energy expenditure is much more similar to the one of a person which is of different body size compared to you. While if you would be walking or running there would be a much bigger difference, because it’s a different impact of body weight.

Even, like in one of my recent studies through my PhD I measured VO2 max on a group of 60-70 people, and for example there I had a subject which was unfit; so all the parameters that we measured seemed to show that his fitness level was quite poor. He had very high heart rate at rest, very high heart rate during all exercises, he couldn’t finished some of the protocols. During the free living part also, his physical activity level was very low.

And the VO2 max test [23:25 unclear audio] it turned a result that he was the most unfit person as well. However, if we go to normalize the VO2 max, so we divide by body weight, this guy became the second most fit of the entire data set just because he’s very thin.

And that’s actually the result normalized by body weight, is what you normally get. Because it’s common practice to report it that way. But at that point, how do you interpret it?

[Damien Blenkinsopp]: So it’s a bit tricky to make it. So VO2 max is the gold standard in terms of measuring this.

[Marco Altini]: Exactly, but it has its own limitations. Yeah.

[Damien Blenkinsopp]: If someone was to go and take that test, what would you suggest they make sure, like to check they get a result that’s useful for them. Is there anything they can look out for or ask for?

[Marco Altini]: So in my opinion at this point, I tend to think that maybe a running test would be a better way to do it, because the relation with body weight is a bit more clear than compared to the biking test. However, normally a biking test is done also because of safety reasons. It’s a bit easier to do a maximal test on a bike; it’s a bit more of a controlled situation.

However, when you then go to normalize by body weight, the fact that your body weight doesn’t have the same impact because you’re biking and you’re not carrying your weight around, then you’re [going] to have this weird results like we did where the normalized VO2 max basically makes an unfit person the most fit person. That’s one of the reasons why I prefer to use VO2 max data non-normalized. So I use the value of oxygen consumption they reach, and that’s it. I don’t normalize it by body weight.

[25:13][Damien Blenkinsopp]: Okay. So, are there benchmarks for that? If they get a specific score back they can assume they’re relatively fit?

[Marco Altini]: Yeah, but the problem with that [25:22 unclear] is then you don’t have this [25:23 unclear] they’re not aware of, that there are these tables for matching it to something like, [25:29 unclear], like fitness is poor or average or good. These tables are all normalized by body weight. So that’s sort of a problem.

[Damien Blenkinsopp]: So what you’re saying is if you were to do this twice, you could get your relative fitness without normalization, right? If I took a test today and I took another test in 6 months.

[Marco Altini]: Exactly. You could calculate longitudinally. That’s no problem, maybe it’s more difficult to compare with other people.

[25:54][Damien Blenkinsopp]: Right. So is there any way we can get around the issue of normalization so that it works for us?

[Marco Altini]: There are some maximal tests which are not all bad.

So basically, some maximal tests, the way they work is that of course they want to predict VO2 max, and they rely on the fact that we know, as I was saying before, that the heart rate changes based on fitness.

So instead of doing a maximal test and measuring oxygen consumption until exhaustion, you do tests at a predefined speed. For example you run at a certain speed, you bike at a certain intensity, and then you measure your heart rate. And that goes into an equation that was developed before using referenced to VO2 max, which basically predicts your VO2 max based on your sub-maximal heart rate, and a bunch of other parameters like it measures your age and body weight and all these other parameters.

And the simplest of this test I actually did on [26:57 unclear audio] to measure heart rate, for example. I think something interesting is that we’re seeing now is also to bring awareness to people with [27:09-27:12 unclear audio] and we got this out from Stanford which is called MyHeart Counts, I believe.

So they measure, they ask you a lot of things and get a lot of reference points and your lifestyle and what you do. And then they track, using the phone, your activity. But since the study is all about cardiovascular health, they ask you to do this fitness test, which is one of the most commonly used because of its simplicity, I would say, where you just have to walk for six minutes.

And you have to time it, and you have to check the distance basically. So the longer the distance you go in six minutes, the more fit you are. And again, here you don’t need physiological data, and this might be probably a better test for people which are not in optimal health conditions.

But I think it’s good because the app is also targeting healthy users. So it’s a good indication that fitness should be of interest for the general population. And there is an effort here to raise awareness.

This being said, I think the potential of current technology is much higher. So you can do much better than that. And you can overcome also the limitations you had, because until now you had to either do a VO2 max test, which is expensive and has all the limitations you discussed, or even if you want to do a sub-maximal test you need still to go to a gym, you need to do an exercise at an exact intensity and then do your math to get what your VO2 max would be.

But right now, since we have phones with all sorts of sensors, and then we have wearable sensors and we have heart rate monitors and all of that, and then we have other reasons that can really automatically understand if you’re walking or running or what is your speed. You don’t even need a treadmill anymore to understand the context around the activity you’re doing.

So, some of the work we’ve been doing recently as part of our research is indeed to give people just a phone and a wearable sensor and don’t ask them to do any specific activity. They just live their life for two weeks while wearing the sensor.

And then all the other reasons we automatically understand: which location they are and what kind of activity they’re doing; if they’re walking, then then what is their speed. And then, basically you put your heart rate in a specific heart rate continuously. And by knowing that, since your heart rate still will be affected by your activity and your fitness, and you also rate the activity because you know the context. And then you can estimate the fitness level basically without requiring any test anymore.

So I think that’s quite interesting because you can finally get to something that is useable by everyone and doesn’t require any specific tests. And again, if you want to monitor them longitudinally, you don’t need to do a test every month. Because you just wear the sensor and it’s sort of being continuously updated just by wearing it.

[30:23][Damien Blenkinsopp]: So when you say longitudinally, that means testing ourselves in time, and seeing if we’ve got an improvement or decline over time.

[Marco Altini]: Exactly.

[Damien Blenkinsopp]: See if what we’re doing is actually working or not.

[Marco Altini]: Yeah. To see if there is basically changes at the individual level.

[30:38][Damien Blenkinsopp]: So this is basically what your StayFit app does?

[Marco Altini]: So basically with this app, I tried to make something where you don’t even need the sensor anymore. So [30:48 unclear] yields a research prototypes. Basically it’s a necklace, you wear it and there is, essentially you get full SG. And then we [30:56 unclear] heart rate. Then there is an accelerometer which we use for activity recognition and walking speed. Then with the phone we use GPS to understand location of that.

However, even if now you have some trackers that do heart rate like the latest FitBit or the Basis, we don’t have access as developers to all of their raw data that you would need to develop algorithms on top of these devices. So what I was thinking is, well of course if you have heart rate data during all of these activities, your fitness estimate can be more accurate.

But, at the same time heart rate at rest has been shown to be linked to fitness. So the lower heart rate at rest the higher fitness. This was the case in many studies, even interventions about physical activity trying to increase physical activity, often show that they were also able to reduce heart rate at rest.

So what I did with this app was to combine the two aspects. So using just the phone you can get activity level based on the step count, which is on the phone, and this data is transformed in energy expenditure, and your physical activity level. And then you combine heart rate. And again since you need context, the way the app is used is by taking a short test in the morning, similar to what the HRV apps do.

[Damien Blenkinsopp]: So, just to clarify, that means when you wake up in the morning you take a reading before you do anything else.

[Marco Altini]: Yeah, exactly. So that’s the easiest way to isolate context without having to go through much trouble. You just, you wake up, you take your test, that’s at least the moment we are the least affected by all other parameters and stressors.

And then you get your heart rate at rest, which goes in the system together with a bunch of other parameters to get you an estimate of fitness. And what the app is actually estimating is basically your sub-maximal heart rate, which is then transformed to a number between zero and 100.

But the whole point here is that since sub-maximal tests basically measure your heart rate at a certain intensity, because that’s what then goes into the formula to estimate the VO2 max. But if you consider that your age, and gender, and body weight will stay pretty much the same if you do two tests in a short period of time, then the actual measure of fitness is just sub-maximal heart rate.

So your VO2 max will be different only if your sub-maximal heart rate is different. So, here I removed the VO2 max step and estimate directly their sub-maximal heart rate. Which is a proxy to fitness, basically.

[33:44][Damien Blenkinsopp]: Great. And how have you seen this work out? Because you’ve been using this app for a while, and I guess you’ve gathered some user data now as well?

[Marco Altini]: Yeah, I did. Not that much, I must say. So I cannot really make any analysis yet, especially because I don’t have a reference point either.

It’s more of an individual tool that you might want to use to track your fitness, but I don’t know the VO2 max of the people using it. So maybe it’s something for future versions would be to try to add some other reference points so that I can do some further analysis like I did with HRV apps.

[Damien Blenkinsopp]: Great. So in your own case, how long have you been using the app, and have you noticed any differences in your fitness? For example, your running time, because I know you’re a runner and you developed it primary because of that interest.

So have you noticed or seen differences in your fitness level, in terms of your efficiency and your performance, and seen those correlate within the app, or has it not?

[Marco Altini]: So I used it for about two months. Something interesting I think is around the metrics that I used. So for example, I used the physical activity level as a measure of activity. So the physical activity level is a normalized version of energy expenditure.

So if you’re telling me your energy expenditure today is 4000 kilocalories, I can’t really infer anything, because if you’re severely obese that may be just your energy expenditure at rest when you do an activity, right. At the other end, if you’re a thin person and a small person, then it means that you’re being very active.

So, the total energy expenditure is difficult to interpret without knowing who are we talking about. And the physical activity level is the energy expenditure divided by the basal metabolic rate, so the component result is your metabolism at rest.

In this case you would get a value which is representative of how much you move. So if you don’t move at all it’s one, and if you move a lot it really doesn’t get much beyond two. So that’s a good indication of physical activity.

And it’s based on energy expenditure, which I think is important because sometimes, for example, I could see in my data is that I went for a trip and I did a lot of hiking, which is a lot of activity but at the same time it’s not really cardio activity or activity that I believe would improve my fitness level. It’s not like when you go running you know the intervals on track.

It’s movement but I would assume my fitness stayed more or less constant those days, right? And if I look at Steps, I see that I’ve been much more active than my average, because you walk all day and it’s much more steps than when you go training. So if my fitness was just based on my activity, I would get theoretically more fit when walking on holiday.

However, since we use energy expenditure, the normalized energy expenditure, the physical activity level, that was pretty much the same as it was when I was here and I was training. Because the activity when I train here is much more intense and consumes much more energy than when you’re just walking. So I think that’s a valuable point of using physical activity level as energy expenditure to track fitness instead of just movement or steps.

[37:14][Damien Blenkinsopp]: Okay. So for your hiking and so on, did you see your fitness level change in the app? Because it gives an index of one to 100.

[Marco Altini]: Yeah, exactly. So it stayed pretty much the same.

[Damien Blenkinsopp]: Right. So you saw basically that that case was shown in the results. Did you do anything where you saw your performance improve in your app and you correlated it to basically better times, or other things that seemed to be improving?

[Marco Altini]: For now I just saw it dropping, which is not good. So, yeah. I guess my condition is not ideal.

But I think it is interesting to track over long time. I tracked for two months, and I don’t race that often. Maybe for a professional person it would be more interesting because their life is training. For me it’s more of a hobby.

But I think looking after a year or so, then you can track it. You can look at data with respect to maybe the half marathons you did and the times you did, and then you get all these reference points, then it could be interesting.

So, you know I’ve been doing some work around HRV for example, and there it’s very valuable on a daily basis. Because there were points that you measure basically those points of this test, which can be training, and you get basically daily advice on how to train, and if your body is ready for another intense training. On the other hand this one tracks a parameter which changes much more slowly. Fitness doesn’t change fast.

[38:45][Damien Blenkinsopp]: Right.

So this one strikes me as it would be more useful to understand the effectiveness of your program. Like, the protocols you’re using to increase your fitness, for the longer term? So a lot of people will follow a set program for a while, especially if you’re a professional athlete you’ll have a set workout and timing and everything.

So you can kind of evaluate the performance of that, and if it’s increasing in the fitness one. But as you said, because a lot of people are using the HRV today. We’ve looked at the HRV in the context of stress, of longevity, and also of course the training in terms of recovery, which you just mentioned.

So, I could imagine that some people might look a HRV and be thinking, “Oh, my HRV is higher so I’m fitter.” Right? Because we’re also looking over time rather than the day to day, looking at the trend. Would you say that’s the case? Or do you think that’s not an accurate way to look at HRV?

[Marco Altini]: I think HRV is great as a day to day tool for recording and a proxy to personal activity and it is true that even at the [39:47 unclear – professional] level, let’s say athletes tend to have higher HRV, and really sedentary people tend to have lower HRV.

But, the link between HRV and fitness is, let’s say far from being clear. Meaning that there have been many studies, and some of them found some link between HRV and fitness, meaning higher HRV higher fitness, but many many studies found no relation there. Especially when doing interventions.

So, you know, longitudinal studies where you take people through a training program and then you measure their HRV at the beginning and at the end. And many of these studies found that heart rate changed and it was lower, but they couldn’t find any change in HRV, so it might be that there is a stronger genetic component there.

And also physiologically speaking, with heart rate you train, so you train your heart which then would be basically able to pump more blood. The volume changes, increases per beat, and that’s why your heart rate also decreases. The more fit you get, you train your heart muscle, which is going to be able to pump more blood and oxygen to the muscles, and then your heart rate as a consequence also decreases.

However this link, in terms of HRV, I don’t think it’s clear. So in general, even in this study I was mentioning before where I had all these people doing VO2 max test and doing also all the free living recordings, that was not a longevity study, so we just got a snapshot of these people. But there we can see clearly there is a very strong relation between heart rate and their fitness level.

And this was true for heart rate at rest, heart rate while they were sleeping, heart rate during activities. So you always see this relation which becomes stronger, of course, for more intense activities, but is there already at rest. While with HRV we couldn’t see any link with VO2 max, even at rest or sleeping or anything. So, I think in general HRV might not be the ideal tool to monitor fitness level.

[Damien Blenkinsopp]: In terms of cardio fitness?

[Marco Altini]: Yes, in terms of cardiorespiratory fitness. And basically as a proxy to VO2 max, heart rate at rest seems to be a much better parameter.

[42:28][Damien Blenkinsopp]: Right. If someone is just looking at their resting heart rate, that’s also a standard in athletics and so on, people could watch that. And then you’ve basically built up a bit more on that, through your fitness index.

[Marco Altini]: Yeah. So I basically used that one and the energy expenditure normalized value together with some adaptation due to age, so that basically the value doesn’t depend on age.

So if your other fitness index tries to predict is just maximal heart rate, basically it tries to predict, for example, what would be your heart rate if you were running, even though you’re now resting and you do these activities in your life. And then that your sub-maximal heart rate and your maximal heart rate are basically depending on your age as well, right. So it will decrease over time.

And so I applied some corrections there to allow people of different ages to get values that they could compare.

[43:26][Damien Blenkinsopp]: Right, right.

So it’s all about normalization, right? Getting normalization right so that you can use it, which would mean that you can compare it against different people. Right?

So just before this call, I was saying hey my score is 60, what it is it like? Does that mean I’m fit or not, compared to you, you’re 70 and I’m like, damn I’m less fit than you. Right? So that kind of context, which is literally what people like to do, right?

[Marco Altini]: Yeah, I think so.

[Damien Blenkinsopp]: People want to be a bit competitive about this, and you know it’s part of team sports and so on. And people are into this stuff.

[Marco Altini]: Exactly. Because for every time if you look at VO2 max, for example, then it’s basically impossible to compare unless you have a person who is basically your age, your gender, and your body weight and possibly also your body fat. Then you can compare. Because otherwise there are too many parameters there.

[44:12][Damien Blenkinsopp]: So I wanted to use this as bit of a demonstration on what’s important in a biomarker if it’s going to be useful to us.

So one of the things you brought up, which is key here, is normalization so we can compare it to other people. There are different devices out there, but sometimes we can’t compare against other people effectively, because as you say it hasn’t been normalized. That’s one part.

What other things do you feel are important? Like if you just think of a biomarker, what would you be looking for to make it effective and useful to make decisions around?

[Marco Altini]: I think in general, it’s important that we always contextualize these things and this whole thing goes together with normalization. Normalizing parameters means also understanding in which context you were measured. So that’s something important.

Try to know everything around it and take care of taking measurements in isomeric conditions, because otherwise it’s easy to make the wrong conclusions just because some other factors are influencing what we are measuring.

[Damien Blenkinsopp]: It’s important to get some benchmarks.

[Marco Altini]: Yeah.

[Damien Blenkinsopp]: So we can understand the implications for our goals. So I’d like to see in the future if you have more data with your fitness app to see if you can compare the range of readings for different users, and things like that.

[Marco Altini]: I think in general, when we make these tools and we release them, for me it’s very interesting to look and take it step by step.

First you try to look at some relations that have been proven already in research, for example with heart rate variability apps, I let the people give me some reference points. So basically they can annotate not only when they train, what’s the intensity of their training and in the next lessons they will be able to add some more text around sleep, and all of that.

And that’s interesting because afterward because then, again, you can put the whole heart rate variability story in context with respect to how they trained and all of that. And then you know from some studies in literature, on maybe 100 people, that there is an important relation between HRV and training.

But then you can just scale that at the level of 1000 people and you start to find all of these relations. And then you can start exploring maybe a new one. So I think that’s quite powerful.

[46:37][Damien Blenkinsopp]: So another thing about this measure and measures that tend to be more useful is its stability. We’ve often come back to this in our podcast in different episodes, with different markers, whether it’s laboratory testing or whatever.

If a marker is moving around a lot ñ HRV is kind of moving around a lot, which can make it more difficult to use sometimes.

So, often you’ll see a pattern where one day it’s up and a little bit down the next day. It’s always kind of a jagged reading, so you have to kind of take an average of the last three days and things like that to get a stable reading on where your recovery is. Of course where there are the extremes and it really drops, then you’re like, “Okay this is a recovery day.”

But the thing about these biomarkers in general is it does help if they’re more stable and they’re moving along more steadily over time so you can make decisions on a more even basis. Because we’re not making decisions hour by hour in these cases where it’s fitness and health. It’s more like what am I doing this week versus next week, and so on.

[Marco Altini]: Yeah, the two cases also something with HRV, I think it’s very powerful because of that, because it can react that way to some stressors. But at the same time, it makes it very difficult to interpret sometimes. Because even consecutive tests can have very different values.

So that makes it quite difficult sometimes. But yeah. With heart rate, that’s a bit less the case. So indeed that’s one other reason why heart rate at rest is better for the cardiorespiratory fitness estimate, because it’s more of a stable parameter like cardiorespiratory fitness is. While HRV is very good as a parameter which you can use to understand how you’re reacting to certain stressors.

[48:22][Damien Blenkinsopp]: Yeah, that’s great. So different contexts. So I also know that you’re now working with data to help mothers with pregnancy.

[Marco Altini]: True.

[Damien Blenkinsopp]: So I wanted to touch on that and see what you’re doing there, because it’s an interesting area.

[Marco Altini]: Yeah. Well basically I’m working at the start-up at Bloom Technologies, where we are working on different aspects and the goal is to better understand pregnancy complications, by monitoring longitudinally different physiological parameters.

Since many of these complications, like for example pre-term birth, or gestational hypertension or gestational diabetes, are poorly understand, let’s say. And even in the developed world, even in the US, the percentage of pre-term birth is more than 11 percent and the whole medical community is, let’s say a bit struggling around how to try to bring this epidemic down.

So what we are doing there is to try to add some parameters to what we are measuring today. For example, uterine activity or even heart rate variability over time. And all we discuss now basically becomes important again because during pregnancy there are even more challenges because all these parameters change also because of pregnancy.

For example, heart rate increases by, let’s say, 10-20 beats during pregnancy because of course their heart needs to work harder because it needs to provide also for the fetus while it’s growing. So you have the additional context of knowing at which stage you are of the pregnancy, and trying to understand how all these parameters change.

So what we hope there is to be able to use this physiological data contextualized longitudinally over time, and try to get a better understanding of what is the impact, for example, of uterine activity and physiological stress, physical activity in all of these complications together with the variables which are already known to be affecting pregnancy.

[Damien Blenkinsopp]: So it strikes me this could be pretty interesting, because you might be able to alert someone to an issue over pregnancy. What kind of outcomes do you expect once this work is completed? What kind of goals would you have?

[Marco Altini]: So I think the first part would be to try to understand better what parameters are influencing some of these complications. And then for some of them there are interventions.

If you consider hypertension or diabetes, you can reduce activity or [51:02 unclear] and you need to know to be a bit more under control. Others are more complicated, for example pre-term birth; there is really no intervention there.

So still by understanding better what are the pathways there, and what is causing the issue, you could then after the second step try to see what is possible to do in terms of, for example, behavioral changes.

It is, for example, known that high stress has an influence on some pre-term birth rate, and on pregnancy outcomes in general. So if you can measure physiological stress, you could also have an intervention around some mediation practice or whatever it is that could lower stress, and then try to reduce complications around pregnancy with these kind of feedback loops.

[51:54][Damien Blenkinsopp]: Great, great, thank you.

I’m guessing it’s quite a ways off in terms of bringing something to market or things like that.

[Marco Altini]: Yeah we hope to have a product by the end of the year, around contractions. But again, let’s say more limited but at the same time that would allow us to collect data and work with hospitals and doctors to start to explore a bit more around this using also the power of having consumers with the device.

And consumer inserted data and data sets can grow much faster than with regular clinical studies while still providing clinically accurate data. So, we’ll be looking into that with some collaborations also here, for example with UCSF in San Francisco where they have a pre-term birth initiative that we are collaborating with.

[Damien Blenkinsopp]: Great, great thanks.

[52:50] So, where should someone look first to learn more about the topics we’ve talked about, VO2 max, or are there any presentations on cardio fitness or anything like that you know of, or maybe a book, that if someone was interested in this to get a better idea of this they could look up?

[Marco Altini]: There are some good resources, maybe I’ll just provide you some links. More on the physiological aspects. I think in general I’m happy to see the whole thing moving forward with this Stanford study.

So even just the website of this study, the MyHeart Counts study would be a good starting point to understand better these things. Because indeed we target as well healthy people. So giving a look at this up, it would be a good starting point for your cardiovascular health.

[Damien Blenkinsopp]: Great, we’ll put those in the show notes then.

[53:36] What are the best ways for people to connect with you, and to learn more about what you’re up to?

[Marco Altini]: I would say through my website. I try to keep it updated. Normally I’m very active. So if they just drop me a line or an email or something, I’ll get back to them for sure.

[53:52][Damien Blenkinsopp]: Is there anyone besides yourself you’d recommend to learn about cardio fitness and these area we’ve been talking about today?

[Marco Altini]: From the HRV stories, for sure all the people you had already on your show are great experts. For the fitness, I would need to think about it, because the research I’m doing, being a researcher now it means it’s going to take some time before it’s out. So I’m sure there are a couple of other groups that are doing great work there, but I haven’t seen much yet.

[Damien Blenkinsopp]: Okay. Well we’ll be linking to your stuff in the show notes of course, so people can check that out.

[Marco Altini]: Maybe I’ll think of something and I’ll get back to you on that.

[Damien Blenkinsopp]: Great, thanks.

[54:34] I’d also like to learn a bit more about your personal approach to body data. Do you track any metrics or biomarkers for your body on a routine basis, whether they be labs, and so on.

I know currently you’re using your own fitness index, correct? What are you doing in your life, or what have you been doing over the last year?

[Marco Altini]: So basically I’ve much of a maker approach. I use this stuff all the time when I make it because I want to try things first and it helps me understand the limitations a lot and where things can improve. So I’ve been using HRV for a long [time] because I have these apps around HRV and now I’m using also these ones about fitness.

In general, the only things I really track are my trainings. So I like to track that and see improvements there. And that’s why I also work around these variables which are connected to activity and fitness, and try to basically close the feedback loop, like with HRV, that gives you advice, and fitness that tries to quantify what your basically current level, what performance can you achieve.

[Damien Blenkinsopp]: Great, great thanks.

