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One big question that anyone faces when starting a new exercise or health regime — like intermittent fasting, exercising at lunchtime, or just eating more veggies — is how to fit it into ‘everyday life’. Answering the question successfully is key to making a lasting change, versus one that falls by the wayside, but integrating a change into work and family commitments is a challenge, and not one that can be resolved simply by ‘trying harder’. (Let’s face it: ‘just try harder’ rarely enables anyone to achieve anything.)
As I’ve started to get the value out of these activities and life choices, I’ve started to be bolder about them. I’m happy to go out running at lunchtime now, and people can live with seeing me in my Lycra and with wet hair afterwards. I’ll just say, “I fast for 12 hours a day” when people look at me askance for eating dinner at 6pm at my desk before heading home. I’m going to take a kneeling chair into the office soon, to help get away from being stuck in one position throughout my desk-bound hours. Because why the hell not?
Joining a health revolution suggests leaping on a bandwagon; being a health revolutionary suggests modelling the change you want to see in the world. Number 93 on Pilar’s list is “Be responsible for yourself”. That means owning the decisions that promote (or demote) health in our lives, and being accountable for them. And that in turn means not shying away from manifesting those decisions in public and making them be ‘everyday life’.
So, in a sort of tedious but inevitable way, I did one of those DNA tests not so long back with 23andme. I was curious about the ancestry reports — no real surprises that I am 100% European — but was disappointed that they are no longer producing health reports. Another website, Promethease, will produce them, though, or at least pull together the literature regarding your genome and classify it as “good news”, “bad news”, or simply “interesting”.
It’s pretty cheap to run once you have the 23andme data, so costs perhaps $100 in total. I did mine mainly out of curiosity, and I don think DNA is the ‘ultimate’ QS data, but having got the report, I think it’s worth analysing a little more. Here is a quick review of the “news” that it gave me, what I make of it, what it means for me in trying to live an active and health life, and other bits that are just entertaining!
This is the biggie. The one that almost everyone wants to know the ‘answer’ to. Inevitably, there are no clear-cut answers, but there are plenty of genes that have been linked to higher or lower incidences of particular cancers. This is an aggregate of what I found out from my report, omitting prostate cancer as a non-issue in my case:
- Slightly lower risk of bladder cancer according to one gene, but two others linked to an increased (3x or 1.4x) risk
- 0.87x decreased risk for ovarian cancer according to one gene
- Three genes linked to an increased (1.17x or 1.4x) risk of colorectal cancer, but also one linked to a ‘normal, risk and one linked to a decreased (0.73x) risk
- Half the risk of endometrial cancer
- Increased (1.64x, 1.6x, or 1.4x) risk of breast cancer according to four genes (two of which are themselves linked)
- An increased (2.6x) risk of thyroid cancer
- An increased risk (1.17x) of gastric cancer
- One gene linked to an increased risk of lung cancer in non-smokers (which I am), and up to a 1.5x increased risk according to other genes.
- “Generally more cancer prone”
So what do I take from this rather scary list of numbers?
- I have a “warrior” gene — versus the “worrier” gene — whereby I lose dopamine more quickly than others. I am likely to have a higher pain threshold, better stress resiliency, but a “modest reduction in executive cognition performance under most conditions”; i.e. less good concentration and a less well-functioning prefrontal cortex in circumstances where I’m not under stress. The placebo effect is also apparently less effective on me.
- I have a gene correlated with a 0.84x decreased risk of Alzheimer’s disease, and another with a 0.85x decreased risk, but another with a 3x increased risk. With one gene I have a reduced memory capacity, but with another I have a decreased (0.76x) risk of cognitive impairment as I age. Another indicates a higher dementia risk, especially amongst Ashkenazi Jews.
- 1.29x increased risk for depression or 1.3x, or 1.4x. Another gene associated with impaired remission from depression. 7x less likely to respond to certain antidepressants, and 18% less likely to respond to citalopram.
- I have an increased (2-5x or 3-5x) risk of dyslexia according to two genes.
- I have one gene that may be correlated with a reduced risk of bipolar disorder, two correlated with an increased (1.51x and 1.32x) and another correlated with a generally increased risk. I have a gene that is correlated with a “normal” risk of schizophrenia, and three with increased (1.58x, 1.1x, and generally) risk of schizophrenia. I have a gene that may render me more prone to less favourable clinical outcomes on antipsychotics.