[55:45] Have you got any insights, like from the data you’ve collected, have you got an insights about your biology? Have you made any changes to behavior, or taken some kind of actions?

[Marco Altini]: No. I haven’t yet. It’s not that I didn’t get any insights, but I think it’s important to track first for very long periods. Meaning a year at least before you can start making changes.

Because so many other parameters affect our physiology and performance, especially if I consider training there are months where everything looks the same. Like maybe I haven’t traveled much, and I kept my diet the same, and my stress at work is pretty much the same. And I think I haven’t over-trained, but still there are some weeks where you don’t perform very well.

So it would be sometimes easy to make the wrong conclusions if you tend to make too many changes. So I think it’s good to track for very long periods, even HRV, to get all the values you see. And then you look afterward how your training had an impact and all of that. And then you try to make adjustments.

Maybe around HRV I am making adjustments, like I tend to follow now what I see there. You find something very interesting things, like sometimes you can spot you are sick before you actually realize you are sick. You do your test in bed because your HRV is like…hugely affected by that, for example like even just a fever or something.

Maybe in the morning you don’t just feel particularly well, but it seems just a regular day. And then your HRV is terribly low, and then the day after you’re sick. And that’s quite interesting to see.

[Damien Blenkinsopp]: I definitely rely on it. I’ve seen that a number of times. If it really drops, then I’m like, “Uh oh.î I’m going to get some vitamins, liposomal vitamin C and stuff like that to try and void the crash the next day. Or minimize it a bit. So I think it is pretty useful like that.

[Marco Altini]: Yeah, it’s quite interesting.

[57:41][Damien Blenkinsopp]: Okay, so what would you number one recommendation for someone trying to use data to make better decisions about their health or performance or longevity?

[Marco Altini]: Be consistent. Don’t expect short term miracles but keep doing it, keep tracking. Try to understand at your personal individual level what is affecting these variables and then slowly start to make changes and bring to mind how these changes affect the rest. Let it be, I don’t know, performance or whatever variable that matters to you.

[Damien Blenkinsopp]: Yeah, I think you make a great point because as you were saying, there are so many different variables which we can’t keep track of. Especially in our busy lifestyles today. Whether it’s travel, a different location, different food, different sleep conditions, or maybe just different supplements and other things if we’re experimenting things. There are a lot of different variables that can influence it. So that makes a lot of sense.

So Marco thank you so much for your time today. It’s been a great chat.

[Marco Altini]: Thank you Damien.

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A look at a collection of high impact endurance tools and tactics – and the top biomarkers to watch for optimization. Vetted by an endurance athlete with years of experiments and competitions behind him.

Today’s episode is about endurance training and using high-impact tools to get the most out of it. We look at self-tracking in diet and exercise when aiming to optimize your body to perform at peak capacity.

We discuss factors playing a role in improving endurance through a healthy progression. What self-quantifying strategies are useful for tracking overall performance and health?

This episode features actionable takeaways on dealing with a variety of obstacles commonly experienced by endurance athletes.

How to make use of ketogenic dieting in maximizing fat-burning efficiency during physically demanding exercise? Which biomarkers are important for tracking individual organ-systems functionality in the body? How to maintain a healthy hormonal status?

Overall, we look to beneficial and practical tactics for athletes wishing to upgrade their performance and discuss common pitfalls to avoid in cultivating endurance.

On this full-on ketosis diet… the endurance payoff was huge. The amount of focus that I had for long periods of time. My ability to just hop on a bike and ride for hours with no fuel at all, with just water. It was pretty profound, because you produce all these ketones as a bi-product of fatty acid oxidation, and they’re used as the preferred fuel… while you’re out exercising. And that’s a huge boon to an endurance athlete.
– Ben Greenfield

Today’s guest is Ben Greenfield who is a professional competitor in endurance-demanding events, including triathlon and Ironman races. Ben has 11 years experience coaching athletes and fitness professionals.

Throughout his athletic career, he has researched physiology of upgrading endurance using a quantified approach. He has performed numerous self-experiments targeted towards understanding his performance parameters, and towards optimizing his diet and exercise.

Ben is the author of a New York Time’s best-selling book titled “Beyond Training: Mastering Endurance, Health, and Life”, which was published in 2014. His top-ranked iTunes podcast is called BenGreenFieldFitness.

The episode highlights, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

What You’ll Learn

  • Ben uses his biohacking experience to coach people on living healthy and attempting on-the-edge extreme exercise (4:46).
  • Ben’s interests in endurance training and research developed over time. No big eureka moments, just meaningful experiences (7:12).
  • Important biomarkers in endurance training specifically, and practical reasons for these picks in exercise self-tracking (11:24)
  • Why regulation of sex-hormones and cortisol (the stress hormone) are important to track in endurance training (15:50).
  • Why standard reference ranges for free testosterone are often not applicable to endurance athletes (16:48).
  • Liver enzymes, kidney parameters, Vitamin D, and digestive track inspections are also key biomarkers for healthy endurance training (18:20).
  • The digestive track plays an upstream role in multiple athlete pains and discomforts (21:18).
  • How to fight thyroid system dysfunction in endurance training (24:17).
  • The key lessons Ben learned from his 12 months ketosis dieting experiment (26:10).
  • The biomarkers for detecting adrenal fatigue symptoms (27:22).
  • Biomarkers and tests for autonomic nervous system functionality and distinguishing adrenal fatigue from thyroid system dysfunction (28:03).
  • Incorporating Heart Rate Variability (HRV) tracking in endurance training (31:39).
  • HRV is Ben’s ultimate marker for optimizing endurance training and quantifying overall health (33:23).
  • Success in endurance training requires optimization between high-volume achievements and short-duration precisely aimed tasks (34:29).
  • Dealing with negative effects of endurance exercise and ketogenic dieting (39:01).
  • Maximizing ketogenic dieting benefits and potentially useful supplements (44:34).
  • Breath ketones are an easy way to test for purposeful ketosis (46:20).
  • Tracking important biomarkers and avoiding excessive ketosis (47:20).
  • Why oxaloacetate can be used as a supplement with ketogenic dieting (48:25).
  • Why cold thermogenesis works for athletes’ bodies, for recovery and for overall performance (50:27).
  • The portal outlining Ben’s work and relevant people recommended by Ben (53:17).
  • Ben’s most-important advice on living healthy is being grateful several times per day (54:48).

Thank Ben Greenfield on Twitter for this interview.
Click Here to let him know you enjoyed the show!

Ben Greenfield, Greenfield Fitness Systems

Tools & Tactics

Interventions

  • Cold Thermogenesis: Can be achieved through a variety of cold exposure methods such as cold showers or dipping into cold water streams . In cold thermogenesis hormesis is used to promote positive adaptations in the body as we saw in episode 8. Amongst other improvements it can help to burn fat more efficiently and improve blood vessel functionality in part by promoting development of your Brown Adipose Tissue (BAT). BAT is a type of fat which is active tissue and able to generate heat.

Tech

  • Heart Math Gratitude exercises: The Institute of Heart Math promotes using specific gratitude exercises to optimize the HeartMath Heart Rate Variability (HRV) score. We’ve discussed the HeartMath form of HRV previously in episode 6. This exercise can be done with one of either of their two HRV feedback devices: Inner Balance for iOS or emwave2.

Supplementation

  • Thyro-Gold: Thyroid glandular extract produced by the New Zealand company Natural Thyroid Solutions. This supplement is used as a biohack to correct thyroid-system dysfunction, sometimes caused by ketogenic dieting – especially with very low carbohydrate intake and endurance exercise.
  • AndroGel: Although the use of testosterone hormone-containing products is illegal in professionally-sanctioned sports events, this supplement is sometimes used because free-testosterone levels often drop in a ketosis state.
  • Ketosports KetoForce: KetoForce contains the endogenous ketone body beta-hydroxybutyrate (BHB) in sodium and potassium salt form. The compound BHB can be used as an energy source by the brain when blood glucose is low. Ingesting KetoForce raises the levels of blood ketones for 2.5-3.0 hours after ingestion. (Note: A similar product from same company is Ketosports KetoCaNa).
  • benaGene: This supplement, oxaloacetate, was previously covered in depth in episode 30 in an interview with its creator Alan Cash.
    Greenfield uses this specifically to increase the rate at which his liver synthesizes new glucose molecules, during a low-carbohydrate ketogenic diet including exercise. The goal is to take advantage of its ‘glycogen sparing’ effect, since glycogen is less available in ketogenic diets, and thus get more intensity out of workouts.

Diet & Nutrition

  • Ketogenic Diet: A ketogenic diet is low in carbohydrates intake and high in fat intake. As such, it induces a state of ketosis in the body – the condition in which the body burns fats and uses ketones instead of glucose for fuel. Previously, we discussed measuring ketones and ketogenic dieting in Episode 7 with Jimmy Moore.
    To provide scientific support in favor of ketogenic dieting for endurance, Ben suggests the research of a University of Connecticut team investigating athletic training and human performance. For more information, see this recent scientific review authored by them on using fat as fuel for endurance exercise.
  • Cyclic-Ketogenic Diet: In some people, full ketogenic diets can lead to hormonal or organ dysfunction (e.g. thyroid). The cyclic-ketogenic diet is the solution often used to avoid these downsides. This is a low-carbohydrate diet with intermittent periods of high or moderate carbohydrate consumption (e.g. a refeed with carbohydrates every weekend). It is used as a way to maximize fat loss while maintaining the ability to perform intense exercise during a ketosis state.
  • Based on his 12 month ketosis self-experiment, Ben has concluded that eating anti-inflammatory food, as well as increasing intake of food containing medium-chain triglycerides (MTCs) and resistant starches, are all beneficial in reducing the potential negative side effects of ketogenic dieting.

Exercise

  • Polarized Training: Polarized Training is scientific terminology for the concept of easy-hard training. Researchers from the University of Stirling in Scotland have concluded that using an approach which excludes medium-intensity training is more beneficial for building endurance compared to an approach that includes medium-intensity training. The polarized training model (80% low-intensity; 0% medium-intensity; 20% high-intensity training) produces more positive results in endurance athletes, compared to the competitor threshold model (57% low-intensity; 43% medium-intensity; 0% high-intensity training).
  • Murph Workout: “Murph” is a CrossFit workout named after Navy Lieutenant Michael Murphy, who was killed in Afghanistan June 28th, 2005. He was awarded the Congressional Medal of Honor after his death. It first appeared on the CrossFit site 18 August 2005. This workout consists of (in order): 1 mile run, 100 pull-ups, 200 push-ups, 300 squats, and a 1 mile run at the end.

Tracking

Biomarkers

  • Heart Rate Variability (HRV): HRV is the measure of the change in the heart’s rhythm over time based on changes between sympathetic and parasympathetic activation. HRV was previously covered in the context of optimizing training workouts using HRV in Episode 1 with Andrew Flatt and using HRV as a biomarker for longevity in Episode 20 with Dr. Joon Yun.
  • Triglyceride to High Density Lipoprotein (HDL) ratio: Researchers have shown that using the triglyceride to HDL ratio is a better predictor of coronary disease risk factors, compared to tracking total cholesterol (which includes HDL and other lipoprotiens). A ratio of 2 : 1 or less is considered optimal.
  • High-Sensitivity C-reactive protein (hs-CRP): CRP is a protein that increases in the blood with inflammation and is used as a marker for cardiovascular health (high levels over 1 mg/l are indicative of higher cardiovascular risk). Both diet choices and overtraining can lead to high levels of hs-CRP (over 1).
  • Ketones: Ketone concentrations can be tested in blood, breath and urine samples to determine if you are in ketosis (burning ketones for fuel) and to what extent. We covered these markers extensively in episode 7 – how to measure ketones.
  • Creatinine and Blood Urea Nitrogen: These two biomarkers are often elevated above normal levels in endurance athletes, without being indicative of a health risk. In endurance training, creatinine levels lower than about 1.1 mg/dl do not pose a health risk. It is also relatively normal to have BUN levels over 20mg/dL.
  • Liver Function Tests: When excessive exercise is present, the blood levels of liver enzymes Alanine Transaminase (ALT), Aspartate Transaminase (AST), and Alkaline Phosphatase (ALP) are elevated above normal.
  • The 25-hydroxy Vitamin D Blood Test: The most accurate way to measure how much vitamin D is bioavailable to be used by your body is the 25-hydroxy vitamin D blood test. Optimum vitamin D levels range between 50-70 ng/ml.
  • Salivary cortisol to Dehydroepiandrosterone (DHEA) ratio: An increase in DHEA levels is highly suggestive of adrenal dysfunction because DHEA is produced exclusively by the adrenal glands. Excessive exercise stresses the body to produce very high levels of cortisol, which causes a depletion of endogenous DHEA. This results in an elevated cortisol to DHEA ratio. Testing for this ratio several times per day provides a more complete image of adrenal function, compared to a snapshot provided by simple monitoring of blood cortisol levels. A normal cortisol : DHEA ratio is approximately 5:1 to 6:1.
  • Thyroid Functional Test Panel: A TFT panel typically includes thyroid hormones such as Thyroid Stimulating Hormone as well as the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Excessive exercise can stress the body to produce high-levels of cortisol (the stress hormone) which inhibits the conversion of thyroid hormone from inactive (T4) to biologically active (T3). This can result in lower levels of active thyroid hormone despite normal or up-regulated levels of TSH. Thus, testing for (active) T3 hormone concentrations is more relevant for endurance athletes self-tracking. Optimal reference ranges for TSH are 0.4 – 2.5 milliunits per liter (mU/L). Optimal reference ranges for free (bioavailable) T3 range between 350 – 780 pg/dL.
  • Sex Hormone Binding Globulin (SHBG) and free testosterone: The standard reference ranges for SHBG are 0.2-1.6 mg/dL for non-pregnant adult females and 0.1-0.6 mg/dL for adult males. Changes in SHBG levels affect the amount of free hormone that is available to be used by tissues, including the levels of free testosterone. In case SHBG levels are in abnormal ranges, then free (bioavailable) testosterone should be tested (reference ranges 1.0-8.5 pg/mL for females and 50.2-210.3 pg/mL for males).
  • Tests for detecting adrenal fatigue and thyroid system insufficiency

  • Iris Contraction Test: This test consists of you looking at the pupil of your eye in a mirror while shining a bright light at your eye. The light should cause the pupil (center black spot of your eye) to contract or become more narrow. The contraction should be sustained for longer than 20 seconds before the pupil starts to flicker or dilate. Otherwise, if the pupil starts to flicker immediately upon shining light, this is a good indication that you have adrenal fatigue – mainly because your adrenal gland is functioning properly in managing blood pressure.
  • Dizziness Test: If you lay down or you sit down and you stand up quickly and you get dizzy, then this is a sign of blood pressure mismanagement. Importantly, problems with blood pressure often accompany adrenal fatigue because one of the main functions of the kidneys is to regulate blood pressure via production of hormones in the adrenal gland.
  • Broda Barnes, MD Temperature Test: This test was developed by Dr. Broda Otto Barnes, who was best known for developing novel perspectives on hypothyroidism – a type of thyroid system disease. In essence, you do oral and armpit measurements every morning in bed upon waking up and keep a graph of the results. If your temperature is consistently low, then this is an indication that your thyroid system is dysfunctional even in the absence of a blood thyroid test.

Lab Tests, Devices and Apps

Other People, Books & Resources

People

  • Dr. Terry Wahls: Dr. Terry Wahls is a a clinical professor of medicine at the University of Iowa. Previously, Dr. Wahls was kind to participate in the third episode of our show, where we focused on linking mitochondrial health to autoimmune and chronic disease.
  • Alan Cash: Alan Cash is the CEO of Terra Biological. Previously, he has been a guest on our podcast in Episode 30, where we discussed the potential for using oxaloacetate as an anti-aging supplement.
  • Joe Friel: Joe Friel holds a masters degree in exercise science and is a USA Triathlon and USA Cycling certified elite-level coach. For Joe’s blog click here. For his Twitter click here.
  • Sami Inkinen: Sami Inkinen is a balanced person. He is a successful businessman and a top-age Ironman competitor. For his Twitter click here.
  • Dr. Peter Attia: Dr. Peter Attia is a scientist who is knowledgeable in healthy endurance exercise and self-quantification. For Dr. Attia’s Eating Academy Blog click here. For his Twitter click here.

Books

Other


Full Interview Transcript

Click Here to Read Transcript
[04:46] [Damien Blenkinsopp]: Ben, welcome to the podcast.

[Ben Greenfield]: Hey, thanks for having me on man. And I’ve got to ask you, is it Damien, or Damion? Or Dami-something else?

[Damien Blenkinsopp]: Or Damian? It depends where you come from, I guess.

[Ben Greenfield]: Okay. Just checking. I don’t want to stick my foot in my mouth.

[Damien Blenkinsopp]: Yeah. You can call me Dam. I tell people to call me Dam, just to avoid all those questions.

[Ben Greenfield]: There we go. I want to sound like I’m cursing the entire episode.

[Damien Blenkinsopp]: Yeah. But it even works in Asia, tried and tested.

[Ben Greenfield]: Nice.

[Damien Blenkinsopp]: I mean you’ve got a three letter name. That works well.

[Ben Greenfield]: Yeah, totally. Ben.

(05:12) [Damien Blenkinsopp]: So, Ben, you’re into triathletes, Ironman, and basically the way I look at you is you go around searching for tactics and tools to give you an edge in these areas that you’re interested in. Is that a fair kind of back story to who you are and what you’re doing?

[Ben Greenfield]: Yeah, I do a lot of that I guess n=1 guinea-piging myself. Going out and doing crazy things like training with the Navy SEALS or doing these Spartan Races or Ironman triathlons, things like that.

But then I also think I learn just as much via a lot of the coaching and consulting that I do, just because people typically come to me for one of two reasons.

They either want to do some crazy feat that’s completely unnatural for the human body to do, like they want to go run 100 miles in the wilderness or something like that, and figure out how to do it without destroying themselves. So my job is to figure out how to do that from a nutrition and a physiology and an exercise standpoint.

Or they come to me because they basically want to live as long as freaking humanly possible, and want me to manage how do you sleep when you want to do something like that, how do you exercise, what do you measure, what do you pay attention to in your blood and your gut. And so there’s that kind of biohackiness that I get into.

And I’ve got to admit, for me personally it’s a little bit of both, really. I certainly do want to live as long as possible. I also want to do as many crazy events as I can during the process, see as much of the world as I can at the fastest pace possible. And so for myself, personally, I’m doing a little bit of both.

But sometimes people come to me and want to do something that I know nothing about, so I’ve got to go and learn it. So part of it is that, too. That, or if it’s not coaching someone it’s writing about that. Because I’ve done a lot of writing recently. This morning [I] published a big article on my website about how to use marijuana to get performance enhancing gains.

And I never really would have delved into that if I hadn’t been asked by so many people, especially here in the US with the growing legality. It’s like, can I use this while I’m exercising? That type of thing. So it’s a little bit of everything.

[07:12] [Damien Blenkinsopp]:Yeah, great. So [what was] the event that started the whole Ben Greenfield fitness podcast, and the blog and everything? How’d you get involved in that? Because you’re obviously very passionate about it.

[Ben Greenfield]: Yeah. Well there’s, I mean I get that question a lot, and frankly – nothing against you – but it annoys me, because I hate when people go, “When did you decide to do this? When did you decide to do that?” I never make decisions. I don’t have a 10 year business plan. I don’t have some ‘Come to Jesus’ moment where I said, “Oh hey, I want to learn how to exercise.”

It’s just that I live my life. I do things that I’m passionate about, or that other people who I’m helping are passionate about and tend to fall into whatever I might fall into based on that. I’m getting into hunting right now – well specifically bow hunting and hunting competitions – before that obstacle racing, before that Ironman Triathlon, before that water polo, before that body-building, before that I was a collegiate tennis player.

It’s just like life is a series of chapters and moving targets. It’s never just like one commitment to do one thing. But I would say, to give you a rough answer to your question, the very first time I decided to something a little bit more endurance orientated – which I would define as something that has a nutrition rate.

You don’t see people dropping out of baseball or cricket games because of fatigue and heat stroke and lack of nutrition. That’s very rare, but you see it all the time in marathons and Ironman triathlons and things like that. So I would say the first time I started to get into that side of sports would have been my first Ironman Triathlon that I did back in the city of Portalane, Idaho in 2007.

And up until that point I’d been primarily an explosive power athlete. Like body-building and tennis and stuff like that. But my girlfriend, who is now my wife, was a runner. She ran cross-country for University of Idaho. So I kind of had to take up running, to a certain extent, just to be able to woo her.

And she dragged me to a triathlon one day and she actually had me run the running leg of the triathlon, which hurt like hell. I was a body builder; my boobs were bouncing up and down and my lower back was locking up and it was horrible. But it kind of got me interested in this high that you can get from endurance sports.

And so I wound up doing a few triathlons and doing, what I would say, is the biggest mistake for anyone who wants to avoid getting into endurance, that is I went and watched an Ironman Triathlon. And after watching Ironman and watching these intense feats of physical performance and the huge feeling of satisfaction and self-completion that these people were experiencing as they threw up their arms when they crossed the finish line I was like, I want that. I want to experience that.

And so I signed up for an Ironman and began taking everything I had been studying. At that point I had a Master’s Degree in Exercise Physiology and Nutrition and I was able to start applying that stuff to my training, and experimenting with a lot of what I was finding in research and sports science and seeing what worked and what doesn’t.

For example, all laboratory studies, or most of them, done by the white coats in their little labs will tell you that the body can take on about 200 to 250 calories of fuel during exercise. You can oxidize 200, 250 calories of carbohydrates while you are exercising. But for anyone, especially anyone who’s above about 150 pounds who has tried to go out and do an Ironman Triathlon, you completely bonk after about five hours on that number of calories, and you technically need about twice that in order to be able to get by in an Ironman race in most cases.

So, it’s a situation where what they’re saying in the lab and textbooks actually doesn’t work once you get out in real life and you try this stuff in the streets, in the trenches. So, that’s been kind of fun too, figuring out from research what works, and what doesn’t.

[Damien Blenkinsopp]: Right. Yeah, we often talk on here about n=1 experiments are often going to be different to the research, for a variety of reasons like the ones you brought up, and the use of averages, and other things like that.

[11:24] So, anyway, in terms of endurance training, since we’re there, what kind of biomarkers have you found to be the most useful to track your performance? Or what do you track around your capabilities for endurance training, and see as important?

[Ben Greenfield]: Oh, for endurance specifically?

[Damien Blenkinsopp]: Yeah.

[Ben Greenfield]: So for endurance specifically, that’s a great question. So one would be your level of HSCRP, which really that’s just for exercise in general. Or high sensitivity C-reative protein, just to make sure that your levels aren’t straying too high above 0.5. And the reason for that…

[Damien Blenkinsopp]: So that’s kind of your benchmark? You try to keep them under there? Where do yours tend to hover around?

[Ben Greenfield]: I actually fall below 0.2 now for HSCRP, probably because I eat a very anti-inflammatory diet, very clean. And I won’t insult your listeners’ intelligence by defining what a clean diet or an anti-inflammatory diet is, because it’s pretty easy to go out and figure that out with Dr. Google.

But I eat very clean. I also use a lot of anti-inflammatories. Like I make ginger tea, and I use a ton of turmeric, usually combined with black pepper to increase the efficacy of it, and I use percumin and I consume a lot of very dark and colorful vegetables with very limited amounts of dark and colorful fruits, and wild caught fish, and fats, and things that really help with inflammation.

And I’m also very careful with my training, where I do extremely focused and intense, but short, bouts of training with a specific purpose. I never go out and just pound the pavement for the hell of it, which is a great way to build up a lot of voluminous training based inflammation.

And so I have a very precise, dialed in training program that also includes things that help to mitigate inflammation, like foam rolling, and cold soaking, and these things that can help to remove a lot of these byproducts of metabolism that can create inflammation. So, inflammation is a biggie. Honestly, it doesn’t take a rocket scientist to figure out that if you keep your inflammation controlled, it’s a good thing.