- I have a gene linked to an “increased susceptibility to novelty seeking” and less efficient serotonin processing (although apparently parenting can help!)
- I have an allele combination that means I am “optimistic and empathetic” and handle stress well, being less likely to be startled by a loud noise and better able to judge the emotions of others by their faces. The combination is apparently also correlated with lower rates of autism, feeling less lonely, and employing more sensitive parenting techniques. However, another four genes were affiliated with increased risk of autism (varying levels up to 2x, with one associated with a 1.19x risk due to worse brain-cell adhesion) and a higher “insistence on sameness”. Conduct disorder is more likely in adolescents with my genotype.
- I am apparently likely to be “bad at avoiding errors” and learning from mistakes and have fewer dopamine receptors. My genotype is correlated with a 0.5x lower OCD risk, but a higher ADHD risk and a greater risk of alcohol dependence or smoking addiction. However, another gene has been linked to higher scores on anxiety-related personality traits, OCD, panic disorder, and other related disorders.
More general health and fitness
This section is mainly about physical traits. Many of these are useful for me in thinking long-term about what I’m aiming to get out of any health and fitness regime.
- I have the genotype that indicates better performing muscles, in the sense of likely being a sprinter, rather than an endurance athlete.
- I have genes correlated with an increased (1.2-1.8x) risk of tuberculosis.
- I probably have an increased (1.9x or 2.3x) risk of developing rheumatoid arthritis, although another gene is correlated with normal risk, and another still with a decreased (0.89x) risk. I have genes correlated with an increased (1.16x or 1.45x) risk of osteoarthritis. I also have three genes associated with weaker bones.
- I have a 10x risk of endometriosis.
- Heart and cardiovascular diseases: Although the results here a bit mixed, the key take-home is that I am at increased risk here. I am at an increased (1.2x, 1.5x, 1.54x, 1.9x, or 7x with a history of high blood sugar!) risk for coronary artery disease. I have an increased (1.6x, 1.7x, 2x, and 2.2x) risk of heart disease, although some studies have shown that ‘regularly eating raw vegetables and fruit’ can decrease this.
- Increased risk of ischemic stroke based on two genes.
- I have several genes associated with higher HDL cholesterol, but one associated with lower HDL, particularly amongst Ashkenazi Jews.
- I have a gene associated with “impaired NSAID drug metabolism“, which is a risk factor for GI bleeds when taking ibuprofen and other such drugs. I also have “probably impaired Warfarin metabolism”, with another gene correlated with an average 40% reduction in warfarin metabolism. This would mean I would need a reduced dose if treated for VTE. Another gene is associated with an “ultra-fast drug metabolism”.
- I have an increased (1.4x) risk of hypertension
- I have genes correlated with an Increased risk of gluten intolerance and coeliac disease
- My genotype has been linked to an increased risk of developing Parkinson’s (according to several genes).
- I have a higher risk of alcoholic liver disease, and alcohol is 3x more damaging to my liver.
This is yet another piece of information that will motivate me to keep my alcohol consumption low (see above about alcohol dependence, and my avoidance of alcohol because of sugar content!).
- I am more likely (1.5-2.7x) to live to 100, and have a gene associated with living 3 years longer than others and another associated with longer telomeres. However, I have a gene associated with faster ageing and increased dementia risk, particularly amongst Ashkenazi Jews.
This is no real surprise, as it’s a running joke that the women on my mother’s side seem to live forever! I’m not sure whether I necessarily want to live to 100, but if I can keep myself in good health, it might not be so bad. Mark this up to another good reason to take care of my health and wellbeing!
- I am less stimulated by caffeine. I am probably a fast-caffeine metaboliser, so it will have less effect on me. This may decrease the risk of heart attack but caffeine will be less effective at preventing breast cancer, Parkinson’s and Alzheimer’s.
- I have “decreased high myopia risk”.
- I probably have a lower (’much lower’ or 0.87x) risk of Type-1 diabetes, a normal risk based on yet another, but another gene suggests a much higher (18.5x!) risk. Two genes indicate a lower risk of Type-2, but two others indicate an increased risk (1.2x or 1.4x), and a gene that indicates an increased (1.32x) risk of early-onset Type-2. Another gene is associated with a lower fasting blood glucose level.