So, a few others that I’ll pay attention to for endurance. When we’re talking about labs, as far as blood goes, TSH, preferably a full thyroid panel, is pretty prudent to pay attention to simply because high level endurance training can inhibit conversion of inactive to active thyroid hormone.

And because of the high amounts of cortisol that can potentially be produced through an improper training program can stress the body out enough to where you experience some hypothalamic pituitary adrenal axis insufficiencies, particularly high cortisol, creating a feedback loop that reduces the conversion of inactive to active thyroid hormone and thus an increase in thyroid stimulating hormone. So your body turns out a bunch more thyroid stimulating hormone to try and get more T4 present, even though a lot of that T4 isn’’t getting converted into T3.

And by monitoring TSH, if you see a pattern or a rise in TSH many times it’s concomitant with an increase in cortisol and stress, and often also accompanies a not enough eating period. Sometimes not enough carbohydrates is the biggest culprit, but in many cases just not enough damn calories, period. Damn, not referring to your first name but to the curse word. Just so we’re clear.

That’s another one is TSH. Cortisol, I alluded to, but when we’re looking at a hormonal panel, I also like to pay attention to sex hormone binding globulin. Because the body has this interesting mechanism where when it’s stressed out, when it’s in a time of famine, in a time of need, under high amounts of stress, doing a lot of migrating, a lot of moving with low amount of calorie intake, the last thing you want the body to do is produce a bunch of babies at that point.

And so sex hormone binding globulin often rises simultaneous to cortisol to keep total testosterone bound, and keep it from being available as free testosterone. So even if your testes are working just fine, or your pituitary gland is working just fine, –obviously talking about the males more than the females now– and even the leydig cells in your testes are producing testosterone just fine, if sex hormone binding globulin levels are really, really high that’s all for naught. And so that’s another really, really important one to keep an eye on. And that’s typically addressed by addressing cortisol.

[15:50][Damien Blenkinsopp]: Right. So, why would you look at SHBG versus free testosterone, or that marker? The [unclear 15:56]?

[Ben Greenfield]: Well, because if free testosterone is low, but if you look upstream perhaps it’s because total testosterone is low because the leydig cells in your testes are not producing enough hormone because you’ve got low levels of luteinizing hormone. In contrast to that, perhaps your luteinizing hormone production is fine, your leydig cells are producing enough testosterone just fine, your total testosterone is high, but it’s more of a cortisol issue than it is a central nervous system issue or a glandular issue.

So that’s why you test that versus just looking at free testosterone.

[Damien Blenkinsopp]: So basically, free testosterone could be many, there’s more reasons behind it, but the SHBG is more specific to endurance and specific dynamic.

[Ben Greenfield]: Yeah. Really, two reasons behind it. Either you aren’t producing enough total testosterone, or you are producing enough total testosterone but it’s not getting converted. So those are really the two main things to look at.

[16:48] [Damien Blenkinsopp]: So, are you looking at the standard reference ranges for that, or do you look for something a bit more precise?

[Ben Greenfield]: A lot of times you have to look at symptoms synonymous, because standard reference ranges are going to vary widely.

I’ve worked with a lot of endurance athletes who have very high libido levels, show no signs of over-training, have very robust nervous systems, high heart rate variability, low cortisol, and even low sex hormone binding globulin, but their total testosterone is in like the high 300s. Which, for a body builder they would scoff at that and say, oh that’s rock bottom low. Even though a lot of times hypogonadism is levels below 100.

And you’ll get many people who just feel like fricking crap at 300, and some people will be closer to 500, and some people will need levels of 700, 800, or even 1000. So it kind of depends. It varies widely, I suspect based on genetics as a big part of it.

So ultimately it’s really tough to hold things up to reference ranges. I mean, you can ballpark it. You can say well if total testosterone is starting to get below 300, that’s where we would really start to get a little bit concerned. But it really is kind of tough. A lot of times it’s a moving target based off of a cluster of other symptoms.

If someone’s complaining of low libido and low motivation, and lack of energy, etc, and their testosterone is at 400, well that’s a pretty good sign that 400 is not going to be adequate for them. So I know that’s one of those deals where it’s total soft science, but it does really depend. That’s one of those ‘it depends’ answers, but that is definitely a variable that I will look at.

[18:20] Liver enzymes is another one, like alkaline phosphatase, aspartate aminotransferase, the ALT, the AST, some of these liver markers just because a lot of times they can be elevated when excessive exercise is present. And so that’s another one to pay attention to. It doesn’t have to be excessive exercise; sometimes it can be alcohol, pharmaceutical intake, things of that nature. But liver enzymes are the one that I’ll look at.

Kidneys, a lot of people say to look at kidneys, but frankly it’s very rare for me to see an athlete who doesn’t have slightly elevate creatinine and blood urea nitrogen levels, which are two common markers in the kidneys that a physician will get concerned about if they see elevated, but that are very common to see elevated if an athlete is exercising anywhere in the 48 hours leading up to a blood panel.

So, as long as creatinine levels aren’t much higher than about 1.1, and as long as blood urea nitrogen isn’t through the roof and – I apologize, but off the top of my head I don’t remember the lab reference ranges for blood urea nitrogen. The reason being that I do most of my coaching for blood panels with a company called WellnessFX. It’s basically more like a dashboard with graphs, more than it is hard numbers, so occasionally I’m looking at graphs more than I am numbers.

[Damien Blenkinsopp]: And they just have those red zones.

[Ben Greenfield]: Yeah, exactly. They’ve got red, yellow, green, which actually annoys me some of the time. Because they’ll flag high LDL as red when I purposefully try to get my LDL high. So there’s some issues with the whole red yellow green type of quantification. But anyways, blood urea nitrogen and creatinine, even though a lot of people talk about those, they’re not super duper important in my opinion, because they’re always going to be a little bit elevated.

Vitamin D, that’s another one that I’ll look at just because of it’s importance. As you can suspect, a lot of these aren’t just specific to endurance, they’re specific to exercising period. Just as a hormone and a steroid, vitamin D is another important one that I’ll look at.

And then as far as other things, I typically will have most of the athletes I work with or the people I advise do at least once a year a full gut panel. You know, a comprehensive gut panel that includes parasitology, measurement of pancreatic enzyme production, measurement of yeast and fungus and any type of bacterial overgrowth in the digestive tract because I find that, especially when you’re jogging your body up and down for 10 plus hours while racing, having a really, really good gut and GI system and very efficient digestion is incredibly important.

And so I will look at things like presence of yeast or fungus, like Candida Albicans, or the presence of H pylori, or absence of hydrochloric acid, or absence of pancreatic enzymes, or overgrowth of specific bacteria, or lack of short chain fatty acids in the digestive tract, in the colon, and a lot of those things that tend to influence an athlete’s performance or their feelings of well-being. So that’s another thing I’ll pay attention to.

[21:18][Damien Blenkinsopp]: Right. A lot of people wouldn’t think of that as something performance related, more like a chronic issue related.

Have you got any case studies where you saw people, basically not performing but not having any negative symptoms in terms of GI distress or anything that they would have noticed, but when you put through these tests some negative results came?

[Ben Greenfield]: Sure. Now we’re delving a little bit more deeply. And I mean, obviously explosive diarrhea halfway through a marathon can be a good sign of digestive enzyme insufficiency, but so can, for example, vitamin B12 or vitamin D deficiencies, or even if you go more advanced and run like an organic acids profile, or an amino acid profile, severe imbalances of a lot of micro-nutrients.

Well if you’re not digesting your food efficiently, for example, if you’re not producing adequate hydrochloric acid, you’re not activating pepsin to break down proteins, beginning in the stomach an moving on to the small intestine, then you’re going to: a. have undigested protein fragments winding up in the bloodstream causing some auto-immune issues, and that can include fuzzy thinking, which no athlete wants.

But then you also can get amino acid deficiencies, like deficiency in the ability to create neurotransmitters, and also deficiencies in the ability to repair and regenerate skeletal muscle tissue, because you aren’t breaking down the proteins that you’re eating.

And the same could be said for something like inflammation in the digestive tract from wearing down of the microvilli. So perhaps you’re not producing adequate levels of lactase, so you’ve got some lactose issues and bloating and gas. Or you’ve got inflammation that is resulting in malabsorption of fat-soluble vitamins, so vitamins A, D, E, and K aren’t getting absorbed properly, or bacteria aren’t helping you to produce those, and so you experience hormonal deficiencies, or steroid deficiencies.

And so, yeah the gut is incredibly important, and that’s one of the things I’ve been kind of getting on companies like WellnessFX, for example, to do is to not just use the strategy of blood testing but also really pay attention to the gut. I mean, in an ideal scenario, what I would like to see is a done-for-you system.

And for me right now, what I do is just kind of string this together for the athletes who I work with. But a done-for-you system where you get your blood testing, you get your gut testing, and you get your genetic testing so we can look at everything from genetic snips to bacterial imbalances in the gut to all the blood and biomarkers, and have all of that done with either one panel or one service.

That would be really nice, because right now you’ve got to go to typically three different places. You’ve got to go to whatever DNAFit, or 23andMe, and you’ve got to go to DirectLabs, or Metametrix for GI affects, and then you’ve got to go to WellnessFX for whatever else. And then if you want to do food allergy testing, well then you’ve got to throw in a Cyrex panel, or something like that.

So maybe it’s a first world problem to want all this stuff to be available in one central location, but it certainly would be nice.

[Damien Blenkinsopp]: Yeah. It’s so near the early days from that perspective. There’s a lot of specialized, it’s still kind of specialized in terms of the labs. Each is in their little separate box and everything.

[Ben Greenfield]: Yeah.

[24:17] [Damien Blenkinsopp]: So, in terms of the kinds of decisions you’ve made, or you’ve advised a client based on some of these values, some of this data that’s come back, what have been the biggest changes that you’ve implemented to optimize training?

[Ben Greenfield]: You mean as far as training?

[Damien Blenkinsopp]: So, say the TSH came up too high, what would you do about that?

[Ben Greenfield]: Oh okay, so for high TSH, obviously it’s never a shotgun approach. It’s never a multivitamin. So for high TSH it may be looking at your carbohydrate intake. That’s the first thing that I’ll look at.

Even before you look at total amount of calories, you just make sure nobody is on some low, like 40 gram per day carbohydrate diet, because frankly a lot of the ‘low carb’ or ‘ketosis’ based diets that are out there were created for sedentary people. Even the bulletproof diet. I love the whole bulletproof philosophy, but it was written by a computer programmer, not by an athlete.

And so the levels of carbohydrate, and even the levels of calories in that diet, have to be adjusted and modified for a hard-charging athlete, especially an endurance athlete. So, otherwise with caloric depletion and carbohydrate depletion, you basically lose a lot of your ability to convert inactive to active thyroid hormone.

And in the case of calories, as you would deduce through common sense, when you send your body a message that calories are insufficient but you’re still requiring it to move a lot, your body down regulates metabolism. And one of the main ways it does that is by down regulating thyroid.

So, I look at carbohydrates, I look at calories, and then I also look at dietary intake of organ meats and fat soluble vitamins, which can also assist with thyroid health. So in my case, because I did an n=1 experiment about a year and a half ago where I did 12 months of ketosis.

Not cyclic ketosis, not cycling carbohydrates in and out throughout the day, but full on eating only 5-10 percent of my total daily intake from carbohydrates. Very low carbohydrate diet. Too low, in my opinion, for most endurance athletes who want to maintain optimal levels of health elsewhere.

[26:10] [Damien Blenkinsopp]: Did you see negative effects from that over the 12 months?

[Ben Greenfield]: Yeah, and that’s what I’m getting at with the thyroid. I started taking thyroid glandular extract. I took one called Thryo-Gold, which is made from New Zealand cows, that are like an A2 cattle.

A lot of A1 cattle has proteins in it that cause an immune reaction within the human body, but cattle that are breed via A2 are cattle that contain this A2 genetic profile that is more bio-compatible with the human body. And so I basically took a T1, T2, T3, and T4 combo, and that seemed to turn my thyroid around. But that was after I had already done a number on it.

So for thyroid, that would be an example of what I would do with something like thyroid, would be increase calories, increase carbohydrates, increase intake of organ meats and fat soluble vitamins. And then for a really hard-charging athlete who insists upon doing something like restricting carbohydrates to tap into the performance enhancing effects of ketosis, understand that you’ve got to get on extra help from the thyroid.

Since your body isn’t going to make T3, dump it into the body. And preferably get it from a whole source, like levothyroxine or synthroid. But a source that contains other elements of thyroid in addition to just T3, so you’re not creating an imbalance.

[27:22] [Damien Blenkinsopp]: Great. Well, connected with the thyroid issues, I was wondering if you’ve come across adrenal fatigue also. If that’s every come up with you or with anyone else.

[Ben Greenfield]: Absolutely. Adrenal fatigue, gosh. There’s like four chapters of my book on that alone. But adrenal fatigue, well what do you want to know about it?

[Damien Blenkinsopp]: Well first of all, have you looked at some of the tests? I’ve done some of the salivary tests.

[Ben Greenfield]: Oh yeah. Yeah, like an adrenal stress index is kind of gold standard, cortisol DHA. If you look at the cortisol DHA curve, that’s much, much better when you’re addressing something like adrenal fatigue versus a blood cortisol measurement, which is just a snapshot. You want to see a moving target of salivary cortisol levels, preferably matched to salivary DHEA levels, throughout the day.

[28:03][Damien Blenkinsopp]: I was just thinking, based on it’s endurance exercise, and it has this tendency to raise cortisol, that that would be more of an issue and something that you would keep an eye on. Or by monitoring TSH, does that kind of take care of itself? If the TSH is alright then you tend not to have an adrenal issue as well?

[Ben Greenfield]: No, not necessarily.

You can still have adrenal fatigue and have a thyroid that’s managed properly. Because what you would typically see in that case is someone is eating boatloads of calories and taking care of themselves from an energetic standpoint, but simply outputting too much energy. They’re just training way too much. Even though they’re supplying their thyroid with what it needs, there’s just too much training still.

And a lot of times you’ll see inflammation high, but yeah. Cortisol DHEA, and that adrenal stress index can be a good measurement. And there are less quantitative measurements. You could do a pulst test, where you look in a mirror and you shine a bright light at your eyes, and your pupils should stay dilated. But if it stays dilated and then just starts flickering rapidly.

[Damien Blenkinsopp]: Have you tried that one?

[Ben Greenfield]: I have, yeah.

[Damien Blenkinsopp]: Because I was just wondering. I did try it and I find it a little bit difficult to judge.

[Ben Greenfield]: Yeah, it’s certainly not as precise as a salivary measurement, but once you’ve done it a few times you can definitely see the pupil, and whether or not it’s actually flickering versus staying dilated. If you look at if for long enough, it’s just going to start flickering period, but if it starts flickering after just a few seconds, that’s typically a sign that your kidneys are not producing enough aldosterone, which is synonymous, or can accompany, adrenal fatigue.

The other one is just the dizziness test. If you lay down or you sit down and you stand up quickly and you get dizzy, that can be a sign of blood pressure mismanagement that often goes hand-in-hand with adrenal fatigue. And again, these are the super cheapo poor man’s methods, but it can give you clues.

And then there’s temperature tests for thyroid, the Broda Barnes Temperature Test, where you do oral and axillary measurements of your temperature in bed every morning, and keep a running graph. And if it’s consistently low, that can be a pretty good indication that even if you haven’t done a blood thyroid test that your thyroid might be having issues.

So, there are a lot of things. One of the best ones I like though is just pure heart-rate variability. Testing the interplay between your sympathetic and your parasympathetic nervous system by using something like a Bluetooth enabled heart rate monitor and one of these heart rate variability apps, and simply paying attention to whether heart rate variability is high or low on any given day.

And if it’s consistently low, and you see consistent suppression of both sympathetic and parasympathetic nervous system feedback, then that can be a pretty good sign that you’re on the cusp of adrenal fatigue illness or injury, and so that’s another really good one to pay attention to. And I do that one every day myself.

[Damien Blenkinsopp]: Do you do it in the morning as soon as you wake up?

[Ben Greenfield]: Yes, that’s gold standard, because that’s where most of the studies have been done on heart rate variability were five minutes resting in the morning.

[30:45] [Damien Blenkinsopp]: Right, right. I believe you use the HR…what’s the name of the company?

[Ben Greenfield]: SweetBeat?

[Damien Blenkinsopp]: Yeah, SweetBeat.

[Ben Greenfield]: Yeah, but because I want to build up that technology and add some features and stuff like that, I’ve actually white labeled their technology. And so I use the app called NatureBeat now, but it’s the SweetBeat technology.

[Damien Blenkinsopp]: Great, great. Yeah, she’s been on the show.

[Ben Greenfield]: Yeah.

[Damien Blenkinsopp]: So I was using that for a long time, and then I just recently started using iFleet, because I also talked to the guys at iFleet, and it does have this other thing that they just added recently. You might just want to check out.

It’s kind of interesting. It shows how high your energy levels are on a given day, so it kind of does this matrix thing. So it shows you if your in the bottom right corner, it means something a little bit different. So I’ve been checking it out. I’m still trying to understand what it means each day. But I do find that when I’m at the bottom, low energy, those days tend not to be good. Even if I have a high HRV.

[31:39] So anyway, out of interest, what is your HRV levels? Because you think normally endurance athletes have higher HRV, right?

[Ben Greenfield]: Yeah. Usually higher HRV, which isn’’t necessarily a good thing if you’ve got what are called HF to LF ratio imbalances.

You want your HF to LF ratio to be pretty close to one. That’s sympathetic and parasympathetic nervous system feedback. And if parasympathetic nervous system feedback, which would be your high frequency number, if that’s super duper depressed, and your LF is really high that can be an indication of aerobic based over-training, or vice versa.

So ideally you’ve got high HRV and a pretty close to a 1-1 ration between HF and LF. That’s what you want to go to. And you want both HF and LF to be up in the thousands. That’s a sign of a really robust nervous system.

So, my values tend to be between about 92 and 98, with HF and LF values that vary between about 4,000 to 8,000, around in there. Generally with a 1-1 ratio, depending on what my previous day’s training had looked like.

And I would expect, for example, this Tuesday I’ll do a CrossFit’s Murph and I’ll do that with a 20 pound weighted vest on, and just crush myself. And that will take me about an hour to do, and I guarantee my LF value will be tanked the next day. But I also won’t be doing any sympathetic nervous system training for like 48 hours afterward.

[Damien Blenkinsopp]: So you recover within 48 hours?

[Ben Greenfield]: 48 to 72 hours, depending.

[Damien Blenkinsopp]: These scores recover for you pretty quickly?

[Ben Greenfield]: Yeah, but I mean, if I were to do something epic, right? Like, usually something that gets you to the state of glycogen depletion. Or let’s say instead of Murph, I do double Murph, or I do a Murph with a 5k sandwiched on either end rather than just a mile, then it can take me several days to recover, for sure.

[33:23] [Damien Blenkinsopp]: If you had to pick one marker to optimize your endurance training by and make decisions on, which one of the ones we’ve talked about would it be?

[Ben Greenfield]: HRV.

[Damien Blenkinsopp]: Okay, great.

[Ben Greenfield]: Just because it’s easy, right? You don’t have to give blood.

And maybe at some point, once we’ve got the lab and chip technology finalized, and I can put a drop of blood onto a little dongle that will plug into my iPhone and I can measure, let’s say, testosterone cortisol ratios, maybe that will become a more valuable metric for me. But at this point, I would have to say something simple and easy to utilize and relatively inexpensive, the HRV would be the one that I’d choose.

If I had to choose an actual blood biomarker, tough to say. Tough to say. I guess I’d probably have to go with HSCRP, again. Just because inflammation is generally going to be high when cortisol is high. It’s generally going to be high when diet is crappy, it’s going to be high when triglycerides are high, it’s going to be high when omega-3 fatty acids are low. So, that’s a pretty good one to measure.

[Damien Blenkinsopp]: Yeah. So it catches a lot of things. Mainly whenever something starts going wrong.

[Ben Greenfield]: Yeah.

[34:29] [Damien Blenkinsopp]: Well so you’ve referred to over training quite a bit over this as something that you’d have to change. So HRV would be one of the first places you’d see over training.

Are there any other tell-tale markers, and what do you suggest, more to the point, because you mentioned earlier that you do very – is it short, intense kind of endurance exercises. And I think a lot of people when they’re thinking about endurance, they’re thinking about very high-volume, kind of long duration activity.

So how do you approach it, and avoid over training? What are the top things you’ve taken in over time?

[Ben Greenfield]: First of all, one of the common pitfalls that people fall into with endurance training is doing the long voluminous training every weekend. It’s very stereotypical that you’ll see in a lot of athletes these Saturday long bike rides and then Sunday long run, for example. Or in a marathon, the Saturday long run.

I’ve found that in most cases, you can maintain endurance really, really well. Unless you’re a professional athlete trying to perform at the peak of performance, most people can perform just fine. With doing digging into the well like that, really, really, deep for like a death march, a really long ride or something like that, you typically only need to do that one to two times a month. Not every weekend.

I’m a bigger fan of using shorter, very temporal based intervals. So to give you an example, for the Ironman triathletes that I work with, while their peers are out doing a five hour ride followed by an hour long run, my athletes will be doing two hours of 20 minutes at race pace followed by 5 minutes recovery. So a very focused activity with a specific goal in mind. And then they’ll finish that up with a 15 minute tempo run at a cadence of 90 plus.

So it’s all extremely high quality. And then once a month they’ll go out and do something big, something long, something voluminous that builds the mental tolerance to training, but that doesn’t dig so deep into the well as doing it every week.

And the reason for that is based off of the human body’s natural slow twitch muscle fibers. The human body’s ability to cool because we’re upright and not covered in fur and hair. Our ability to sweat, rather than pant, to reduce heat. And a cluster of other factors.

We’re pretty good at going for long periods of time. And when training for endurance, bigger limiters are things like power, speed, cadence, strength, the integrity of the fascia connective tissue, the intelligence to be able to use nutrients and calories properly.

And really pointing in one direction, and going for long periods of time is not that much of a weakness for the human body, but the problem is that it’s easy. And people take pride in it. They’re like, “Oh I persevered today. I did my three hour run.”

And my question to you is well yea, but what did you accomplish side from being on your feet for long periods of time? Which frankly I could stand up at my standing workstation and write an article for three hours and get the same amount of time on my feet as you just did out pounding the pavement. So it would be better in that case to do something with intervals at race pace for a shorter period of time.

Focus on cadence. Allow enough time before and after for a good warmup. Maybe some meditation and breath work. Some good recovery. And so that’s where the more intense, more quality, lower volume approach nine times out of ten trumps the voluminous approach.

The exception to that fact would be the person who has a lot of time on their hands to train: the professional athlete. Professional athletes, assuming they’re using this 80-20 approach, it’s called polarized training. 80 percent of your training is done aerobically, with about 20 percent done high intensity.

That approach works very well, and it is what a lot of the elite cross-country skiers and marathoners and cyclists etc. will use, but what is important to understand about that approach is it requires many, many hours per day.

That approach can require two to four hours per day of training, and even more than that, on weekends, for example. And the majority of folks simply don’t have the luxury of time available to utilize that approach effectively. That in a nut shell is my approach to training.

I’ve got a couple of athletes who I work with who are more, what I would consider to be on the professional level, who have that luxury of time. And I do train them with that aerobic approach, where they’re out doing long voluminous sets of training at a controlled heart rate aerobically, putting lots of time in the saddle or time on the pavement. But its very few and far between that I’ll recommend an athlete to train like that.

[Damien Blenkinsopp]: Great, great, thanks. That’s a great summary of it.

[39:01] I wanted to move on to, because I know you did this 12 months of ketogenic dieting. Could you talk a little bit about that? Give us an overview. What was your approach to that, what were you actually eating, and was there any specific goals to track over the year?

[Ben Greenfield]: Well yeah, for that specific diet, that was for a study at University of Connecticut that was done on, basically, a group of athletes who followed a high-carb/low-fat diet, versus a group of athletes who followed a high-fat/low-carb diet.

And it was basically a measurement of fat oxidation during exercise. And they also did muscle biopsies before and after exercise to see the rate of glycogen use as well as the rate of glycogen replenishment following the post work out meal to just see if the body does a better job at oxidizing fat, or at sparing glycogen during exercise when you’ve eaten a high-fat diet.

And it did turn out in that study that the athletes who followed the high-fat diet were oxidizing a lot of fat. The textbooks tell you that you can burn about 1.0 grams of fat per minute, and the group of athletes who followed the high-fat diet were burning 1.5, 1.6, 1.7 grams of fat per minute. Literally rewriting the textbooks when it comes to how much fat you can burn during exercise.

I haven’t seen the muscle biopsy data yet to see how much glycogen conservation actually took place, or whether or not the body became more glycogen depleted when using primarily fatty acids as a fuel. But ultimately, what that diet consisted of was really controlling carbohydrates.

Whereas I would normally – and this is what I do now – I would carb-cycle, or I would do cyclic-ketogensis or cyclic-ketosis, where I don’t eat carbohydrates all day long and at the very end of the day, typically in the post-workout scenario, with dinner I’ll eat anywhere from 75 to 200 grams of white rice, red wine, sweet potatoes, sourdough bread. You know, safe starches, not like pizza and ice cream, but good carbohydrates. And then the rest of the day just high fat and moderate protein.

Whereas on this full on ketosis diet, it was pretty much just things like bulletproof coffee, and high fat shakes and lots of coconut milk and coconut oil, and heavy cream and MCT oil and seeds and nuts, and just fats, fat, fats. Bone broth and avocados, and olives, and you name it.

And frankly, in my opinion, it wasn’t that enjoyable to have to not have sweet potato fries, and not have, even coconut ice cream has cane sugar in it. So you have to make your own with chocolate stevia. And so it’s a little bit laborious and a little bit tough, but I mean at the same time the endurance payoff was huge.

The amount of focus that I had for long periods of time. My ability to just hop on a bike and ride for hours with no fuel at all, with just water. It was pretty profound, because you produce all these ketones as a bi-product of fatty acid oxidation, and they’re used as the preferred fuel by the brain, by the heart, by the liver, by the diaphragm while you’re out exercising. And that’s a huge boon to an endurance athlete.

And like I mentioned, there’s some blow-back. Like the TSH could take a hit, the testosterone could take a hit. But ultimately, it’s a cool little bio-hack. If I could go back and do it over again, I would definitely start taking thyroid glandular earlier to stave off some of those thyroid issues.

I would,– it’s not legal – but I would really encourage folks to pay attention to testosterone. And I mean like, you can’t use testosterone in a WADA, or a USADA or like an NCAA sanctioned event, but my testosterone dropped so much during that experiment with ketosis, I would say if you’re not competing, use AndroGel or just some kind of testosterone support because your testosterone is going to fall to pieces.

And then the question becomes well is it really worth it to you if you’re doing this thing and you’re not even competing.

[Damien Blenkinsopp]: Yeah. Did you feel different?

[Ben Greenfield]: Oh, yeah.

[Damien Blenkinsopp]: Because we talk about testosterone with things like anxiety, your drive, your libido, of course. And so did you get any kind of low testosterone symptoms?

[Ben Greenfield]: Oh yeah. Absolutely. I mean even something as simple as only having to shave every four or five days, whereas normally I would just shave every one to two days.

[Damien Blenkinsopp]: That’s a benefit.

[Ben Greenfield]: I mean, little things like that, but you notice. Yeah, potentially. You save money on razors.

Yeah, the libido, sex drive, number of times having sex per week, desire to have sex, quality of the erection, all of those kind of things certainly they took a hit during ketosis. They weren’t good. But that was, mind you, ketosis in the presence of high amounts of physical activity. Even doing the ‘low volume approach’ it’s still a massive amount of work, right?

[Damien Blenkinsopp]: Right.

[Ben Greenfield]: You’re still working out 60 to 90 plus minutes every day, and longer than that on the weekends.

And you look at something like Dr. Terry Wahls and her ketosis approach for managing MS. Well sure. I mean, that’s going to work just fine for managing MS. I mean, going on a walk with your dog every morning, and maybe lifting easy weights, three sets of 10 for 20 minutes twice a week.

But once you jump into hard exercise, it’s a whole different type of ketosis.

[Damien Blenkinsopp]: Right, right. Just to be clear, were you getting better times? Did you feel like you were competing better?

[Ben Greenfield]: Oh, I was competing way better. Yeah. Absolutely.

[Damien Blenkinsopp]: Right. But it’s just the downsides to your lifestyle, to all the other things, were too great to do this on a constant basis.

[Ben Greenfield]: In my opinion, yes, because I don’t like being cold all the time, I don’t like not having libido. So again, I’m not saying you can’t do it properly, even though it’s way, way tougher once you get into training, but I think that you basically have to use supplementation pretty intensively.

[44:34] [Damien Blenkinsopp]: Did you kind of see the benefits evolve and get much better as the months passed, or is this something someone could do on a month basis, one month on and one month off?

[Ben Greenfield]: For exercise, you barely even see any benefits until you’ve been doing it consistently for about six months, and the real benefits start to manifest after one to two years.

But the other thing to realize is that right about the time I finished up the experiment, companies like KetoForce started coming out with beta hydroxybutyrate salts that could be consumed to elevate your ketone bodies, even in the presence of a lot of carbohydrates or glucose. And so it’s possible that now, since the experiment that I did, you could get the best of both worlds.

And I actually have some bottles of the beta hydroxybutyrate salts and the resistance starches, and a lot of the things that, if I had to go back and do it all over again, I would try to get the best of both worlds. I would eat more carbohydrates, but then I would also hack myself into ketosis by consuming actual ketones bodies.

The question there becomes a matter of long term health and gut health and how that actually manifests in terms of actual symptoms or the way you felt, or even I would definitely pay close attention to blood and biomarkers.

Were I to delve into that type of bio-hack? I potentially may. I could see myself, and obviously I’m at a point in my athletic career where I’ve still got a good eight years of hardcore performance left in my body, and I could see one of those years being spent utilizing a ketonic approach again, but with the incorporation of beta hydroxybutyrate salts, resistance starches, even higher amounts of MCT oils, particularly like the C8s and the C10s. And a little bit more attention paid to ways to get into ketosis that go above and beyond just carbohydrate restriction and exercise.

[Damien Blenkinsopp]: This is great Ben, this is a wealth of information.

[46:20] In terms of the biomarkers you would track, you said you would track some biomarkers if you were going to do this again what kinds of ones that we haven’t spoken about already would you look at? Did you track your blood ketones?

[Ben Greenfield]: Yeah. Breath ketones. I mean, urinary ketones become, many times, absent after a few weeks in ketosis just because you’re utilizing your ketones. Blood ketones are accurate but expensive and invasive to test, and breath ketones are pretty [easy].

There are breath testing monitors like the Ketonix device that, one breath and you know your ketones, and you’re good. So breath testing is a really good way to go as far as measurement of ketones. You look for values anywhere from 1.0 up to 3.0 millimolars. You’ll finish exercise as high as 7.0 millimolars.

You’ll rarely see ketoacidosis, which would be like 10 plus millimolars. It is a non-issue. I have yet to see any athlete I work with go under ketoacidosis, which would be an actual deleterious biological state. Not something you need to worry about unless you are letting yourself become severely hypoglycemic.

[47:20] [Damien Blenkinsopp]: So again, is that something you saw evolve over the months? Like your ketones ratings would get higher.

[Ben Greenfield]: Yeah. You get to the point where it’s just super duper easy to get into ketosis. Yeah. And your ability to go for long periods of time without eating just goes through the roof.

So ultimately, the biomarker I would say, in addition to what we’ve already talked about, would be breath ketones. And then pay attention to triglycerides too, because they’ve shown that compared to total cholesterol values, a better predictor of your coronary disease risk factors is your triglyceride to HDL ratio, specifically keeping that at one or lower in terms of your number of triglycerides versus HDL.

But I’ve found that some people will switch to a high-fat diet and have such a high intake of vegetable oils, and even an imbalanced high intake of animal based oils, like butter for example, versus olive oil and avocados. Their triglycerides go through the roof.

Pay attention to that HDL ratio. That’s my advice is make sure that that thing isn’t getting much above one, that would be another important thing to pay attention to, especially on a higher fat intake.

[Damien Blenkinsopp]: Great, great. Excellent points.

[48:25] So there are a couple of other things I’ve noticed you’ve done in your experiment. I read your book of course. One of the things that we’ve come across before – I spoke to Alan Cash from benaGene –oxaloacetate, and I was wondering what you’ve done with that and if you’ve tracked anything or learned anything about that.

[Ben Greenfield]: Yeah, obviously if you talked to Alan Cash your listeners can go back and listen to that to learn more about what oxaloacetate is. But in a nutshell, the reason that I used it was because it can increase the turnover rate of lactic acid into pyruvate, and increase the rate at which lactic acid is shuttled back up into the liver to be reconverted into glucose.

And so if you are eating a low-carbohydrate diet anyways, that by nature means you might not be taking as much exogenous glucose in, or might not even have as high a level of glycogen stores, but you can still take the lactic acid that you’re producing as a byproduct of metabolic activity anyways and have that reconverted into usable glucose sources to have a glycogen sparing effect and to get a little bit more intensity. And so the way that would be achieved if you’re going to increase the rate of that cycle, which is called the Cori cycle, would be via the use of oxaloacetate.

And so, I actually did use that. I don’t use it right now. It’s one of those things where it’s just like, I would benefit from it its just one more supplement to remember to take. But I certainly used it through that entire ketotic experiment with the oxaloacetate just to increase the conversion of lactic acid into glucose.

[Damien Blenkinsopp]: Right, it sounds like it would help specifically in that ketogenic diet state when you’re exercising.

[Ben Greenfield]: Exactly.

[Damien Blenkinsopp]: So you designed it that way? You decided to take it before, or was it something you came up with afterward to help?

[Ben Greenfield]: I talked to Alan at one of the Bulletproof bio-hacking conferences. We talked about the physiology of oxaloacetate, and then based on that I just kind of had a little light bulb moment, where I realized that if I was restricting carbohydrates anyway, that this was one more way that I could create endogenous glucose more quickly.

[Damien Blenkinsopp]: Great, great.

[50:27] Cold thermogenesis. Do you still play around with that? Is there anything like, for instance, have you seen your HSCRP any time, potentially when you first started it or did it a bit more intensively, change with that?

[Ben Greenfield]: Yes. I have not done a dedicated experiment with cold water exposure, cold temperature exposure, or the use of ice baths or cold showers to see the direct effects on HSCRP, although reduction of inflammatory cytokines has been observed in literature when it comes to cold thermogenesis and inflammation.

What I use cold thermogenesis for is increased conversion of white adipose tissue to brown adipose tissue. Simply because it’s very difficult to kill fat cells, but you can convert fat cells into energy utilizing and heat producing tissue. And that’s one thing that cold thermogenesis is good for. That would mean cold baths, cold showers, cold soaks, etc.

Also very useful for increased production of endothelial nitric oxide synthase, which can cause your blood vessels to dilate much more readily, which is good for everything from exercise to sex to heating your body when it needs to be heated. And then there’s also increased tolerance to the mammalian dive reflex, which is that activation of our sympathetic fight-or-light nervous system in response to stress.

And when you are able to withstand cold stress without taking that sharp influx of breath, that means that you have become more resilient and more resistant to subconscious activation of that fight-or-flight nervous system. You’re better at controlling stressful events that happen.

And so, what I do is I never take a warm shower. I do a cold shower in the morning, cold shower in the evening. I do once per week a 30 minute cold soak that gets me up to shivering level, typically needing to shiver for one to two hours afterward in order to regain warmth. And those are the ways that I use cold thermogenesis. I also keep my house relatively cold. My office is at about 55 degrees. In my home, typically I’ll sleep at 60 to 65 degrees.

It’s just a really, really good way to make yourself tough, to burn fat, and to increase blood vessel health. And it’s just super simple. And frankly, the other cool thing is when I go hunting or when I have long periods of time outdoors or when I’m at the beach and evening comes and I forgot my coat, I don’t get as bothered, which is just kind of nice. You’re just more tough.

[Damien Blenkinsopp]: It sounds like the only time it was an issue when you were doing you ketogenic thing. What was the issue there? Were you getting a lot colder, or?

[Ben Greenfield]: Yeah, but that was because of the thyroid. If you have hypothyroidism, cold thermogenesis is going to be very uncomfortable. Heck, even normal temperatures you’re colder during. So I was still doing cold thermogenesis then but it was quite unpleasant. It was hard for the body to get warm again.

[Damien Blenkinsopp]: Okay. Right, great.

[53:17] Some quick fly questions that I have just to finish off here.

First of all, if people want to connect with you and learn more about you and what you’re up to, where is the best place? Twitter, your website?

[Ben Greenfield]: Bengreenfieldfitness.com, because if you go there, you’ll find links to my Twitter, Facebook, Instagram, my blog, my podcast, etc. So that’s a good place to go as a portal.

[Damien Blenkinsopp]: Great, great. And who besides yourself would you recommend to learn more about endurance training, or some of the other topics we spoke about today? Ketogenic diets and so on?

[Ben Greenfield]: As far as people who have their head screwed on straight who are paying attention to the research, I’d say three people come to mind.

Number one would be Joe Friel. He’s coached a lot of professional cyclists, but also has just been in the sport a long time and pays attention to the science and the research and has a pretty good unbiased view of things.

Sami Inkinen, who is a top age group for Ironman competitor. He’s a higher fat diet, pays attention to quantified data, and is a smart, well spoken person who performs well.

And then Dr. Peter Attia, who I would not say is on the pointy edge of physical performance, even though he’s in much better shape than the average, general population. He’s not out doing Ironman triathlons or anything. But, as far as the science goes, he probably knows the science better than just about anybody else when it comes to being able to speak to these things, and he also does quite a bit of self-quantification himself.

So, those would be three people that would be good resources for this.

[Damien Blenkinsopp]: Great, thanks so much for that.

[54:48] Beyond everything, like all the biomarkers we’ve spoken about today, are there any other biomarkers you pay specific attention [to] on a routine basis, I don’t know whether it’s monthly –that you feel are important that we haven’t spoken about?

[Ben Greenfield]: I’ll finish with this because it’s important. And many times in our type of circles it’s not talked about, and it’s not quantifiable to a great degree, as far as I know. And that would be simply paying attention to your levels of gratitude every single day, and multiple times per day.

For me, I guess you could kind of quantify it – at least six times per day I’m grateful. Because I’m journaling, and at the beginning of the day I journal three things I’m grateful for, and at the end of the day I journal three amazing things that happened to me that day. So there’s at least six times per day that I’m being grateful for things.

And then I practice quick coherence technique, which is something you can read about at heartmath.org, which increases heart rate variability and decreases stress. And that’s where you simply think of something that you love or someone you hold dear, and you imagine intense feelings of gratefulness washing over your body and going into your heart after you feel those feelings of gratefulness.

Saying thank you to people, saying I love you to people, randomly calling up people and telling them how much you appreciate them. If you listen to my voicemail, I ask people to end their voice message by telling me one thing that they’re grateful for that day.

It’s certainly something that’s not super duper quantifiable, again, but it is one thing, not a biomarker, but certainly something I pay attention to every day is gratefulness for being alive, for the people in my life, for the experiences that I’ve had, and for simply being able to take one more breath.

[Damien Blenkinsopp]: Excellent. Thanks for that, that’s not the typical, but definitely something really important. So I can see how that would be useful. I do a meditation gratitude every morning too, and I find that really, really useful.

So Ben, thanks so much for your time today. It’s been really stock full of biomarkers and hacks and everything, so it’s really been a great episode. Thank you for your time.

[Ben Greenfield]: Awesome. Well thanks for having me on, Dam.

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This episode is about experimenters in the field of biohacking, the people actually in the trenches doing stuff. We’re focusing on wearable devices such as watches, shirts, bracelets, necklaces and on and on.
We’re focusing on wearable devices such as watches, shirts, bracelets, necklaces and on an on. Basically, anything that you can put on your body that can give you data on your performance.

Wearables are here to stay and there are more coming out to track different aspects of our biology, of our health and our fitness, and so on. Which of these devices give us the most accurate data? How can we make good use of the data and improve our lives instead of just letting all those numbers cause confusion and distraction?

“You really have to get this intersection of who is the user. How much data do they want? Are we giving them enough data and is it accurate data?”
– Troy Angrignon

Troy Angrignon is an emerging technologies consultant with expertise in marketing strategies and segmentation for wearables. Troy spends a lot of his time testing several of the latest wearables while doing a range of relatively extreme athletics and feats, including military style training like that done by SealFit. He reviews and compares the products then maps them all out into big ‘x and y’ diagrams simplify data and make test easier to understand.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • Troy’s interest in wearables started with early generation sports watches that could tell the user how much recovery time they would need after a particular workout. (4:05).
  • Improvements in utility of wearable devices over the past 10 years from sport watches to fitness trackers, to activity trackers to smart watches. (6:25).
  • Value of wearable tech depends on the user’s activity level and goals – Troy Angrigon’s 5-tier approach ranging from the semi-active user who needs little more than a watch with a timer to measure how long or how fast they ran to the pro athlete looking for clinical data. (7:33).
  • Devices currently available that cater to the tracking needs of elite-level endurance athletes: Garmin 920Xt and Fenix. (11:10).
  • Discussion of accuracy of wearable devices – Damien notes that tests have shown the degrees of error to be roughly the same between manufacturers. (13:10).
  • Devices currently available that are accurate enough for optimizing performance at a high level (17:10).
  • Problems with current software that misinterprets sedentary activity such as watching t.v. and reports it as sleeping. (20:32).
  • Fitbit Surge design advantages – combines GPS with optical heart rate monitoring (21:42).
  • Design areas where Troy Angrignon thinks manufacturers are excelling: Fitbit has good tracking for lower level users, Jawbone offers good customer service and good apps, and areas that still need work: understanding the customer, how they live and what they are going to use the tool for. (22:45).
  • Devices for lower activity level users: Fitbit, Jawbone and Body Media (23:47).
  • Devices for mid-level users: Fitbit Surge HR, Garmin Vivoactive, Garmin FR620 (27:14).
  • Devices for high-level users: Garmin 920XT, Fenix and Epix models (29:10).
  • Platform compatibility issues between manufacturers – users with several devices from different manufacturers can’t pool or cross correlate their data easily(29: 58).
  • Application issues with EEG devices: Muse, Emotive; collect data but few apps have been developed for converting the data into usable or actionable information. (30:40).
  • Meditation as a tool for improving mental and physical performance. Damien mentions using meditation in conjunction with the Muse (32:05).
  • Discussion of sleep tracking devices for different user/quantification levels: level 2 analysis reports how many hours in bed and of that how many hours spent sleeping vs. tossing and turning; level 3 reports deep vs. light sleep phases, records snoring, level 4 provides clinically verified data, level 5 provides raw sensitive data. (35:04).
  • Troy and Damien describe techniques they’ve each used to improve their sleep quality: cover bedroom window with blanket to darken the room, turn off all screens, programmable lights; devices to use: Basis, Jawbone, Fitbit Sealfit Unbeatable Mind, Lumen Trails. (39:48).
  • Price ranges of wearable devices (50:00).
  • Risks associated with EMF exposure from wearable devices. Damien mentions that most people aren’t aware of potential detrimental health effects of EMF’s. Topic is discussed in the book 4-Hour Body by Tim Ferris. (52:55).
  • Sleep coaching tool: Sleepio.com. Troy mentions this tool, which educates the user on the complexities of sleep and identifies the user’s particular sleep issues. (56:30).
  • Troy Angrignon’s prediction for the direction wearable device technology is going in the next 5-10 years: we are currently at an immature stage in being able to collect and analyze data. He hopes we can compress the maturation period of this technology and not have to wait 30 years until we can turn data into actionable intelligence (57:55).
  • The biomarkers Troy Angrignon tracks on a routine basis to monitor and improve his health, longevity and performance include sleep via Sleepio.com, heart rate variability with the Garmin Forerunner 920xt and recovery levels through RestWise.com.
  • Troy Angrignon’s one biggest recommendation on using body data to improve your health, longevity and performance is to decide on the one thing that would make the biggest difference to you and track it.

Thank Troy Angrignon on Twitter for this interview.
Click Here to let him know you enjoyed the show!

Troy Angrignon

The Tracking

Biomarkers

  • Sleep-Related Biomarkers: Measure sleep in total time (hours and minutes) and percentage of time spent in different sleep phases:
    • REM (Rapid Eye Movement) sleep : Characterized by random eye movements and is physiologically distinct from non-REM phases of sleep. Troy mentions that the Basis watch measures the amount of REM sleep.
    • Deep Sleep: Characterized by slow, synchronized brain activity and is the most restful phase of sleep. Mentioned by Damien in relation to inability of the Basis watch to track properly.
    • Light Sleep: Also known as stage 1 sleep, a non-REM sleep stage that forms the transition from wakefulness into deeper stages of sleep. Mentioned by Troy in context of the Basis sleep tracking watch.

  • Heart Rate Variability (HRV): Mentioned by Troy as an indicator for over-training. HRV is a physiological phenomenon whereby the heart rate changes to accommodate physiological, mental or emotional stressors.
  • VO2 Max: Mentioned by Damien as a test available through fitness labs. Measures an athlete’s maximum oxygen consumption rate and is used to gauge aerobic fitness levels.

Lab Tests, Devices and Apps

  • Colored LED Lights: Damien mentions using these to help with sleep.
  • Apple Watch: Smart watch with fitness tracking capability.
  • Basis Watch: Smart watch with sleep tracking. Mentioned by Damien for its inability to distinguish sleep from sedentary activity.
  • Beddit: Sleep tracking device. Troy mentions that version 1 was offered in consumer or pro models, with the consumer model being cumbersome to operate.
  • Beddit Misfit: Under mattress sleep tracker.
  • Body Media Fit : Mentioned by Troy as having a loyal customer base. Strap-on style device worn on arm.
  • EEG (electroencephalogram) Devices : Measure brain wave activity, used to determine sleep cycles. Mentioned by Damien in relation to tracking sleep.
    • Emotiv: EEG monitor Troy mentions that he hasn’t tried yet.
    • Muse Headband: Contains an EEG device.

  • Fitbit Products
    • Fitbit Surge: Fitness watch that offers GPS tracking, heart rate monitor, all-day tracking, sleep tracking, and wireless syncing. Troy mentioned it in relation to its optical heart rate detector.
    • Fitbit Charge HR: Fitness watch with automatic monitoring.

  • Garmin Products
    • Garmin Fenix: Mentioned by Troy as a durable device, good for competitive and endurance athletes.
    • Garmin Forerunner 920xt: Mentioned by Troy as a durable device, good for competitive and endurance athletes.
    • Garmin Vivoactive: Good for running, cycling and swimming but not able to track transitions in triathlons
    • Garmin Epix: Similar to the 920XT and Fenix plus a larger screen with high-reolution color and apps.

  • Jawbone Up : A line of activity trackers. Mentioned by Troy as being problematic for its clip-on style and not being waterproof.
  • Lumen Trails: Tracker app Troy uses to simplify tracking for many things.
  • Sleep Tracking Devices
    • ResMed S-Plus: Sleep tracker with connections to Phillips Corp.
    • SleepRate: Sleep tracker mentioned by Troy as having a different scoring algorithm than Jawbone.
    • Sleepio: Sleep tracker mentioned by Troy in relation to its scoring algorithm.

  • Restwise: App Troy uses to track post-workout recovery.
  • Suunto: A Finnish manufacturer of measuring instruments that carries a range of sport watches. Troy mentioned their products as having excellent hardware but cumbersome software.