- I have a lower risk of obesity based on one gene, but a higher risk based on another (and am likely to be 0.22 BMI units higher). I am not one of the lucky 12% who find it easy to maintain weight loss without plenty of cardio exercise, but I have a gene affiliated with less weight-gain on high-fat diets and greater weight loss on a low-fat diet.
- I have a 1.74x increased risk of gout.
- I have an increased (2-6x) risk for cluster headaches.
- Reduced beta-carotene conversion to retinol.
Miscellaneous “fun” facts
- I have a combination of genes that are associated with a lower viral load and slower progression towards AIDs, should I ever contract HIV.
- I have a resistance to prion disease.
- I have the highest odds for a photic sneeze reflex.
- Larger mosquito bites.
- Possibly unable to taste bitter in some foods.
- Early riser, by about an hour.
Hell yes! Early morning FTW. I will keep running in the morning, then.
By way of background: for Christmas last year, I got a Fitbit One, about which I’ve already written an initial review. I’ve been using it daily now for seven weeks, and I thought I’d write something more detailed about how it has affected the way I think about my health and lifestyle, tracking devices, and the idea of a Quantified Self. I’ve also written before about my hesitance about society’s general willingness to abdicate responsibility for self-awareness and owning decision-making about health and well-being to doctors.
The QS movement aims to bring about greater understanding of one’s self and one’s health as a result of data, data, data. The most “traditional” type of self-tracking is dieting, of course, and at its core, the Fitbit is based on this model: it is interested in how much you move, how many calories you are burning, and how many calories you are eating. The sleep tracker moves a step beyond this, looking at data relevant to mental health and wellbeing, energy levels, etc. The Fitbit website allows one to track moods (and allergies!), as well as heart-rate, BP and blood glucose levels (provided you have the appropriate kit at home), but the app does not, limiting the flexibility and responsiveness of the tracking experience that the Fitbit offers.
Tracking one’s diet is quite valuable, I think. Although the protein/carb/fat mix of your daily intake is important, the more critical thing to track seems to me to be the levels of vitamins and minerals you eat on a daily basis, and the food databases within these sorts of apps (the Fitbit’s, MyFitnessPal, etc.) are patchy at best at giving this information. Even if they do, what sort of accuracy can there be, really, when using these average figures? The same goes for the calories in your food, even assuming that you can accurately measure everything, even assuming that calories-in-versus-calories-out is meaningful (it’s a very blunt instrument). (There’s a nice LifeHacker post about this issue and how best to go about keeping track of weight/body measurements, but it remains imperfect.)
I think this basis of generalisation is a real problem for the sort of low-level self-tracking that the Fitbit represents. Even one’s weight is not fixed. It will vary throughout the day, and throughout the month (for both men and women!) as hormone levels vary. So when do you weigh yourself in order to say that you have lost weight or not? Most of the mechanisms that we have available to measure lean-mass versus fat (e.g. weighing scales or skin-fold callipers) are also liable to a relatively high degree of inaccuracy. The closest I think that one can get is actually measuring the body with a measuring tape, although it’s easy for there to be random errors here, too, by holding the tape slightly tighter one time versus the next, or slightly further down one’s chest/waist/thigh.
So given these frustrations, what’s the point?
Well, there is a certain attractiveness to merely having the data. It can act as further motivation — whether your weight/measurement/body fat rises or falls — and it can help to maintain a focus on health that might otherwise get lost in the maelstrom of day-to-day life. It is nice to feel that you’ve done the best that you can on a certain day, and be able to identify where you might improve for another, provided the data does not become ‘law’, affecting beyond reason how you think about yourself.
I’m going to keep using my Fitibt (along with the MyFitnessPal and Sleep Cycle apps), and I’m toying with the idea of paying the £40 pa in order to access Fitbit Premium, which gives you more data that can be compared with the large number other Fitbit users. This element of big data is attractive, and might be worth it, but I haven’t quite decided yet. If I do go for it, rest assured that I’ll be writing about it here!
I’m mainly using the Fitbit with my iPhone at the moment, rather than via the Fitbit website. I’m using the app in conjunction with the My Fitness Pal app (I have never used that one online) because the Fitbit’s food database might as well be non-existent. That is the one disappointment so far. In reality, I’ve actually now got three apps, as for some reason there is no function in the app to record one’s pulse. I can see why as it’s done using the phone’s camera and not with the One itself, but it would be a useful add-on, I think, particularly given that the option exists on the website. In any event, the Fitbit app has an attractive interface that is easy to use.