Other People, Books & Resources

People

  • Dr. Greg Welk: A Kinesiology Professor at Iowa State University where he oversees the Physical Activity and Health Promotion lab. Listen to Damien’s interview with Dr. Welk on the accuracy of fitness trackers in episode 18.
  • Dave Asprey: author of The Bulletproof Diet Mentioned by Troy in regards to brain training for increasing focus and blood flow to the pre-frontal cortex.
  • Ben Greenfield: Mentioned by Troy in relation to sleep improvement tips. Maintains a fitness website and blog.
  • Ray at DCRainmaker.com: Triathlete who maintains a website and blog. Mentioned by Troy for his extensive product reviews.
  • Dr. Kirk Parsley: Sleep clinician for Navy SEALs. Associated with performance program called Sealfit Unbeatable Mind.

Organizations

Books

  • The 4-Hour Body: The book by Tim Ferriss mentioned by Damien in relation to health effects of EMF’s.

Full Interview Transcript

Click Here to Read Transcript
[Damien Blenkinsopp]: Troy, thank you so much for joining us on the show.

[Troy Angrignon]: Hey Damien. Thanks, great to be here.

[Damien Blenkinsopp]: So, you have the absolute, most comprehensive review of wearable technologies, wearable devices I’ve ever seen. It looks like something from my consulting background years where I was paid big money to create those kinds of things.

So when I saw it I was like, yeah I definitely have to get this guy on the show. He’s put so much time and effort to looking at it from a user; what people actually need and the functionality out there. How did you get into this? Where did your interest in wearable devices start from?

[Troy Angrignon]: I’ve always been interested in them. I’ve always looked in the very early days at running watches, all the sport watches in the early days. The Suunto’s and the Garmins’s and things like that and even in the early incarnations, you could see some kind of cool things that were happening.

They would have interesting features in them. It would say, ‘you have to recover four hours after this workout’ and then say, ‘oh wow, that’s really cool. How are they figuring that out?’ So I got interested in some of the early sport watch stuff and really followed it through that. I’m a nerd and kind of a geek in general.

Anyway I like data. I’ve been involved in data based industries and loved doing sports. It really came from probably the sport watch side of things in the early days.

[Damien Blenkinsopp]: Great. So how long have you been doing this because the sport watch has been around for quite a while now?

[Troy Angrignon]: They have, right. Probably ten plus years and I really got into; I’d say what we know as this current generation of wearables or near-ables. You want to use that phrase.

Really about four years ago when I started looking at sleep issues; I was having sleep issues from working on a start-up and getting no sleep, and all those things. So I started looking at better sleep practices, a lot of stuff that you and I both went through in the bio-hacking space.

And looking at sleep practices as well as tools, so I started looking at a lot of tools and from there that was kind of the beginning. I think you were probably very aware of it at the same time. The sleep tools were happening and the activity trackers were starting to come out and things like that. That was probably 2011, 2010?

[Damien Blenkinsopp]: Right. Absolutely. What it is though, is sleeping activity is a big area? It’s interesting. Have you got a lot of data from over ten years reflected from all of these watches and things?

[Troy Angrignon]: No. Especially in the early days a lot of it, it’s hard to get the data off or it just comes off into space and you could look at it on some desktop application or something. So no, I think my largest, continuous data set is probably three years. I was just looking at it actually, all my workouts, probably for the last three years.

It’s spotty. There were sections where things didn’t track or I lost data or whatever else. Probably the last three years has been pretty rigorous.

[Damien Blenkinsopp]: I think you’re probably got pretty much on top of what’s been actionable and what’s been most useful for you over that time. How have you seen the curve of utility go up for you personally, because obviously you’ve been testing different devices and it’s been ten plus years?

In the beginning, was it useful or was it like trying to get some value out of this and getting a little bit but not so much? Like how to use scales on like one to ten, how has it changed over the last then plus years?

[Troy Angrignon]: Well I think two things have changed. There’s how have I changed. I own an approach to thinking about the data and I’ve kind of gone through my own levels of maturity in thinking about it. And then the technology, of course, is changing.

You and I have talked about this before where I kind of do think in that ‘x and y’ and I think that the market has evolved. We’ve gone from just sport watches to now, we’ve got fitness trackers, activity trackers and I can get into definitions of those things. Smart watches.

Some of the fashion companies; they’re with traditional fashion watches are now getting into smart watches. And so you’re getting this kind of bigger fragmentation and more features being developed. At the same time as what I want data has definitely changed and matured and mutated over time. So it has been definitely a change in both ways.

[Damien Blenkinsopp]: Great. Thanks. And who do you see is getting real value from the wearables tech on the market today? I mean you can take yourself as an example. What are you getting real value out of today and who else do you see getting real value out of these wearable tech today?

[Troy Angrignon]: That’s a tough question. I think a lot of different people of different skill sets can get value and it really comes down to what they are trying to do. So I think, maybe it will help set the stage probably for the rest of the call and give us a framework. Why don’t we talk through what we discussed the other day?

But I tend to think of user types as kind of a zero to five in a very gross, coarse way. So a zero would say, ‘I don’t care about data. I’m not going to use any of these tools. I’m just going to go run. I want to just feel the wind in my hair and get outside.’ Where a one would start to ask for some data, like I just want a watch that shows me the time. Like how long did I run? How far did I run? Maybe something basic.

A two would say, ‘well I want that but I want a little bit more data. Give me a few more fields.’ And a three really starts to say, ‘I want to know my time, my splits, my cadence, my running dynamics, my vertical oscillation. They start to get pretty technical in terms of what they’re looking for.

And the fours, they’re really looking for that. They want it to be trusted. They want to know that the data that they’re getting in those devices or applications truly is actually legitimate data. Where the threes are ok, just give me the number and I’ll kind of look at the numbers Is it going up or going down. I don’t really care if it’s super accurate.

And then the fives, you’re really talking Olympic athletes to that point. You’re talking people getting clinical, grave data. And so if you think about kind of the levels and you can apply those levels to the level of athlete too; zero probably doing nothing, one just starting, a two sort of semi-active, a three quite active, four pro-amateur level and five being a lead athlete.

And so if you think about those levels and then you think about what they do. Is this a wellness client who’s saying, ‘I just want to feel better, eat a little better, lose a little more’ or are they kind of a fitness type person that’s saying, ‘well I jog a bit, I run a bit, I cycle. I do a couple of things, I dance, I do yoga whenever. Or they’re really starting to get into the endurance in space.

So, I do run. I do marathons. I do long distance cycling. And then all the way up to what I call to the right on my charts where you’re beginning to know super competitive endurance and ultra-distance stuff. And ultimately you’re getting into like the outdoor, backcountry stuff where they’re like, ‘I’m going to go, put my watch on and go ten days into the back country.’

That’s a different animal. It’s a different kind of an athlete. So I tend to think of it kind of an ‘x by y’. And that’s a long back story to answer your question. But I think that people from, kind of the ones to the fives, on the y axis. And then everything from the sitting on the couch and just trying to get a little more active, all the way to the outdoor backcountry folks.

There are pockets of people in there who are getting a lot of value but I think it’s less about them and less about their specific technology and more about the process. So, are they clear on what they’re trying to figure out? Have they chosen the right tool? Does the tool give them the data and can they look at the data and have a feedback loop and say, ‘ok, I got what I needed. I’m going to improve my running speed or I’m going to back off and train less hard because I’m over-trained or whatever else.’

So, that’s a really fuzzy way of saying some people are getting useful stuff out of it and a lot of people are just looking at stuff and they don’t know why.

[Damien Blenkinsopp]: Right. And what we were talking about is a critical need the other day. You were talking about competitive athletes who want to shave off a few seconds off of their times or whatever.

This is critical needs and I guess these are the guys that would be using the fours and the fives that exist today. What kind of devices out there are there that provide that level of detail today, if there are any?

[Troy Angrignon]: Yeah, up in the competitive endurance space. I would look at, these are folks who are doing pretty aggressive, marathons, triathlons, cycling races, multi-sport, even obstacle course racing, which as you know is pretty popular these days, Spartan racing, those kinds of things.

And it’s less about those sports and more the level at which they compete in them. So we’re talking upper 50 percentile, upper 25 percentile folks. Now we are either looking at their times, very aggressive about their times. So once you get into those environments, your use case is pretty tough for a device manufacture.

You can throw a FitBit on these people. And then a lot of my friends bought Jawbones or Fitbits or whatever. What I would can an activity tracker, meaning something with an accelerometer in it and they last about a day because you get them wet, you cover them in mud, you get them in the ocean. Whatever happens, they short out.

So those kinds of users that are really competitive and endurance athletes, they’re hard on their toys. And they really need devices and apps, in fact they don’t even carry their phone with them cause they just trash them. So, you’re really looking at things like Garmin 920xt’s are a great example in the triathlon space or the Fenix, which is the new Garmin in the Fenix Backcountry watch.

Suunto has some excellent hardware, although their data is really hard to move around so I’m not a big fan of them for that reason. So yes, there are definitely tools that work in that space.

[Damien Blenkinsopp]: Great. And in the general where do you see most people using today? Is it in the level one? We were talking with Greg Welk who’s done ongoing studies on the accuracy of these devices and we got into this discussion of how they’re not accurate, most of them to varying degrees. They’re biased.

However, they’re roughly the same wrong every time. So you can check, the relative is difference to what you did yesterday. Consistently one direction wrong or the other so you will talk about the usefulness of at least I know had more activity or I was faster than yesterday at the very least. Is that how you look at that whole area right now? I mean it’s more of a relative difference you can use it for.

[Troy Angrignon]: Absolutely. And again, think of the ones to fives. Kind of drawing a picture in your head of kind of the ones to fives on the left side and then really the bottom of the chart, consumer wellness on the left and all the way through fitness, recreational endurance, competitive endurance and outdoor tactical on the right.

And so I think your question really gets to who uses these, let’s say activity trackers, like Jawbones, Fitbits, these little things that you can clip on. I don’t like clip on ones cause you just throw them in the wash and lose them and break them.

But let’s say the bands you can put on. And you nailed it; they’re not that accurate but if you’re a one you don’t really care. All you’re looking for is step data. And so, did I move a little bit more than I did yesterday? Is it consistently capturing the step data? Is it good enough?

And I have met so many people who say, ‘oh I’ve got my first one and I love it because I used to do 2000 steps and now I do 3000 steps.’ And does it matter that it was 3500 or 2500? No, it’s irrelevant. What they know is they a feedback loop which gives them some objective measure and it’s better than what they had before, which was nothing.

So I think that there’s still a lot of value there. There’s a really interesting company I was actually looking at it yesterday after you and I talked. Diva Metrics I think is the name and I think they’re in Montreal. I may have the city wrong, or Calgary.

And they’ve gone through a really rigorous analysis on how inaccurate all these tools are and making data correction tools. So they’ll say, ‘well this thing is 92% accurate so we’ll just take the data and just up it by the requisite 8% to reality.

[Damien Blenkinsopp]: That’s interesting.

[Troy Angrignon]: So, it’s pretty cool.

[Damien Blenkinsopp]: They can be selling that to the companies who design the devices.

[Troy Angrignon]: So I think there’s still a lot of value in just having some kind of indicator. Calories, I could go on a rant about calories for days. The shorter version is that I think calories in and calories out is a dead model. But a basic summary, whether it’s steps or calories, is it a number that’s higher or lower than it was yesterday.

That’s a great indicator for people that just didn’t have awareness of that before.

[Damien Blenkinsopp]: It’s definitely kind of how serious you are about doing what you’re doing. So if you take an example of sleep. That’s what we were talking about this last time and we’re both fans of sleep, obviously.

I was really interested in the Basis Watch when they were bringing the sleep tracking out because I wanted to understand my deep sleep versus other areas of sleep. And I really just wanted to know I was hitting my eight hours that I wanted and trying to push it up to nine for a while.

I was pretty disappointed because it was saying I was asleep a lot of the time and I wasn’t able to trust that data because if I was sitting around watching TV, or even working on my computer sometimes, it would be like yeah you were asleep in the middle of the day.

So I couldn’t actually use that for just an estimate of how long I was asleep and because I didn’t trust that, I didn’t trust how much it was saying I had in deep sleep either. I didn’t feel like I could do any of the experiments, like to increase your deep sleep because that’s one of the things that I was interested in doing.

I gave up on those experiments and trying to optimize that. By having these biases, it really limits the kinds of experiments and what you can do. If we’re just trying to get a little bit better, like say with the activity trackers. Its fine, we just want to make sure we’re moving. The Basis Watch I’m sure, loads of others, you can point out would be ok for that.

But if we want to actually go to the next stage and optimize it to another level, to a higher level, a more competitive level and get more out of that performance, whatever that angle is. If it’s sleep or running, it’s not quite there yet.

Or are there devices which you feel are there in certain areas, whether it’s sleep or running or areas where you can really optimize pretty well and move to the next level?

[Troy Angrignon]: There are and it’s interesting and I’ve really been wrestling with this a lot. I’ve looked at and broken everything out there or bought and given it away. I’ve tested pretty much everything I’ve ever written about.

You can definitely get more data. You just gave a great example with the Basis and it’s a bit my favorite whipping horse because it’s got some weirdness in the way they develop product. But essentially they try to give these really advance, what I would call QS level, quantified self-level for type of graphs.

A graph is pretty complex and you would expect a person in a pretty deep understanding of visualization and data analytics in order for them to use it. But yet a whole watch was really aimed at couch to 5k, people who are walking and maybe cycling.

In fact, that’s all it will even track, actually. It will self-identify activities. And then in the sleep arena, as you said it had things like deep sleep, REM sleep, light sleep and activity but everybody I know who has one said, ‘yes, they always tell me I’m sleeping when I’m sitting at the opera,’ which is probably true but that’s not relevant.

I don’t really want it showing that I’m sleeping at the opera. Or I’m watching TV or I’m sitting down to dinner. It was trying to do automatic sleep categorization. We’re running into really tough to build hardware and software that does auto-sensing and auto-identification of activity, whether that’s sleep or running or cycling or anything else.

You tease apart all of these issues, what it really comes down to is, as a vendor these guys have to get together and say, ‘well who really is our user and what level are they at? What use case are they using it for? Are they a triathlete and if they’re a triathlete, are they a one, two, three, four, or five?’

In my view, I know triathletes who don’t use watches. They literally just have a Timex. They don’t care about anything else. They don’t use complex sport watches. I would call them almost a QS-1, a quantified self-level one, but serious competitive triathlete.

You really have to get this intersection of who is the user. How much data do they want? Are we giving them enough data and is it accurate data? There’s this really complex landscape out there, which you and I talked about. This is why people are so confused right now.

[Damien Blenkinsopp]: Your charts are amazing. It’s amazing how many devices are there, already. And there is obviously a lot of money going into this space. What I guess is interesting is if you take the Basis as an example, again and I guess the Apple iWatch which is coming out.

Applications like that are trying to give people at home a very generic tracker, which is going to have a broad spectrum of things it’s tracking. But it sounds like you’re saying that just because the hardware isn’t there yet in terms of actually getting data from us, that the software can’t handle figuring out what we’re up to.

If you’re trying to track everything like are you asleep, are you moving, what are you up to, all of these kinds of things, yet the hardware isn’t accurate enough to be able to take that data and use some software to interpret it.

But if, like you said, we focus on a narrow use case, where the conditions we understand a lot more closely because it’s just one area of use rather than trying to track someone’s whole life. And that’s working and you can see that it’s possible that we can get there this time even though the hardware is not quite there yet. Is that kind of your viewpoint?

[Troy Angrignon]: Yes. I think it’s a reasonable summary, especially when we started with things like 3D accelerometers. They really don’t do much. They just give you rotation and space and G-Force, and that sort of stuff.

It’s pretty hard to extract really clean signal out of that and figure out what the heck is really going on. Is this person running or jogging or doing cycling. That was a big issue. There just wasn’t enough data or the sensors were even terrible and there weren’t enough of them.

Then we started to do things like, a great example I think that I was quite impressed by, is Fitbit Surge, their new heart rate based one. It has GPS for location, it has optical heart rate on the back, so it’s shining right into the skin, in the tissue just above the wrist and reading your heart rate which is pretty challenging to do.

They have the 3D accelerometer and they can use all of that combined so the GPS will be shut down. It will say, you’re not moving or it will actually just be shut off. It will say heart beat is low and there is no motion in the body and it’s late at night.

So it’s starting to get easier and easier for them to identify that you’re going to sleep and to pick that pattern out, or to just show that you’re active. I can see you’re active. Your arm is moving, your body is pumped up and I’ve got a lot of very heavy heart rate, sustain heavy heart rate. You’re probably doing something.

Now they don’t try to self-identify, which I think was the right move. You can mark it and tell it that you’re doing yoga or doing a workout. I think it’s all trending in the right direction.

[Damien Blenkinsopp]: So if you were would like to point out on the landscape right now what manufacturers are doing right and what needs work, in specific areas, where is your pet peeves and where are the areas where it’s doing a really good job?

[Troy Angrignon]: I think my biggest pet peeve across the board is just not understanding your customer. It goes back to what I said a few minutes ago. Know who your customer is. Know how they live and what the use cases are that they are going to put the tool through.

That really helps the vendor narrow down to what features does it have to have, how rugged does it have to be, how much battery life does it have to have. I have not been traditionally a fan of Fitbit. I know they are the 800 lb. gorilla here in North America. I think they had 67% of the market share in 2013 and I’m not sure that’s a ’14 number, but they have a broad spectrum of product.

[Damien Blenkinsopp]: So which devices do you see as being the most effective, the best buys right now, doing a really great job for users?

[Troy Angrignon]: Again, it depends on who you are, but I think there are some ones that are standing out. Moving left to right again and from ones to fives, lower left to upper right if you keep that chart pictured in your head that we talked about earlier.

The folks that want to just get a little more active than they were or they’re lucky to move a little more, track a little more and ones and twos in terms of tracking and they’re not really hard on their toys. Any of the new Fitbits (they’ve launched a whole new line) I think are doing a pretty good job.

They’re number one for a reason. I think what’s going to be interesting in that space is Jawbone. Jawbone I lost and or broke and destroyed a bunch of them and they were very good in Customer Service and kept sending me new ones.

I like their apps. They’ve got a good partner network. They’ve got a new one coming out; the Up 3 and they’re actually integrating some of the technology they bought from Body Media and I know that people who have Body Media’s, you can’t pry them off of their cold dead bodies.

It’s pretty interesting. They are rabidly loyal fans. That was the big one you strap on your arm basically. A lot of people are really attached to that and so they’ve taken some of that technology, like the bio impedance sensors and things and put it into the new Jawbone Up 3. I haven’t tested it but I have a pretty strong belief that they’re going to do a pretty good job at that low end of the activity tracker section. It will be interesting to see and that should be out March or April.

[Damien Blenkinsopp]: With those two devices, what kind of things do you think people could reasonably do? What kind of functionality are people thinking they just want to know they are doing more? How far do you think they can push those devices and get useful decision making out of them, using them to maximize something?

[Troy Angrignon]: You really can’t do a ton. They do basic activity tracking. They basically show you how active are you; you’re active parts of your day. They’ll give you calorie data and it’s totally inaccurate, so I wouldn’t use that. I would use the steps as just an indicator like you and I talked about. Am I doing more or am I doing less? That’s really what you want to look for, just for trend data day to day.

The Fitbit has sleep tracking. The low end of their stuff you still have to push a button or mark it. I think that’s a non-starter. That’s not sustainable because people forget. As you move up into their new ones like their Charge HR, which stands for heart rate and a Surge HR which has a screen and also does heart rate, you’re getting into more into the fitness tracker space.

Now you can track your day to day activities, see trending patterns. You can actually auto-sense your sleep or it will auto-sense your sleep. It’ doesn’t give you very deep sleep data. It just shows you are you restless or are you awake or are you asleep. It’s really three states essentially

If you’re really a nerd like you or I and you want to see deep sleep and light sleep and all that, it really doesn’t do that. Jawbone actually has always done that, although they’ve only done it through the 3D accelerometers. I’ve never really trusted that data.

With the inclusion of the new stuff, the new technology they bought from Body Media, I suspect they’re going to start to be able to pick up because they can sample the heart rate through the night and do things like figure out your morning resting heart rate which is a nice thing to know.

So I think that’s going to be an interesting entry in the higher end of that low end, if that makes sense, the activity trackers. And then as you get into the middle range, I’d say fitness folks who are doing a couple of sports, maybe they dance or running or the odd bit of cycling, but nothing ongoing, then the Fitbit Surge HR.

I sound like a Fitbit rep which is funny because I’ve never been a big fan. But I think they’re doing a good job and you can mark different sports. It’s pretty good actually. The accuracy is even surprisingly high when I cross reference it to some of the higher end tools I use.

Really to me, it’s kind of one of the only successful ones in that middle of the road fitness tracker space; Garmin is releasing something called a Vivoactive which will be squarely in that spot. It’s for running and cycling and swimming but this is a key point- not for triathlon because that’s a whole other use case where you need to connect those sports together in a block, like a swim and a transition and a bike and a transition and a run.

That’s a multi-sport thing which really you find at the high end. So I would say in the fitness tracker stuff in the middle, you’re looking at the Fitbit Surge HR, maybe the Garmin Vivoactive. I have not tested it. I’ve seen it and I’ve used it and I find the touch screen a bit finicky.

Maybe the Garmin FR620, which is their running watch, is pretty nice in that space; clear, bright screen, auto-upload on WI-FI and Bluetooth. So literally you do your run and then that’s it. It just synchronizes and it sends the data up which I think for these things to be sustainable, all of this stuff has to happen automatically.

You and I talked a lot about that. It’s like how much overhead can we take away. We shouldn’t be saying to the user, ‘you need to mark sleep, you need to do this, you need to do that.’ We’ve got enough on our plates. They don’t want to adopt a baby. It’s not a Tamagotchi watch.

I think that the watch can do, the better. And then at the high end, definitely these days I would really lean to the Garmin lineup. They release three new ones at CES, the Consumer Electronic Show, which I was quite impressed with because I think they’ve done a very good job of understanding the use case.

They’ve got a 920XT for the triathletes and multi-sport folks, a Phoenix which is that plus the backcountry stuff and then their Epix, which is all of that plus a great big screen with high-resolution color and apps on it.

I think the Fenix and the 920 are the winners out there because they’ve got the same thing; auto-upload on WI-FI and Bluetooth. And to me the big deal is data. Is it automatic, is it easy to use, is it automatic, does the data go somewhere and can you get the data to other places. Does that make sense?

[Damien Blenkinsopp]: Yes, absolutely. There are different platforms, like the Basis is a closed one, or not?

[Troy Angrignon]: It’s an island and so is Suunto. They’re off in space, Timex is the same thing. And anybody who’s an island, it doesn’t make any sense anymore because people have something like, I’m making this number up, but crazy numbers of 20 or 30 fitness apps on their phone and they want all that stuff to connect.

[Damien Blenkinsopp]: And it’s also a trust factor I think. Because with the Basis you can’t extract the information so where do these numbers come from. So I think there’s also that angle when you’re talking about people who are getting more involved in it.

They can’t take the data off of it. They’re wondering what the data is inside of it and how it’s calculated and things like that. I know that’s been a big frustration with Basis users. Another interesting model is the Muse, like the Muse Calm, they had that EEG device where basically you have an open API and they’re bringing this hardware to market and anyone can connect to it, develop aps on it, although no one seems to be doing that yet, so I’m wondering how that’s going to go.

[Troy Angrignon]: I talked to Muse and have not used the Muse. The Emotive is another one. And any of these EEG things essentially they are saying it’s something you put on your head. It’s this thing that looks like it’s from the future. It has all these touch points on your skull and it picks up your brain waves or brain wave patterns.

I think the big question I always have is, to do what. What’s the application and so I understand you have the hardware and I understand you have some kind of open API application programming interface, some way for me to get the data out, but ultimately what am I doing with it.

I tested another one. I picked up one from Dave Asprey’s Bullet Proof site which was a brain trainer, focus trainer which is ostensibly teaches you to move more blood flow in the pre-frontal cortex. I have it and I could actually do it. It’s actually pretty cool because you can put this little film on and you can fly over the mountains and you can actually control it with your brain, which is really cool for about ten minutes.