The pedometer is pretty standard, and the altimeter giving the number of floors climbed is a curiosity but not a huge interest. The recording of active minutes is quite useful, though. For example, it’s interesting to see when wandering around the shops is or is not ‘activity’. The weekly email summary that Fitbit sends is also quite useful, so that one can see the data in the round. It is far more startling to be told that you have eaten more than 3,000 calories than you were meant to (*ahem* it was Christmas, and I don’t really believe in calories anyway, but one has to start somewhere…).
The function that I’ve found most informative so far is the sleep tracker. As far as I can tell, it is much more sensitive than the app I was previously using on my iPhone (Sleep Cycle), which detected movements in the mattress. Sleep Cycle fell down because it only gave the amount of time the app had been running, essentially, rather than the amount of time one was actually asleep. The FitBit corrects this by judging when you were awake and ‘restless’ and omitting these from the sleep time calculated. The arm bracelet for the One is comfortable, and it is easy to remember to use it if you are already wearing the One on your clothes, although I can see that it could be easily forgotten otherwise.
Over the next few weeks I am going to try to use the website a little more in order to take advantage of the more detailed tracking it offers.
No, I don’t mean those silly Slendertone things!
A thoroughly exercise-averse colleague has recently been converted and taken to jogging/running around Maida Vale of an evening, and swimming in the non-fast lane (for now, at least). Whilst I don’t really object to swimming (despite it being rather boring and repetitive), I do have something of an objection to running. I know, I know, it’s a contentious subject, but I really do think that it’s an unnecessarily body-stressing activity to undertake on a daily basis, particularly running on tarmac.
Women’s Health did (a long time ago) a sum-up of the pros and cons for strength and cardio, which I think still holds (HuffPo have a similar, more recent article). Built Lean also has a critical dissection of a recent Duke research publication that claimed a victory for cardio. Personally, I’ve only been in a gym once in the last year (while on holiday), and I don’t run (see above), so my cardio is limited to my trademark very brisk walking. I walk for at least 40 minutes a day. Otherwise, I’m all for free weight strength training and yoga. My aim isn’t particularly for fat loss, but even if it were, I think I would advocate this same programme!
I have been catching up on this programme, as I missed a few episodes. I wrote about episode 1 — and particularly the Quantified Self aspects of it — previously, but episodes 2 and 3 got me thinking about the programme more generally.
As I said, I like Michael Mosley, and I like the idea of this show: subjecting to critical, scientific scrutiny some of the health and well-being myths and contradictory advice in an easily accessible way is in itself a public service. I do worry a little about the very title of the show, though.
Socially, we put a lot of faith in medical science, and doctors have significant authority. Is the title of this show supposed to be ironic? It is inviting us to question, but to question under the guidance of the panel of doctors. Even if it is supposed to be ironic, it’s a mixed message. Don’t get me wrong, I don’t advocate turning to pseudo-doctors like Gillian McKeith instead! But I do think the tension of this show shows up a general habit of abdicating responsibility for critical thought to someone ‘qualified’. We’re all qualified for self-care in the general course of life, and we should all know our own bodies (and minds) better than a doctor.
For example, when a GP confidently asserts that the dulled hearing in my ear — which I have had for at least a year — is definitely hayfever, he is wrong. He has no interest in me, the actual facts about my body, or how to help me. He is interested in approximating my body to a hypothetical body, diagnosing this hypothetical body according to a knee-jerk response (‘experience’, he would call it), and in getting me out of the door as quickly as possible convinced that he has assisted me and done his job. He is wrong, and more troubling, he is deluded about himself and the work he is doing.
Again, don’t get me wrong. There are lots of good doctors! But we shouldn’t assume that each and every one that we meet will be good. Trust and respect should be earned. I’ve written before about the work of Ben Goldacre and others in examining the medical profession’s underside, where it is not science-based or acting in patients’ best interests. I do wonder whether programmes like Trust Me, I’m a Doctor, which don’t at least touch on the fact that medical professionals must take some responsibility for the prevalence of myths around health and well-being, may be doing us a disservice by building false confidence in doctors.