[Damien Blenkinsopp]: But it was, I was at this bullet proof live conference so I did it there and it’s a lot of fun but it’s a nice fast game. It’s not integrating with your life I guess. It’s something like meditation that you have to take time out for.

[Troy Angrignon]: which I’m a huge fan of. I think meditation, I do it every if not every day, every second day. I know a lot of people, especially athletes who are really, really find that critical piece of their training. But I don’t think that these tools are necessarily getting you there.

I think they’re kind of early attempts to say, ‘look at the pattern in your brain’ and you’re like, ‘great, what do I do with it’. I don’t know what to do with that information.

[Damien Blenkinsopp]: My personal experience from the Muse so far, I’m meditating every day and I’m using that. I’m playing around with different things and different types of meditation, for instance.

Dan [unclear 0:32:45:5] and so on, and I have managed to shift it. Basically you have an index . You don’t exactly know what that is so that’s a bit worrying to me because it’s their index that they’ve given you.

[Troy Angrignon]: Again, it’s another made up number

[Damien Blenkinsopp]: Rather than some standard that you can rely on more easily. So I think that’s another concern I have about a lot of these devices. Some of the manufacturers come up with an index which is 1 to 100.

It’s not based on any standard and you’re left wondering, I hope it’s doing what I want to because otherwise I’m spending of time meditating and hoping that I’m getting better but I might actually be getting worse.

I definitely want to dig more into what that data means and how it’s calculated. Now I’ve spent enough time on ‘I have to get around to looking at this’. So I think people have that concern at this stage too. And it’s kind of this transparency thing again. If you can just pull the data off and you can see exactly what it is then it would give you that comfort factor.

[Troy Angrignon]: Well, let’s step through that though, back to the beginning of the conversation. A level one person, in this case a quantified self, level one person, they only want that number because they don’t really know and don’t want to know the complexity underneath the numbers.

So I understand why the manufacturers do that, to look at the slave tools. They’ll give you a score. Your sleep score was 85%. Now Jawbone’s sleep score is not the same as Sleep Rates sleep score, or Sleepio’s sleep score. Those are all different sleep scores. And they have different algorithms underneath.

Some are transparent, some are not. But ultimately the user just wants to know, ‘hey it was 85 yesterday, its 90 today’. I’m trending up and that’s a good thing. And they’re good, that’s fine as long as that’s all they want then they’re already ok.

But I think you and I, we’re not ones. You’re definitely not a one. You’re a five.

[Damien Blenkinsopp]: Hey, you’re a five too.

[Troy Angrignon]: I’m a five, you’re a five.

[Damien Blenkinsopp]: Don’t stop for any fives around.

[Troy Angrignon]: So, we’re not that user and I think we need to be cognizant that a one doesn’t want the level of data that you and I want. And that’s ok because they’re just in a different place. And it doesn’t mean also that we’re a badass athlete and they’re not.

You can find world class athletes who are ones. Who are like just give me my Timex watch, I don’t want to know anything else. So I think that those are two separate dimensions. So to get to your point, yes, a lot of people are doing these roll up scores.
In my mind that’s a thing you deliver to the users who are ones and then if you’re delivering product to be also available to the twos, the quantified self, level twos, then you say, ‘hey, here’s your sleep score. It’s 85%.’ Underneath that means is, you were in bed eight hours but only six and a half of that you were sleeping and an hour and a half of that you were tossing and turning.

That’s kind of a level two analysis. And a level three analysis would be; well actually you had deep sleep, light sleep, here are the different phases. Here’s how many times you were interrupted and maybe here’s a recording of you snoring. Sleep rate does that, which is a little bit creepy.

And a level four would be that plus all of that is trusted, absolutely, clinically verified. And then a five would be the raw sensitive data. Put me in a lab and hook me up to 50 machines, which I’m sure you do.

[Damien Blenkinsopp]: I’m tempted. I haven’t done it as much as I’ve wanted to yet. I bet you’ve been doing it for a long time.

[Troy Angrignon]: No, I do actually show up to something with three or four devices on me. I was at a heart zone training session in this last week and I showed up with all of these devices on my arms and everyone was like, ‘why do you have so many watches’.

[Damien]: Because I don’t trust anyone of these.

[Troy Angrignon]: I’m cross referencing them all.

[Damien Blenkinsopp]: Which one do I trust today. Just out of interest, you were talking about labs, you’ve done VO2 Max or any of these kinds of measures. I know you can go to fitness labs and do those kinds of things.

[Troy Angrignon]: No surprise. I love to do more of that lab type testing. In fact, I’m actually doing one this week with a start-up that’s in stealth mode around heart zone training and threshold analysis. I would love to do more of that.

Most of mine has been with these consumer grade tools. Really just looking to see which one is the most accurate of the bunch because I am not at the level with my own training and with my own coaches where I need to be within, for heart rate threshold analysis, I don’t need to be within one beat. It’s not material useful for my training.

[Damien Blenkinsopp]: For most of my stuff I’m there. I’d say like the most critical thing I have is sleep. And I’d really love to know exactly how many hours I’m sleeping. And it’s more, for me its accountability. It’s just like if I get a little alarm and it’s like you only slept five hours the last few days, then I’m going to act on it. That’s the big thing and that will change my life, just that little thing there.

[Troy Angrignon]: I think it would change everybody’s life. I fell into this rabbit hole. You and I both came to this from having health issues. I was having sleep issues. That was my big thing at the time. I’m sure a lot of your listeners know your back story.

So I came into it from the sleep angle of going, ‘man, I’m not sleeping,’ and I’d like to prove that. I learned a lot from the bio hacking community and the bullet proof executive and Ben Greenfield and all of these guys.

And I was like, ‘ok, I need to make the room black and I need to go to bed early and turn off my screens at night’. All the stuff that we now know is good sleep discipline. There is another word.

[Damien Blenkinsopp]: Sleep discipline is a good word because all of things take a little bit of effort to do them, that’s all. Once you’ve got a routine and you’re doing them, then it’s great.

[Troy Angrignon]: Right, and so coming into it I think that everybody kind of vectors in on these things like what is your one thing that you’re working on. Actually, that’s a good thing to talk about here which is, what is your one thing? What’s the one thing you want to change the most?

Do you want to increase your time or do a race and just finish or do a race and be top ten? Or just sleep better? And that helps you pick the universe of possibilities of things you might use as a tracker, maybe you just pick the one thing that will help you get to that step and don’t try and boil the ocean.

[Damien Blenkinsopp]: So you’re saying don’t just try to attempt to track everything? When I got the Basis I wanted to have it all. I’m not picking on Basis here, it’s just that when I happened to jump on to it a couple of years back so I had the most experience of it. And it didn’t do that and the Jawbone or the Fitbit didn’t do it at the time. So what you’re saying is decide that one thing and that’s going to decide what device you get and you’re going to get that value out of it, if that’s the most important thing to you, whatever you want to change.

[Troy Angrignon]: Right. And I think that that’s a really good object lesson for all of us. I’ve been through all of these things so I ultimately I always come back and think about it. Now that I’ve tested it and I can talk to other people about it, that’s fine. But for me, what am I working on next and therefore what is the right tool for me, today or this week?

[Damien Blenkinsopp]: Well cool, let’s talk about some quick case scenarios then and the market and where it is today. What would you do? Let’s start with sleeping. If we’re just trying to improve our sleep or get some accountability behind it, which device would you choose right now, and you think it would do the job? Would you think it would do the job?

[Troy Angrignon]: Yes. So I wouldn’t even get a device. Actually I would just listen to Ben Greenfield’s podcast that he did, a long presentation, a bunch of Q&A that he did at Sealfit Unbeatable Mind, I think you and I talked about Sealfit. He was down there for a conference. He’s published the podcast and it’s an excellent podcast. I highly recommend it.

[Damien Blenkinsopp]: Cool, is this on sleep or is it Q&A?

[Troy Angrignon]: Well inside there he has this whole how to bio hack your whole life. He goes through 4000 things you can do and so many at the end rightfully said. ‘Look dude, my brain exploded. Where do I start?’ And he came to the same thing. He was like, ‘pick one thing. Pick one area that you would like to improve, one metric in that area and look for the right tool.’

To go back to your question, the right first device to fix your sleep is not a device. It’s reading up on the basics of sleep, understanding what good sleep discipline is, doing things like blacking out your room. Maybe the first device is a big hairy blanket you hang from your window. That’s probably the best device. The cheapest thing that you can buy that’s going to have the biggest impact.

[Damien Blenkinsopp]: You’re laughing about that but that’s exactly how I started. I just got a big furry blanket and I’m guessing you did too. I had come to visit my parents and I all of a sudden read this stuff. This is years ago and I grabbed a blanket and put it up and they were like, ‘what the hell are you doing?’ And they really didn’t like it because it’s just not done, I guess.

[Troy Angrignon]: Somewhere I read was like, ‘tinfoil doesn’t pass any light through’, so I completely tin foiled my window and the very next day the building manager came up and said, ‘you need to take that down, you look like a crazy person.’

[Damien Blenkinsopp]: Some of these things, if you go this route, is a pain to take down. Otherwise you just leave it up. You’re like, ‘well I’m not in that room during the day anyway.’ But other people aren’t so [unclear 0:41:56:3]

[Troy Angrignon]: Exactly. I think there’s a lot of work and we don’t need to go down that. This is more about devices. There are a lot of things you can do. I would say black out the room, put things like ‘F LUX F. LUX’ on your computer at night. It dims the screen. There’s a lot of stuff about not having blue light at night. This is all well documented at Ben Greenfield or Dave Aspreys Bulletproof podcast.

[Damien Blenkinsopp]: Well the one thing I have done, because I didn’t trust the Basis data, was I have this little tiny app which tracks all manor of things. It’s just like a little tracker app. It’s called Lumen Trails. There are probably plenty of others like that, but for some reason three years ago when I started tracking a lot of stuff, that was the one out there.

And it just allows you to put data in and it just allows me to press a button which says I’m going to sleep and then when I wake up, press it again and now I’m awake and then I know how long I slept. That’s really the most reliable measure I had and I’ve got huge chunks of data like months where I was doing that.

And I found that useful although it’s not automatic, it’s a pain. But at least it gave me some kind of register. Because I found out I really don’t know sometimes what time I, especially if was tired if I went to sleep, I won’t really remember at what time I went to sleep and what time I’m waking up unless I’ve actually gotten it written down somewhere.

[Troy Angrignon]: And I think you just nailed it. You’re a very quantified guy and it was still a pain and we need to get away from that stuff. This whole thing of you have to click a button, it doesn’t matter how small that motion is, we have too much going on to make the users do that.

I’m coming back to being a PR dude for Fitbit here, but I think the Charge HR does this as well but I know that the Fitbit Surge HR does this. It just automatically figures it out and unlike Basis, which would say I slept five blocks of 30 minutes, which is just insane.

The Fitbit Surge actually does a really good job of saying, you went to bed now and you got up then and it was eight hours and you were actually asleep for six and a half. It doesn’t give you any depth below that, so it’s kind of a quantified self, level two answer.

Eight hours with six and a half with real sleep inside there and there are no phases or anything else, but it’s automatic. I don’t have to think about it. I’m quite willing to make that trade off because I could get more data but then I would have to think about it and I don’t want to think about it. I have enough tools in my life.

[Damien Blenkinsopp]: And for 99% of people, that data is going to be actionable. That’s going to tell them what they need to know.

[Troy Angrignon]: Absolutely. Because you can look at it and see, ‘oh well, gee, I got four hours, four hours, four hours, four hours. And it actually displays your actual sleep time. So it’s been showing me things like three and a half hours. I’ll be in bed for five or six and it will say three and a half. What do you mean three and a half?!

It’s showing the actual time that I’m not moving and I’m really dead to the world. I have to laugh about that. I think finding a basic device like that is good, but something that’s automatic I think is also helpful.

If you have real sleep issues, sleep is a really critical issue and we are all as a population lacking in good quality sleep, I think this is worth investing time and energy and focus on, because it improves everything. There’s hormonal issues and weight loss and moods, just a million things. In my book it’s foundational so I think it’s the place everybody should start.

[Damien Blenkinsopp]: Sleep and meditation I think, are the two things that I want to get done every day. We are always thinking about these huge lists of task, but I’ve really tried to start putting these two things at the top. So if I don’t do anything else at least I’ve slept and I did my meditation.

[Troy Angrignon]: Yes, if more people would prioritize that. Down at Sealfit Unbeatable Mind there’s a really great fellow there, Dr. Kirk Parsley. He is a Sleep Clinician for Navy Seals and he said, ‘my biggest challenge is, a) they don’t sleep that much because they’re training all the time and b) I have a hard time in getting their heads around the fact that sleep is fundamental and foundational to everything they do. And that lesson is not just for them. That’s for all of us.

[Damien Blenkinsopp]: So you fixed your sleep. What did you find that the main things were that you’re doing and that worked for you just since that’s something that you worked on a lot?

[Troy Angrignon]: The big things were I had to make changes at work. I had a very great team that I was working with at the time and I said, ‘look these are all the things going on and we need to shift some stuff.’ There were work changes, darkening the room, putting timers on my phone that would alert me to say it’s 9 o’clock and start winding down.

One of the big things that I did, which has made a huge material difference, is as soon the Phillips Hue light
ing came out where you could change all the bulbs and control them from your phone. I put timers on them. Back to the whole ‘don’t have blue light at night thing’, I put timers on them and I basically set the entire house and the whole thing dims from normal lightening and deep submarine red lightening.

It feels like I’m in the Hunt for Red October movie. Feels like I’m in a submarine. But the whole house dims to basically 10% deep red by 9 o’clock. So really it’s fantastic and it sends this signal.

[Damien Blenkinsopp]: I bought some Amazon lights and I was doing that myself at one point but depending on my location it hasn’t been convenient. But have it set up at your homeand automatic, that’s really amazing. If it’s done automatically it’s going to happen.

[Troy Angrignon]: For a while I was doing it manually. I would turn certain lights off or I would do various things. Again, back to the overhead, I don’t want to think about this. I have enough going on in my life. We all do.

[Damien Blenkinsopp]: Well right because you say you were re-organizing your work. I would just be interested to know, you’re basically talking about stress loads here. For me I’ve been subscribing to the fact that if you have too many things in your head, we’re talking about adding things in terms of I’ve got to track this, I’ve got to track that.

That’s not going to be an easy way forward for us because it’s just too much. We already have too many items based in our heads. I don’t know if you did this for your work, but for my work I’ve been hiring a lot more people and systematizing a lot of stuff and basically knocking things off my table.

So just, even if I’m still working the 40, 50, 60 hours, at least I’m only working on four things. And I find that helps tremendously with sleep and just general stress levels. I don’t know if you’ve seen something similar.

[Troy Angrignon]: It does. I think you’ve nailed it and I think that this is all very self-reinforcing and everything is connected to everything. So your sleep supports your work and your work impacts your sleep. And this we could talk for days on this subject. So I think there are basic things that I did.

[Damien Blenkinsopp]: So it’s hard to actually see the quantitative impact in your sleep I guess. I don’t know if you were able to see that. Well you just feel better. You were able to see more hours slept or were there anything that you were able to see that and changed?

[Troy Angrignon]: No, absolutely. I went from two hours to near panic attack sleep to eight, nine hours of solid sleep and it took probably a year to make that change.

[Damien Blenkinsopp]: That’s something I didn’t have as serious as you. I was waking up at 4 o’clock in the morning and I there was nothing I could do about it. I would go to bed at 12 and I would wake up at 4 every day. I’d start working in the dark.

Luckily, I lived in Mexico at the time so I was looking out at the light, the sunrise on the beach and it was amazing. But my girlfriend wasn’t a huge fan of me waking her up at 4 o’clock in the morning when I left. So for me gradually the hours increased.

I think this is kind of funny; I was tracking it for a long time then I stopped tracking and I knew it was fixed because I wasn’t concerned about it anymore because now I’m sleeping seven or eight or nine hours consistently and it doesn’t feel like a problem for me anymore and so I haven’t tracked it for maybe six months.

[Troy Angrignon]: And that’s a really good point. You had an issue amongst all the other issues that you were working on and then when you got to a point where this isn’t really a problem anymore. I don’t need the extra overhead and headache of waking up, finding my phone, clicking this button, doing these things, tracking these numbers. You don’t care at that point. You’re not working on it anymore.

And that’s why it’s kind of like peeling the onion. Pick the one biggest thing, the one biggest boulder and pick one thing that you can do about it and start there.
[Damien Blenkinsopp]: And it’s not necessarily going to be the same thing that you’re going to be doing for the next year. Maybe you’ll work on it for three months, you’ll fix it and then you will say, what’s next. Hopefully you don’t have to buy a new device, depending on your budget.

Let’s talk quickly about budget, actually. I’m guessing the Garmin’s are some of the more expensive ones. I haven’t looked at the prices myself, but what do you think of the pricing at the moment? For the things I’m buying it’s relatively accessible, I think. They’re around $100 or $150, tops.

[Troy Angrignon]: There’s such a huge range. Before we jump to there, I’ll come right back. But before we leave the sleep subject, just so we can wrap up on the devices. There are a lot of devices ultimately after you get through figuring out what you want to do and fix, there are a bunch of devices as you know that will help you track sleep.

It could be as simple as a sleep cycle on your phone. I’m not a fan of that unless you put your phone on the Airplane Mode because you’ve got this EMF blasting a hundred meters of Wi-Fi right beside you.

[Damien Blenkinsopp]: Did you trust the data on that, because I used it for a little bit.

[Troy Angrignon]: No I didn’t really think the data was any good because it’s too hard to pick it up from the accelerometer on the phone and it’s sitting there beside you. It seems like a bit of a dorky way to do it. But again, if it’s better than it was yesterday, it’s consistently probably inaccurate, back to our beginning conversation.

[Damien Blenkinsopp]: I think that app is a couple of dollars, or is it free?

[Troy Angrignon]: Exactly, it’s a cheap way to get your toes in the water. And then going up a step from there, you could look at some of these low end, Fitbit or equivalent things that kind of clip on. Withings had one which was really dorky.

You’d have to find the sleeve and stick this thing in the sleeve and put the sleeve on and the sleeve would fall off. It was ridiculous. It was unsustainable. So I think anything that’s just really easy that you can put on and hopefully have to push one button and hopefully you don’t even have to push that button in the morning.

That’s a better case. The best case is you’re always wearing it and it just automatically knows you’ve gone to bed and it automatically knows you’ve gotten up. So, if and when you go to check the data, the data is already there and you didn’t think about it.

[Damien Blenkinsopp]: So after you looked at the Beddit and there’s a Phillips one as well. Or they’ve basically have got things placed on the mattress?

[Troy Angrignon]: The Beddit comes in multiple versions. The Beddit V1 came in two versions- consumer and pro, it was Bluetooth legacy, so it was a huge headache. So the process, very briefly was, go find your phone, turn on the phone, open it up, open the app, connect to the sensor, sit there and wait for it to connect to the sensor. Eventually it would connect and you would select the sensor.

Then you would open the app and you would go through these questions. I wanted to throw my phone out the window I was so stressed trying to go to bed every night. And I hated it and everybody I know who used it, stopped using it.

And Dave Asprey was always saying, ‘oh, I love my Beddit.’ And I couldn’t figure out why so I went and talked to Lasse Holstrum who is the founder and he said, ‘oh he’s got the pro version.’ Apparently they went to Bluetooth, BLE, Bluetooth Low Energy and cleaned that all up so it automatically connects to the sensor. So literally all you do is open the app, it auto-connects and you just say, ‘hey, I’m going to bed.’

[Damien Blenkinsopp]: So just to clarify, is that Bluetooth running all night?

[Troy Angrignon]: It is and that’s Bluetooth Low Energy and the transmitters are hanging off the edge of your bed, but there’s a great podcast that Ben Greenfield did about this one as well recently too. These things are not labeled or marked and for folks that really EMF wary, which I’m becoming more so these days, I’m not a huge fan of that frankly.

I haven’t used the Version 2, which is the one they did in partnership with Misfit. What I heard from the founder they were doing the right things for V2. Ultimately I tossed it in the box and got rid of it. I’ve tried the S-Plus by ResMed, which bought some of the IP from CO and it’s actually downstream from Phillips. I think it’s tied into Phillips Corp.

It’s this contact list that sits there at the edge of your bed and bounces these 10 G HZ signals off of your body and it uses echo location to try and figure out your chest respirations from your chest. I didn’t trust that data at all. They say the gut research data that says it’ as good as a 3D accelerometer, which is not saying much.

[Damien Blenkinsopp]: But what you said about it bouncing waves, so it’s bouncing waves of you all night?

[Troy Angrignon]: Yes. It’s basically just sitting there blasting EMF at you all night long, which seems like a bad idea.

[Damien Blenkinsopp]: That seems like a really bad [idea] especially for sleep. If you want to have good sleep, I’m not sure that’s the best idea.

[Troy Angrignon]: In my building I have 20 visible Wi-Fi access blasting out full-bore 100 meter, 2.4 G so I’m swamped in here anyway. So I wasn’t keen on it, sent that one back and then Withings go so slammed by people who hated their product that their CEO actually apologized for how terrible the product was so I don’t think there’s much there.

Then InFIT is one I saw at CES and it looks interesting. It’s a very heavy strip which sits underneath, not on top of top mattress but in between the top and the second mattress. It scans you through the bed. Again it’s doing some kind of signal through the bed.

This is a problem. Everything swarm you in EMF and pulls this data and broadcast from you and I think we’re going to be paying the price on that one at some point, but I’m not sure.

[Damien Blenkinsopp]: There don’t seem to be many manufacturers who are concerned about that though.

[Troy Angrignon]: They’re too busy in the hay day of wearables.

[Damien Blenkinsopp]: I guess we’re ahead of the curve thinking about EMF. Most people aren’t concerned about EMF. Most people you talk to don’t even realize there’s a problem. Although there’s some books which I appreciate like 4-Hour Body by Tim Ferriss.

He talks about the phone waves and keeping them away from your balls. But it’s little things like that. Ever since I read that, that’s a rule I’ve had. I’ve had my phones switched off for most of the time. We don’t know where it’s going.

That’s why there are all these devices out there and a lot of them have these and it’s the one thing that makes me resistant to play with all of the devices.

[Troy Angrignon]: Yes, because it’s an overload.

[Damien Blenkinsopp]: Yes. Maybe in ten years this is going to be something that I wish I hadn’t pursued so intensely.
[Troy Angrignon]: When you’re growing a third arm out of your forehead and you say how did that happen? I think to wrap this thing up on devices; there are a few different things that I would say, easy, lightweight, relatively inexpensive.

I would look at the Fitbits. It’s not deep data but its ok. I would look at the Jawbone Up24 or the Jawbone Up3, which is the new one coming out in month or two. And I think that those are reasonably good. I think the Jawbone actually does now and will have better sleep tracking with more data in it, if you’re more nerdy. That could be an interesting one.

That’s for now. Then actually I think the coolest thing I’ve seen in the sleep space and I’m actually using their program right now is a little thing called Sleepio., which is a sleep coaching tool. Sleepio.com and they’re in the UK.

And I can’t believe how well-done it is. Essentially you’ll get this little animated, British professor who walks you through the complexities of sleep and what your specific issues are. They’ve got incredibly deep, rich branching logic in behind this thing.

If you say my biggest goal is this and my biggest fear is that and my biggest issue is whatever, then that builds the curriculum from there and every week it pulls in your Fitbit or your Jawbone data and then it reviews it with you and says here’s what we learned. Here’s what we were working on. Here’s what you’re going to work on next week.

It walks you through it and ask you, ‘I will make a commitment to you that I will only give you advice based on these 30 years of scientific research and you need to commit that you will do your best to stick to this program because change is hard and changing sleep habits is hard.’ I thought that was a really interesting addition so it’s not a wearable device but it works with wearable devices.

[Damien Blenkinsopp]: That’s more intelligence side and definitely we need to see more of that. What do you think is going to happen over the next five or ten years because that seems like one of the endpoints where you have near artificial intelligence walking you through step by step and fixing your problems for you?

[Troy Angrignon]: I think that’s an early indicator of the direction that we’re going. The stuff that you and I have had to go through just to figure out a) figure out what we were asking and b) how to collect the data c) how to make sense of it or rationalize it or normalize it.

That was really hard for us because we started so early and d) what does it mean? When you look at it on charts and graphs, ‘well am I learning anything or not.’ How many thousands of hours have you spent looking at graphs thinking ‘I have no idea what that is.’

[Damien Blenkinsopp]: I have. You can Google a presentation of me showing people. It’s ridiculous.

[Troy Angrignon]: I actually had people call me on that. ‘That’s a pretty graph, what does it mean?’ It’s been a lot of work for us to figure that out and yet ultimately I have gotten to a point where I’ve been able to say, ‘I know what data means. I know what this is telling me. I know what these trends and patterns are. I can compare this to my goals and I can see I’m either moving towards or away from my goals.

That was a lot of work. That’s why I was so impressed with Sleepio, that they would come right out up front and say, ‘You’re not alone. A lot of people have these sleep problems. It’s also hard so get ready to dig in and do the work and we’re going to walk you through it.

It’s not artificial intelligence but it’s really well-done branching logic.

[Damien Blenkinsopp]: It’s pretty amazing it’s done that. As you said a lot of their hacks, hacks to fix sleep, hacks to improve different things. They’re just kind of still appearing and we’re just getting to the grips of the science and a lot of things.

This is why we have this show. We can focus on data or the data behind things so that we are acting and making decisions that are good versus we don’t know. It’s just opinion. We see a lot of opinion out there when it comes to fitness, health and all of these areas.

I think that’s part of the challenge with that. Before we can get there we need to accumulate a lot of data and people really need to know for sure that when you do this it equals this. But it sounds like they’ve got a really good job. Do you know where they got the actions, basically the things that they’re recommending from?

[Troy Angrignon]: No. I was going to dig into it and I thought actually that I would try a week or two and just walk through their process to see how that’s handled and I’m so impressed that now at this point I have to go back and dig into what their evidence is. What’s their ‘peer reviewing’ research.

[Damien Blenkinsopp]: Excellent. While I’m in London I might reach out to them Thanks for bringing it up.

[Troy Angrignon]: Actually I would definitely do it. They would be worth having on the show I think. And I think to answer your question, ‘where do we go?’ I had this really interesting conversation with a friend of mine, a colleague from my old industry which is Business Intelligence as well as some military intelligence analyst.

I said it seems like we’ve already seen this movie. We already know how to get from data to actionable intelligence, to smart guidance. To say given you’re trying to do ‘x’ the data says you should do ‘y’. And we already know what that data supply chain looks like.

Like how you get the data, clean the data, analyze the data, run it through some kind of mental model or framework and then that outputs this answer which says you should do ‘x’. Then you do ‘x’ and you run through the whole process again. And you say did that work or not. Where we are, we are just really immature.

We’re way back at step one where we’re collecting a huge pile of data and we’re providing some pretty charts and graphs. They’re not that useful and we’re providing a chart or graph, or five charts or graphs for one sensor.

What you really want is this nice, blended, normalized view of all of your data on one time base where you can just look at it and see, almost like those old biorhythm charts, if you remember those things. It’s like your mood is doing this and your sleep is doing that and you’re food intake is doing something else and your workload from your training is doing something else.

You can see the patterns and do eyeball correlation, like when I sleep really short my productivity really sucks the next day or my mood sucks the next day. We’re early in that process I think so we’re going to go through maturation.

I’m giving a talk on this IOT World, I think here in San Francisco soon. What I’m hoping is we can take those lessons from the other industries and instead of taking 30 years to get to the point where we can take data and turn it into actionable intelligence, maybe we can compress that to ten. I don’t know.

[Damien Blenkinsopp]: You’re absolutely right. It’s already being done so well. When I think about my corporate training, it was all analytics was being the big thing for a while. When I was in management consulting and strategy consulting, a big thing with that when you’re trying to roll it out was the KPI, the Key Performance Indicator.

It is one number which you’re trying to bundle a whole bunch of stuff into and then you had to balance the scorecards. You might have heard of those. Those are another nice way to look at data and make it more useful. So you’re right. It’s just about playing with all of these models that we already have. So much work and literally a decade has been spent on those things.

[Troy Angrignon]: I think we know that stuff. We just need to bring it across and import it from those other industries and hopefully we can do that and not take the same 30 years.

[Damien Blenkinsopp]: At some point. Where should someone look to learn more because you’ve got all of these great charts on your blog? So if someone wants to see the map of the whole wearables devices in 2015, those charts are awesome. Where do they go to get those?

[Troy Angrignon]: I don’t have a short URL for that. I’ll just give you the website and I’ll spell it out for everybody since it is a French complicated name. But its www.troyangrignon.com, that’s my full name, Troy Angrignon. There’s a Wearable section, Health and Fitness section, Market Map section and they are just different views into all of the different blog posts. I would say that’s probably the best place to go. Everything I write and all of my speaking that I do is always posted there as well.

[Damien Blenkinsopp]: We’ll put direct links to all of the charts and stuff and show notes as well as well so the people can find it.

[Troy Angrignon]: Oh yeah, that’s fine too, very good. That’s a great idea. Perfect.

[Damien Blenkinsopp]: I thought it was a French name.

[Troy Angrignon]: I can only swear in French.

[Damien Blenkinsopp]: Do you speak any French? So, besides yourself, are there other people you look to and you learn from in this whole wearable tech area, which are on top of it?

[Troy Angrignon]: Ray at DC Rainmaker. Anybody who has ever done any sports and used any sport device owes Ray a huge debt of gratitude. He has a site called dcrainmaker.com. You looked at my charts and we were laughing.

I said I felt like Russell Crow from Beautiful Minds sitting there in my garage connecting things with strings because everyone looks at this and asks is that in your brain? He’s even more extreme. He will do these reviews that are longer and better than any other review on the planet, but he will preface it by saying, ‘This is just a brief look. I will do my full review later.’

It just makes me laugh. And his real reviews are 30 pages deep of every screen and unboxing and it’s just insanely deep. So I have learned a ton from Ray. I owe him a huge debt of gratitude for getting me up to speed over the last couple of years. I would say he is the leader.

He knows so much about the industry. He gives great presentations at the ANT+ forum each year. You can often Google those and find those presentations. I get a kick out of them because he always starts with his first slide, ‘Why should you listen to me?’

And it says my site is now responsible for $900 million of purchasing decisions and he is not making it up. This isn’t even his day job. This is his side thing he does for fun. I would definitely point at him. The bio hacking stuff, you and I are already pretty big fans of folks like Ben Greenfield or Dave Asprey, lots of folks in there and their camp. Those are probably the biggest ones that I can think of.

[Damien Blenkinsopp]: Great. Thanks very much. Now for you; what are you focused on in terms of data metrics for your own life along routine basis? Maybe you’re doing a lot of projects at the moment but are there other things that you track on a routine basis and pay attention to?

[Troy Angrignon]: Aside from wearing four devices all of the time and cross referencing them, so the data I’m looking for is how good is the data. That’s a different thing. Personally, the things I track day to day are my sleep so I can go visit my little British Sleep Prof over at Sleepio and he can berate me for how little sleep I’m getting and my daily workouts. I throw a heart rate strap on and I put my Garmin 920xt on, which I love. I go do my workouts. I come back in and save it and it uploads and all of that stuff goes into Garmin.

[Damien Blenkinsopp]: Which actual markers do you look at? Do you scan them all or are there ones you pay attention to more? Do you look at HRV for instance?

[Troy Angrignon]: Yes. HRV, Heart rate variability, which we’re not going to go into here obviously, but it’s an indicator of how over-trained you are. I think my biggest ones are really sleep, activity level through my workouts and recovery level. The HRV and I use something called Rest Wise at Restwise.com.

I use Rest Wise, HRV, morning heart rate, muscle soreness and just my own intuition to assess how I am feeling. Am I over training? Do I need to back off or not? To me this has been a really big issue, which is ‘we can see the trees, we can’t see the forest’. Ultimately at the end of the day, I want to train as hard as I can; going up the curve towards some events I have planned.

But I also don’t want to over train and then incur risk of injury. I think we talked a lot about that in our one to one call. I think for me its sleep, recovery, nutrition, training load and stress load, which is an ambient awareness of it.

[Damien Blenkinsopp]: I guess with the sleep is what we were talking about. You just keep an eye on it and the number of hours you’ve slept.

[Troy Angrignon]: That’s a really interesting thing. I used to be very focused on deep and life and one of the pieces of education I got from Sleepio, is they’ve said, ‘we done this 30 years. We’ve realized that the phases inside don’t matter, which was a bit of a surprise to me, frankly.

What really matters is of the ‘x’ hours you spend in bed, what percentage of that time were you asleep. The phases inside that really aren’t material.’ Now I think that that’s a different case if you’re self-medicating yourself to sleep and you’re not getting the phases.

I’m just using Fitbit and Sleepio. It’s giving me a record and it’s giving me an efficiency score and that efficiency score is pretty low. It’s 65%. So I am spending 30-35% of my sleep rolling around.

[Damien Blenkinsopp]: I don’t remember my numbers. With the Basis mine were lower but I don’t know about these devices. That might be average for that device, right?

[Troy Angrignon]: It’s definitely nice having both the accelerometer and the heart rate in there to cross reference that data to get the slightly more accurate sleep analysis.

[Damien Blenkinsopp]: Thank you so much for your time today, Troy. Final Question; what would be your number one recommendation to someone who is trying to use some form of data to make their lives better, basically decisions on their body’s health performance and longevity?

[Troy Angrignon]: I think the number one is really just to know what you’re trying to do first. We talked about it in this call. What is the one thing that would make a real difference to you and what is the one goal you have set there? Is it your sleep or it doesn’t matter? Pick one.

Pick that one thing and do one thing in that arena and track one thing that’s material. That makes a difference. For sleep you want to just track number of hours and percent of time you’re in bed actually asleep. That’s huge. Have a goal and then track something that’s material that makes sense in relation to that goal.

I’ve seen too many people tracking way too much data that’s not material and that’s not useful and doesn’t lead to change. I had a conversation with somebody who literally tracked every meal for three years but didn’t lose a pound.

And they changed their diet and suddenly started shedding the weight because they got more information. For three weeks of not making a change, it should’ve been what I am doing isn’t working. I guess maybe that’s the second fall on point to make. Use the number and test the metric. If it’s not showing up try something new.

[Damien Blenkinsopp]: Absolutely. Keep it simple.

[Troy Angrignon]: And if the change you’re looking for is not happening, you’re probably not changing.

[Damien Blenkinsopp]: You have to give it a little bit of time, a week, two weeks, depending on what that is. And adjust for sure. Well Troy, thank you so much for your time. This has been a great discussion. We’ve pretty much looked at the whole landscape today. Thank you so much for your time.

[Troy Angrignon]: Damien, it’s been great.

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According to a 2015 consumer wearables report, 1 in 10 Americans has a fitness tracker. Yet there have been various media reports questioning the accuracy of these devices. Today we talk about whether the accuracy of fitness trackers matters; upcoming research trends; and, the most important question, even if they are accurate, are fitness trackers serving their purpose? Are they getting us moving by holding us accountable?

With the help of our expert, Dr. Greg Welk, we discuss the complexities involved in making a device to quantify movement. We will also explore the findings of Dr. Welk’s 2014 paper from Medicine & Science in Sports & Exercise that captured media attention by examining the accuracy of what are now earlier versions of eight mainstream monitors available on the market.

We live in a very challenging environment to be active today…monitors provide a way to keep people accountable…[People] have to build physical activity into their day; it doesn’t just happen. It has to be actively planned and prompted during the day.

– Dr. Greg Welk

Dr. Greg Welk is a Professor in the Department of Kinesiology at Iowa State University, where he oversees the Physical Activity and Health Promotion lab. With more than 50 peer-reviewed, data-based research publications to his credit, he is a national leader in developing and assessing the accuracy of physical activity measurements while promoting physical activity.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • Expensive accelerometers, previously used for research, were introduced to the consumer market through development of the Wii (4:58).
  • University researchers have performed calibration measurements on consumer devices; the degree of accuracy they have found reflects the level of calibration research occurring at the consumer device companies (7:38).
  • The integration of several types of sensors enables better inferences of activity (9:46).
  • An overall error of 10% to 15% was found in the 2014 study of consumer devices; this is a reasonable level of error given that the goal of consumer monitors is behavioral change, not precision (12:39).
  • Companies must balance accuracy with fashion and functionality (15:32).
  • In the forthcoming study, device accuracy was measured while the subject engaged in twenty-minute time periods of sedentary activity (office work); locomotive activity (aerobic workout) and circuit training. Analyzed in this manner, monitors would overestimate activity for certain types of work and underestimate activity for other types of work, contrary to a previous study showing a reasonable overall error (17:09).
  • Consumer companies develop their own equations and algorithms and work to improve them, while researchers publish, share, and exchange calibrations used (19:21).
  • Currently in research there is a movement to use accelerometers that report in the same unit, g-forces. This unit allows inferences across monitors (20:15).
  • Different data storage and software processing capabilities are required between consumer and research devices (21:15).
  • There is a ongoing movement to use monitoring devices to integrate patient activity and other parameters into an electronic medical report for healthcare purposes (23:15).
  • In the coming years, minimizing inactive behavior, while promoting active behavior, will be a desirable combination for the market. Researchers are currently pursing ways to better monitor sedentary time (28:15).
  • Upcoming studies will be looking at the new Jawbone Up3 and FitBit Charge. Other studies will be looking to expand the health coaching model (36:09).
  • The biomarkers Dr. Greg Welk tracks on a routine basis to monitor and improve his health, longevity and performance is to minimize sedentary time. He previously tracked heart rate variability.
  • Dr. Greg Welk’s one biggest recommendation on using body data to improve your health, longevity and performance is to use devices as needed to hold oneself accountable for actively planning and prompting physical activity throughout the day.

Dr.Greg Welk & The Physical Activity Lab

The Tracking

Terms & Technology Used in Activity Trackers

  • Accelerometer: a device measuring body movements in terms of acceleration.
  • Altimeter: measures altitude.
  • Counts: a unit that lacked consistency across initial devices due to how devices were scaled or internally processed. Researchers would then take this unit and link it to an area of interest, for example a certain number of counts would equate to a number of calories.
  • G-force:: the force of gravity.
  • Gyroscope: a device used to measure orientation within 3D space.
  • Piezoelectric: an early accelerometer type, able to be scaled and calibrated, that converted a physical force into an electrical current and produced units referred to as counts.

Devices

The list of activity and fitness tracking devices discussed in this episode:

  • ActiGraph: Demonstrated a 12.6% error in the 2014 paper.
  • Amiigo: Mentioned by Damien, Dr. Welk did not have plans of it in future studies.
  • Apple Watch: Performance to be evaluated in upcoming spring study, with results projected for January 2016.
  • Basis B1 Band: Highest error on 2014 study (23.5%) and has been discontinued.
  • Body Media Fit : Top performer in the 2014 paper with a 9.3 % error.
  • Directlife: Demonstrated a 12.8% error in the 2014 paper.
  • Fit Bit Charge: Performance to be evaluated in upcoming studies.
  • Fit Bit Flex: Performance to be evaluated in upcoming studies.
  • Fit Bit One: Top second performer in the 2014 paper with 10.1% error.
  • Fit Bit Zip: Top third performer in the 2014 paper with 10.4% error.
  • JawBone Up: Demonstrated a 12.2% error in the 2014 paper.
  • Jawbone Up 24: Performance to be evaluated in upcoming studies.
  • Metria Patch: The wearable patch with monitoring technology of a device.
  • Nike Fuelband: Demonstrated a 13% error in the 2014 paper.

Biomarkers

  • Heart Rate: Dr. Welk previously used heart rate monitors to track intensity of workouts in high level training.
  • Heart Rate Variability (HRV): An athlete can track HRV as an indicator of whether the athlete’s body has fully recovered from previous workouts and whether the athlete’s body is ready for the next workout. Athletes can use HRV to identify symptoms of overtraining. Please check out other episodes and guests of The Quantified Body focusing on HRV: Episode 1: Andrew Flatt (resistance training), Episode 6: Ronda Collier (managing stress), and Episode 8: Todd Becker (hormesis and stress).
  • Calories: Devices may overestimate or underestimate the number of calories burned by ten to fifteen percent. On the level of individual assessment, the exact number of calories burned is less important; what is important is that using the device may cause the individual to make a behavioral change.
  • Steps: Individuals may use monitoring devices to track steps taken. As is the case with devices used to track calories, the use of devices measuring steps may cause positive behavioral changes.

Other

People

Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Hi Gregory.

[Dr. Greg Welk ]: Hi.

[Damien Blenkinsopp]: Greg, thank you so much for being on the show.

[Dr. Greg Welk ]: Yup, my pleasure.

[Damien Blenkinsopp]: So, first of all, I wanted to dive into what the interest is in tracking exercise, or activity in general. What kind of benefits do you think this can have for us?

[Dr. Greg Welk ]: Well as researcher I’ve been using monitors for many years. We use them to study how active people are so we can quantify associations with health benefits, and evaluate whether interventions work to change behaviors.

So the recent movement to consumer monitors has been a really interesting development. So I think the research community is at least still tying to learn how best to use these devices, and whether they do work to change behavior or not.

[Damien Blenkinsopp]: Right, so it’s mostly about, is it going to change our behaviors, and thus provide benefits in terms of, say increased activity, or more focused activity, on things that are tending to work. Obviously, there’s still a lot of exercise science debates going out there. Like, is cardio better, is weight lifting better, resistance training better. There’s a lot of these kind of discussions still going on.

Maybe over time, if we’re tracking exercise on a larger level, and we have big data. Do you think it can help some of these questions?

[Dr. Greg Welk ]: Sure. I think the devices give consumers the power to monitor their own behavior. I guess the key is whether they pay attention to the cues, and tune into them. Because tracking data by itself won’t necessarily change behavior unless it becomes something that’s use in your daily life.

So what we would refer to the data as, would be helping people with self-monitoring. Learning to monitor their own behavior, and using that as cues to change their behavior. But when you talk about the broader level of the data being stored in the cloud, and being able to infer what people are doing and not doing, it opens up all kinds of new opportunities to understand human behaviors. So that’s very exciting as well.

[Damien Blenkinsopp]: Great. And so perhaps you could talk about, what were you doing before this exercise tracking market started developing? What kind of things were you doing in order to estimate and assess activity?

[Dr. Greg Welk ]: Well again, accelerometers have been around for 20 or 30 years for active research in the research community, so there’s been probably second or third or fourth generation monitors being used by researchers since the early 1990s, I’d say. Even a little bit, there were some preliminary models in the 1980s. So we’ve been using accelerometers for many years.

I guess the key that turned it into a consumer marketplace was when the Wii was developed, actually. Because when the Wii was released, the accelerometer that was used in the Wii device all of the sudden became in demand, and the price came down.

And that’s what allowed some of the monitors to develop a consumer versions that were more price competitive at sort of the price point. Because we were previously using very expensive accelerometers, and then the price dropped tremendously and allowed all the consumer development.

[Damien Blenkinsopp]: Great. For people at home, could you describe briefly how does an accelerometer work?

[Dr. Greg Welk ]: Right. Well there’s different technologies. Actually, many people aren’t aware, but Leonardo Da Vinci is credited with coming up with the early idea of a monitoring device, and Thomas Jefferson was one of the first developers of a mechanical pedometer, hundreds of years ago. So the concept of tracking steps has been around for many years.

The most early accelerometers use what’s called a piezoelectric bender moment. This type of device would allow a physical force to be converted into an electrical current, which could then be scaled and calibrated. So the way researchers use these initial devices, the devices all produce a unit that we called counts, an activity count.

And it’s a nebulous unit because a count depended on, it didn’t have a value to it, and it depended on how the device was scaled or internally processed. But researchers could take that device and then calibrate it by linking it to a certain number of calories, or oxygen consumption, to determine how many counts equates to how many calories, for example.

And now those calculations are built into most of these devices. Again, the early devices were piezoelectric, and there was some concerns about the reliability of the sensors, for example, in the early models. But then when they went to solid state devices, they became much more reliable. And now there’s the typical accelerometer that’s at least used in most research devices, it’s more of a men’s accelerometer that senses true gravitational forces, rather than bending moments.

And that opens the door for other type of sensors. So some of the accelerometers can tell, for example, by the direction of the moment whether you’re standing or sitting. So there’s interest in posture as well as movement.

[Damien Blenkinsopp]: So it sounds like there’s quite a wide variety of accelerometers that are available today, and some of them are still more expensive, and less expensive. So it sounds like it’s a technology in evolution. The ones you’re using in research currently are basically ahead of the game compared to the ones we have in consumer devices. Is that correct?

[Dr. Greg Welk ]: Well, somewhat. But actually the studies that we’ve done recently, we’ve compared some of the consumer monitors directly head-to-head with some of the established research monitors. And they’re in the ballpark. So the consumer monitors are not far behind. Which leads you to conclude that there is some calibration work going on behind the scenes at these companies.

So the various companies don’t really talk much about the research. I guess they figure the consumers don’t really care or want to know the details of how accurate it is, and that’s why researchers like myself study it. So we did compare some of the leading consumer monitors against standard research grade monitors.

And several were better than others, but in general it shows that some of the technologies are probably using pretty advanced calibration methods, or multiple sensors, to get the type of precision that they’re getting.

[Damien Blenkinsopp]: So when you say multiple sensors, is that so they have maybe more than one accelerometer inside the device, and they’re using algorithms to calibrate?

[Dr. Greg Welk ]: Right. In addition to a standard accelerometer, a lot of devices include a gyroscope, for example. That’s built into almost all of our cell phones. So, a lot of the way the field’s moving is that a lot of the technology that already exists in your cell phone can actually be an activity monitor. So instead of wearing something on your wrist, we’re actually wearing a very powerful sensing tool in our pockets.

The challenge is calibrating it to having people wear it in different body positions, and things like that. So a standard position, if it’s worn on the wrist, for example, gives you a better way to calibrate it, because everyone’s wearing it in the same spot. But the other sensors would be gyroscopes, or altimeters.

So the one limitation of accelerometers, for example, is that it can’t really tell if you’re walking up a hill , or carrying a backpack. They’re based on gait, for example. So the accelerometers get pretty good at detecting that locomotion is taking place. And then if you’re running, you’re moving faster, and there’s more counts, so your count rate goes up. And they can tell that that’s running.

And more advanced sensors are now using pattern recognition technologies that can determine what type of activity it is. The real challenge is you’re limited if you’re using just an accelerometer, because we know, again, it can’t detect if you’re carrying a backpack, or walking up a hill. So, including an altimeter or some of the devices, including heat sensors, or heart rate monitors. So the integration of several sensors allows you to make better inferences about what people are doing.

[Damien Blenkinsopp]: Great, great. So, let’s talk a little bit about some of the accuracies. Which devices did you actually look actually look at in your studies?

[Dr. Greg Welk ]: Well, that’s the challenge and some of the fun. The paper we had published even just this past year in Medicine and Science and Sports and Exercise compared a number of the leading consumer monitors, but by the time the paper goes live and is published, there’s already new monitors in use.

So, for example, FitBit is a very popular device, and in that original study we compared the FitBit One and the FitBit Zip, which were worn on the hip. Those were the early FitBit devices. And we also compared the BodyMedia Fit, which was an armband monitor, and a host of other monitors. The Groove, DirectLife, the Nike FuelBand. But then, by the time the paper is even out, the consumer models are already very dynamically changing.

So we actually just finished another study that’s submitted and in review now, that compared most of the recent wrist worn monitors. So the movement in the field was away from the waist worn monitors, which is where researchers have typically used them and where pedometers are worn, to the more wrist position, because people are used to wearing things on their wrist, and it’s more fashionable.

Our new study we used the FitBit Flex, which is the wrist worn monitor, and also the Jawbone Up24. And those two tend to be the leading performers, at least in our tests so far.

[Damien Blenkinsopp]: So it’s the Jawbone and the…?

[Dr. Greg Welk ]: The FitBit worked out reasonably well. I’ve seen better results in almost all of our work with the BodyMedia Technology. BodyMedia was the original developer of the most powerful research grade monitor, and most of their technology and development went into the JawBone. So I don’t know if consumers are aware, but JawBone is a very powerful technology company, BodyMedia, that is behind a lot of the infrastructure and the pattern recognition work that they do.

[Damien Blenkinsopp]: Yeah, I mean, because it’s interesting, because some of these companies are now even if they were start-ups are getting bought out by some of the bigger companies. Because Intel bought the Basis watch?

[Dr. Greg Welk ]: Right.

[Damien Blenkinsopp]: Well, of course Intel’s a huge company.

[Dr. Greg Welk ]: Sure.

[Damien Blenkinsopp]: I mean, you’ve got Apple moving in with the watch. Which I guess you haven’t had access to, with their watch.

[Dr. Greg Welk ]: We’re actually just starting that. We have plans to do another study in the spring with the Apple watch. But it’s not going to be out for another couple months, or maybe January or so. For us, anyway.

[Damien Blenkinsopp]: Great, great. So in general, if you’re using a JawBone or the latest FitBit, you think it’s good enough for people to be using, and not be concerned with any accuracy differences between the reality the research grade ones you’re using?

[Dr. Greg Welk ]: Right. I’m pretty comfortable with the results. Actually, our paper showed an error of 10 to 15% for overall estimates, and I have a caveat to that to add, but that’s considered an individual level assessment. So if a person is wearing it and it says that you burned 200 calories, a 10% error would mean its 220, or 180.

So there’s a buffer around that point. But that’s a reasonable amount of error for a consumer level device. Especially when the goal is behavior change. So if you’re using it for research, then precision is more important. But if your real goal is to use it to monitor your activity and to prompt you to be more active, then I think the accuracy is pretty good.

[Damien Blenkinsopp]: Yeah. And I guess the idea behind that, also, is if you’re just wearing something, it’s kind of relative. If I took 10,000 steps one day, and I take 8,000 the next day, is it safe to say that the monitor’s reporting the same kind of bias if it does have a bias and so…

[Dr. Greg Welk ]: Right. That would be constant error, and you’re right. If you have more on one day than another, that would say that you’re more active. And that’s the real goal from a behavior change standpoint, is to have it cue your behavior and prompt you to be accountable to move.

[Damien Blenkinsopp]: Right. And I guess for the moment, that’s probably one of the best uses, in terms of, let’s say, because exercise science is still trying to define what’s, say the ideal movements and the things like this.

I don’t know if you’ve looked at the Amiigo. I don’t think it’s commercially available yet, but that was looking at trying to track more different aspects of the exercises. The movements, and so on.

[Dr. Greg Welk ]: No I haven’t heard of that one. We keep pretty close on this. My students keep me tapped into all the latest and greatest out there, but we hadn’t heard of that one. But I think you’re right, that eventually the movement needs to be to integrate these sensors with other technologies, where they can provide more information.

So it’s not just the amount of movement that you’re getting, and how does that relate to your health, and does it change your behavior and change your health outcome.

[Damien Blenkinsopp]: Right. Right. I guess it’s going to be evolving for quite a while, until we get to any kind of ideas of what’s optimum. Because it’s probably going to be different for each person, as well, depending on where they’re coming from. It’s quite complex.

For the Basis watch which I used for about a year what I found, first of all, it didn’t really reflect very well changes like in the steps reporting, trail running, walking. Sometimes it would think I was doing one thing versus the other. So I think that was for sure something that needs ongoing work to… I don’t know how the Basis turned up in your work. Did you look at the Basis compared to the others?

[Dr. Greg Welk ]: Yeah, we did in our early study. And it didn’t perform too well, but we got contacted by the company after that, and they said, ‘Oh, I think we can do better than that.’ And they were surprised by the results, but we reported what we got. The Basis was one of the poorer performing monitors in our initial study, but they indicated it might have been that we had an earlier version than their latest, or something along those lines.

But you’re right, it’s a challenge for the companies to balance the need for accuracy with consumer forces. So right now, most of the emphasis in the development is on fashion, or size, and making them smaller. But accuracy is not a high priority among most of the companies. And that’s the balance that they’ll have to play, is how to keep the quality good and add new sensors, but without making them bulkier, or not as functional or fashionable anymore. So there’s this balance that they have to play.

[Damien Blenkinsopp]: Yeah, it seems like the people who are most concerned about accuracy are, potentially, some of the athletes, the people who have more going on, or quantified selfers. But for the mass market, it seems like they just kind of assume that it works. Kind of thing.

[Dr. Greg Welk ]: Yeah.

[Damien Blenkinsopp]: And that they don’t have to worry about it too much. I mean, it’s not something that they really question a lot. Because I guess it’s kind of beyond them. We’re talking about accelerometers, and the technologies are relatively advanced and complicated for just the average person to start trying to dig into.

[Dr. Greg Welk ]: Exactly. And so the consumer, like when our study came out, actually the media picked it up, and a lot of the media buzz was, ìThe monitor isn’t as accurate as you think.î And so, again, I pointed out that 10 to 15% error was decent in the paper, but when the media spun it then it became known that your monitor may not be as accurate as you think.

But I think the media and the general public, for example, don’t fully realize how difficult it is to quantify movement. So when we walk around, the accelerometers are basing most of the estimates only on this ability to detect gait: walking and running. If you’re standing, lifting weights, the monitor can’t tell what you’re doing. And if you’re walking up a hill, for example, it can’t note that and really capture the true energy cost. If you’re digging a ditch, with these monitors, you could be burning tons of calories, but you’re not moving in space. And so the monitor’s not picking up that detail.

And that’s the caveat I mentioned earlier, that I was going to get back to. Our recent study, we broke up the time periods and we looked at the accuracy of the devices for sedentary time, like typical office work. And then we looked at locomotor activity, like an aerobic workout on a treadmill. And then we looked at 20 minutes of circuit training.

So we had people for about an hour come in, and we had them first do 20 minutes of sitting around, standing around, just doing office work. 20 minutes on a treadmill, and then 20 minutes in a free weight circuit training environment. And then we looked at the accuracy for all three settings.

So, when I was pointing out earlier that the accuracy was 10 to 15% that was in a more controlled study, and also for an overall period. Like for a full hour. But then when you break out the accuracy for individual segments, the monitors were all over the place. So they overestimated for one activity and underestimated for another.

[Damien Blenkinsopp]: So I guess they’re mostly, are they standardized on jogging or walking primarily?

[Dr. Greg Welk ]: Pretty much, yeah. That’s where the JawBone BodyMedia Fit tended to be better performers, because they have other sensors that are detecting the patterns. Whereas the FitBit and the DirectLife and the Nike FuelBand had more variability in their estimates for each individual activity. So they have more error, even though the overall estimates looked comparable.

[Damien Blenkinsopp]: So what are they combining with the accelerometer in order to determine the type of activity so that they can run a different algorithm, I guess, on the count.

[Dr. Greg Welk ]: Right. A lot of the work actually looks at the patterns within, how the counts are accumulated. So if the counts are in a repeatable pattern, like in a rhythm of frequency, then we know it’s walking. If they see a chaotic pattern, then we can know it’s not walking, or running, and then other patterns can be detected. For example, the BodyMedia can detect a pattern in cycling that most other companies have not been able to do. And we’ve done studies that show it gets better at predicting the energy cost of cycling than other monitors.

So they use other sensors, again, these heat sensors, or just the pattern within the minute. And so even though the devices are producing an estimate of a single minute they’re actually sampling at 30 hertz or more to capture all this rich data.

[Damien Blenkinsopp]: And so, I guess an important thing to understand here is that they’re using proxies, right? They’re taking data which isn’t directly counting steps, calories, and then they’re using research is it standardized research, or is it their own personal estimates?

[Dr. Greg Welk ]: For the most part, all the consumer devices are doing in on their own, and that’s what researchers are now starting to test. Again, when the original calibration work that came out that most of the people in our field use; we developed the calibrations, they get published, and they get used by other researchers. But the companies are on their own to kind of develop their own calibration equations, or pattern recognition algorithms. And then they work over time to improve them.

[Damien Blenkinsopp]: So there’s no activity going towards a standardization of any of this as yet? Whether it’s the hardware, or the software?

[Dr. Greg Welk ]: Not within the consumer market. In the research world, we’re sort of converging back around the use of raw G-forces, I’ll say. So the original accelerometers were producing an output that was called counts. Again, that was you couldn’t compare one count to another count, because they were scaled differently. But if all the accelerometers could report in the same unit, which is gravity, G-forces, then we can make inferences across monitors. And that’s becoming the unit that we should have been using all along, but it wasn’t possible before. But there’s sort of a move towards using raw data, and using raw G-Forces as the unit of comparison.

[Damien Blenkinsopp]: That sounds great. So, I guess, would you envision that consumer companies will eventually be doing this, or is this a very different cost? Has it got a very different cost structure as yet? Could you give us an idea of what the difference is? Is it 10x, or…

[Dr. Greg Welk ]: No, I’d say maybe 2x or less, in terms of the sophistication of a research monitor. It’s more the processing capabilities that they built in the data storage that differentiates a consumer monitor from a research one. So, what researchers want to know is we want to be able to see the raw data in minute by minute form, or second by second. And that requires a lot larger data storage, which then makes the device bigger.

And also we need better processing software. A lot of the consumer monitors export only data every hour, for example, because it doesn’t require as much storage in the unit and keeps the data piece smaller. So it’s a factor of what’s important. So a researcher needs different things than the consumer needs, and it’s kind of that trade off.

But I’d envision, again, the consumer monitors evolving more in the direction of combining multiple sensors, and linking, eventually, to other health related indicators. There’s a big movement now towards how they could be used by physicians, or behavior change applications. So I think the real key is going to be how these devices can interface with the health care system.

Right now they’re just kind of a fun thing that people are using. But the real question is whether health care providers will start using them, and whether insurance companies will start paying for it. Because getting people more active would go a long way to preventing chronic disease and reducing obesity in the population.

[Damien Blenkinsopp]: And for something like that, that’s going to encourage the device manufacturers to move, potentially, towards some standards like the one you were just talking about, which, when it comes to government and stuff, they want something more standardized. And we can’t have just all these monitors.

Just if all the medical doctors arenít going to be able to work with all of them, obviously, that’s not the way it works. And I can imagine there would be some kind of approval process eventually. I don’t know if you’ve seen anything going on like that. I know that Apple was apparently talking with the government, and some of the health bodies I don’t know if you were looking at that about some of the markers and some of the structure that they were putting behind the watch.

[Dr. Greg Welk ]: Yeah, I’ve seen a little bit, but probably not enough to comment. I think stymieing competition would go against what America’s about, and what the companies are about. And so all companies should have a chance to compete for that marketplace, and not force health care providers to use the same device.

But the key is whether the devices can be successfully integrated into an electronic medical record, for example. So I work with a couple of companies that have already been working on the medical interface. And there’s a patch the product’s called the Metria Patch and it’s basically a piece of, version of an accelerometer that a doctor could slap on a person’s arm, tell them to wear it for a week. And then they tear it off and mail it back in, or bring it back in.

And it has all the sophistication of the best available research device, but in a form that a physicianís group could use. And they’ve started working into how that data can be incorporated directly into an electronic medical record, where it can be acted on.

[Damien Blenkinsopp]: And that’s big enough to store the type of minute by minute data you were talking about?

[Dr. Greg Welk ]: Oh sure. Yeah, it is. Yeah. And it has the adhesive capabilities, so when you put it on, it becomes like a patch that sticks to your arm for a week at a time, or even a month at a time. You could swim with it, shower with it, and eventually when it’s taken off and they’ve even figured out the breathability, like how to make sure that if you’re wearing it, that it doesn’t affect your skin underneath. So there’s a lot of work in that particular interface.

But even with that device, I think the missing piece is the health coaching that goes along with it. So for it to ever get traction in the health care community, they need to know that they can see the data, and then use the data to inform behavior change. We’ve done a lot of work lately with health coaching applications of some of these monitors.

We have a virtual health coach, for example, that can see the participant’s data, and we can comment about whether they’ve been active that week, or whether we see patterns that they could act on to improve their physical activity or weight loss behaviors. And so we’ve got a number of studies in process with this kind of health coach model.

[Damien Blenkinsopp]: That sounds very interesting. How long before you think this kind of thing becomes more available to consumers? I know there’s some health patches already out. We’ve spoken with one provider, Ronda Collier, and she’s been working with the health patch for a heart rate monitor. So there are some of these starting to creep into the market.

But they’re still a bit cost prohibitive, based on the fact that it’s a usable one, consumable. So you have to buy one every week, or every month.

[Dr. Greg Welk ]: Right, but that at least gives a cost structure that a physician’s group can budget for. It’s more challenging to use like a physical device that gets lost, or that they have to buy and upgrade. It’s sort of like disposability is an advantage, in a lot of way, because it can be built into the fee structure.

[Damien Blenkinsopp]: That’s right, and it can be updated easily, rather than having to pay a higher price and have someone have to have that for one or two years before they can upgrade.

[Dr. Greg Welk ]: Right.

[Damien Blenkinsopp]: Especially at this time when the technology’s moving very fast. So do you foresee the technology changing rapidly for the next five years, or do you think it’s going to settle down soon?

[Dr. Greg Welk ]: Oh I think it’s just getting started in dynamic phases. I think all these are new and very exciting. We saw them all out at Christmas, I’m sure a lot of people got them in their Christmas presents this year. You saw them highly advertised at the Christmas sales and things.

I think the movement will be towards these smart watches, and the integration with your cell phone. And again, in a few years, the technology already exists in cell phones to do this, so the watch really becomes the cue, or the device, that prompts you about how active you are. Whether the accelerometer is in your watch or in your pocket doesn’t really matter, they’ll basically start interacting with other aspects of your life and provide prompts about your blood pressure, and your heart rate, and other features that can inform your health.

[Damien Blenkinsopp]: Great, thank you very much. Do you have any practical tips for use, which could help to get better feedback, more accurate feedback, over time? For instance, a lot of these watches are, as you say, worn on the wrist. Does it make any difference which wrist you put it on?

[Dr. Greg Welk ]: No, I don’t think that matters. The companies may tell you it’s best if worn on the left, because that’s where they calibrated it. The right or left doesn’t really matter, but I think the key, as you pointed out earlier, is that people should use them on a relative basis, as a reminder to be active. If they want to take a day off and remove the monitor, that’s okay. The world’s not going to end if they have a gap in their data, because the real goal is to be using it to cue your behaviors.

I, for example, don’t use one every day, or I use them when I feel the need to monitor, or things like that. Other people, however, really do benefit from the daily accountability, and want to have that as a daily reminder. So it’s kind of an individual preference there.

[Damien Blenkinsopp]: Yeah, one of the main things I was using it for was just judging how much I was walking, and how far, or how many steps. Just trying to keep that at a reasonable level, and increasing it. Actually, at the time I was suffering from chronic health issues, and it was difficult for me to walk.

So it was great for me to see the progress. Like, I made 10,000 steps today, that’s awesome.

[Dr. Greg Welk ]: Right.

[Damien Blenkinsopp]: Unfortunately, it didn’t take into account the hills which we’re talking about which was a huge factor in whether I made that 10,000 or if I went up this hill. So I’m sure that’s going to come relatively soon.

In terms of the next things you see happening in the market, which you’re kind of excited about, you talked about the patch. Is there anything else you see in the consumer market which you think will be coming soon? Or in the next five years?

[Dr. Greg Welk ]: I think one of the convergences is going to be with the balance between not just promoting activity, but minimizing inactivity, or sedentary behavior. So the researcher community is really intrigued with the dual effects of both inactive lifestyle, and basically being more active and less inactive. That’s one of the things I’m personally much more interested in is minimizing my sedentary time. So I’m like a number of people that have a standing desk, and try to be on my feet more than I’m sitting. So I think the monitors that can start proving information about sedentary time and activity time, that’s going to be a desirable combination.

[Damien Blenkinsopp]: And position, as you said earlier. Because right now most of them don’t tell if you’re standing or sitting. And there’s a fair amount of research, as I understand it now, that sitting’s a really bad idea. For our backs and other aspects. Whereas, at least it sounds like you and I are trying to stand, and do the standing desk thing, more because of that, but it’s not getting tracked?

[Dr. Greg Welk ]: Right. But most devices don’t really have a good sense of how to track sedentary time. The research community is actively pursuing that, but we haven’t really seen good output from most of the consumer monitors on sedentary time yet. I mean, I think they’re working on it. So I think eventually there will be these separate indicators.

And even on the smart watch, the prototype for Apple, they have a really cool interface I don’t know if you’ve seen that, that shows these loops. There would be a circle, and when you meet the day’s activity goal, your circle would complete, or you would get a full circle. And if you also minimize the time you spend sitting, you would also get a full circle. And the way they track that is you can’t have any hours where youíre sedentary for more than an hour. So basically it forces you, every hour, to remember to stand up and move, which is a good cue.

And so they have built that into the planned smart watch. Again, I haven’t gotten to try one myself yet, but that’s what I’ve seen in the prototypes.

[Damien Blenkinsopp]: Yeah, and if you have alerts. We have calendar alerts on our IPhone, if we have alerts on our watches that say hey, you’ve been sitting for an hour, it’s time to get up. The Basis watch actually has it, so every day it would say I was sitting for too long a period. That’s one of the other things it used to say was I was asleep whenever I was watching TV, or something like that.

Which is difficult to assess, when you are asleep versus watching TV or something very low key.

[Dr. Greg Welk ]: I think yeah, that’s a movement where the research community is actively interested in both the effects of promoting activity and minimizing sedentary time. I guess you brought up before that there’s not a consensus about the right type of activity, but I think among researchers and the public health community, we’re in agreement that more physical activity is better, but a moderate amount is sufficient for health. So if we can get the population to do 30 minutes of physical activity on most days of the week, that’s what we’re after. Unfortunately a large percentage still doesnít do that.

And then the addition of resistance training is a really important piece that isn’t really captured with these monitors, unfortunately. So that’s where we need people to be adding some resistance exercise to their routine, because that adds independent benefits also.

[Damien Blenkinsopp]: And the Amiigo I brought up, which is trying to do that. I’ve actually been watching for a year. I don’t think they’ve actually delivered any of the devices yet, it was an Indiegogo project. I could be wrong, I haven’t look at it for a while. But they’ve run into some manufacturing issues, and I’m not sure what the technology was there. But someone is trying to incorporate this resistance training aspect into it.

[Dr. Greg Welk ]: Yeah, I had seen a couple. And we were planning to incorporate them into that study I mentioned, about resistance training, but we couldn’t get them in time. I forgot the names of those, but they weren’t ready. So we just decided to go forward with the study with the monitors we had.

[Damien Blenkinsopp]: Great. So this is an ongoing work project, right? You’re going to be continuously looking at the new devices coming out, and tracking. Is this something that you’re going to continue working in your assessment center?

[Dr. Greg Welk ]: Oh, definitely. My students are very interested in that, so I have a whole fleet of grad students that help me do this work. They’re very interested in keeping up on the latest technologies. Our lab is called the Physical Activity Lab. So if you went to physicalactivitylab.org, we have, that’s where we post information on our past studies, and things like that.

But when we finished testing this one consumer study, we then completed another one in the fall that will be presented at a conference this spring. And that’s, again, in review now for publication, and we’re already planning another study this spring to compare the new smart watches, like you said, and also the new JawBone Up3, and the FitBit Charge. Those are the latest devices that, again, are released. Even before we can finish testing them, there’s new monitors that come out. So we’re very interested in testing the new JawBone Up3 that has a number of new features in it.

[Damien Blenkinsopp]: Yeah, that’s great to hear you’re going to be keeping up with it, so we can follow you and keep up-to-date on all of this. Because I haven’t seen anyone else covering this in so much detail.

I’d like to ask you a couple of personal questions about your use of data. In terms of biomarkers or personal data, do you track anything on a routine basis for yourself to either monitor or improve your health, longevity, or performance?

[Dr. Greg Welk ]: Yeah, I’m kind of a dabbler, probably, more than a regular user. So I dabble in them maybe because I’m more thinking about them from a research perspective. But as I think about it, the indicator that I’m probably most intrigued with is the sedentary time. So it operates in my mind all the time about how long I’m sitting, and trying to minimize sedentary time.

So, I’ve started becoming more interested in devices and assessments that can do that; either simple cell phone apps or logs that I can track my behavior with. So I used to do a lot with high level training and using heart rate monitors to track the intensity of my workouts and things like that, but I kind of know by now my own ranges, and if I’m working hard enough. So as an exercise physiologist, I kind of know what I need to know about my own training. But this whole sedentary world is a new frontier.

[Damien Blenkinsopp]: Great, great. Did you ever look at HRV? We’ve talked about this quite a bit on this show.

[Dr. Greg Welk ]: Yeah, early on I used to use a heart rate monitor and using HRV to track. It’s a good indicator of, over training, for example, if your body’s not rested from a previous night, a lot of athletes would use the advanced heart rate variability indicators to determine if their body’s fully rested and ready for the next workout. So at one point in my life I was very focused on triathlon training and did a lot of that monitoring. But recently it’s not been as high of a priority for me.

[Damien Blenkinsopp]: Great, thank you. What would be your biggest recommendation or insight on how people could use data effectively? Because there’s more and more data coming about, and especially with these devices. How would you suggest that they use this data effectively to improve any aspect of their life?

[Dr. Greg Welk ]: Good point, and I think that’s where the goal would be for using the device to help you change your behavior, and to use it to inform decisions, not just to collect data for the sake of collecting data. So, I think as the devices become more sophisticated they’ll provide actionable insights that give you prompt, that says last week you were active in the mornings, or you weren’t active in the mornings. And it would cue you to maybe be more active at different periods of the day.

So I think that’s where it’s got to get, where the devices are basically helping people to make changes. I mean, we live in a very challenging environment to be active today, with people using cars, and the busyness of our lifestyles. And so I think the monitors provide a way to keep people accountable to their goals, and realize that they have to build physical activity into their day; it doesn’t just happen. It has to be actively planned and promoted during the day.

[Damien Blenkinsopp]: Great, thank you so much for that. I’d really love to have you back on in say a year or something. Would you mind if we reached out and, obviously, you’re going to be seeing the trends as they develop, and I’m sure you’ll have a completely different idea and research on where things have got to in a year’s time.

[Dr. Greg Welk ]: Yeah, I’d be happy to. I’m actually, we’re working on our health coaching models, we’re testing some of the new devices in the spring, and we’re also including expanding our health coaching model, where we’ll be testing this new patch device from a physical physician referral system. I think that’s where the key is. And we’ll be able to learn from these studies what type of information consumers need to change their behavior, and what level of involvement do they need.

So a lot of our goals in our health coaching studies is to figure out a very cost effective solution. For example, can we give people a monitor and a few tips every week, and even text messages. Is that enough? Or do we need to give them a one on one counseling session, three weeks in a row, and then put them on their own?

And so we’re trying to figure out that optimal dose and scope of what a behavior change component needs to be. And, you know, we’ll have a lot more to know by next year.

[Damien Blenkinsopp]: Great. Yeah, and so you bring up a lot of the challenge of using these is understanding the psychology and the behavioral implications of it. So this is the more complex area to look into, really. Analyzing, as you say, how to report the data of people on frequency, the format, and what actually influences behavior and gets us to the end goal.

Well great Greg, thank you so much for your time today, and looking forward to talk to you again as your research expands and continues to look at this area.

[Dr. Greg Welk ]: Yeah, I’d be happy to join, and I’ve been enjoying following the blogs, and I look forward to continuing the discussion.

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