For years I have endured a broken body.  I equivocated that things weren’t so bad, others had similar problems, etc.  Then I fixed things – and life is better.  Don’t ignore a broken body.  Fix it.

I feel like this dog. © steve ball - Fotolia.com

Broken Breathing

Problem: Can’t fucking breathe.

Nisqually Glacier on Mt. Rainier – altitude 9K ft.  I’m taking three breaths per step and dry heaving.  Can’t fucking breath.  My climbing partner Julie is totally fine – she pitches camp early because I am weak and wimpy.  We don’t summit.

Ben: ‘You must have really worked hard to get into great shape.’

Julie: ‘I’ve played a bit of frisbee – but really I’ve been a bit lazy’

Ben: ‘What?  I’ve been kicking my ass for months preparing for this – how are you kicking my ass up here?’

Julie: ‘Doesn’t sound right – maybe there is something wrong with you.  Ever heard of exercise induced asthma?’

For my whole life I’ve dealt with being a terrible cardio athlete and puking with exhaustion on long hikes – especially at altitude.  I equivocated by telling myself I ‘just wasn’t good at cardio’, ‘must be out of shape’, ‘don’t adjust well to altitude’, etc.  All reasonable possibilities.

These were reinforced when an exercise induced asthma test in Boston post-Rainier showed all clear.  I let things lie for another few years and continued gasping for breath.

Fast forward to last December.  I had arrived in Jackson Hole and spent a couple days truly gasping for breath at 6-10K feet.  Damn altitude.  I started going to the gym (Mountain Athlete kicks ass) and puking during every workout.  Damn my deplorable fitness level – which was a wee bit confusing considering I had been training hard for over a year.  My friends arrived and acclimatized better in a day than I had in a month.  A 3600ft ski tour left them tired and satisfied – it left me puking, wheezing, and sick as a dog.  WTF.

Another friend echoed Julie.  ‘This doesn’t sound right – let’s go see a doctor.’

To make a long story short – 4 doctors and a huge exertion of personal willpower later I arrived at a diagnosis of exercise induced asthma.  It’s triggered by altitude, cold, and dry air – ie. wouldn’t show up on a test indoors in Boston.  I’m now on some lovely steroids (Advair) and a rescue inhaler (Ventolin).  On a similar 3400ft ski tour post-medicating I felt amazing – I could have turned around and done the whole thing again without trouble.

Broken Digestion

This is a story about my shit.  Feel free to skip it

Problem: Poor digestion pretty-much all the time - diarrhea, bloating, etc.

A Paleo diet fixed many things in my body – but digestion remained terrible.  I resolved to finally fix this after having lived with it 10+ years.  Other people seemed to have no digestion issue whatsoever.  Curious.

Traditional Medicine: GI doc tested me for really nasty stuff like Giardia and Celiac – said I was clear of all that – and was left only with the squishy/bullshit diagnosis of Irritable Bowel Syndrome.  Basically - ‘If patient is still complaining of poor digestion and we don’t know what’s up – diagnose with IBS and tell them to choose a less stressful life.’

Alternative Medicine: Got a stool analysis at Your Future Health.  Had a great discussion with a specialist over there who basically said ‘your gut is full of bad bacteria – you need to wipe it out and get some good bacteria in there.’  Solution: Monolaurin and Citric Seed Extract to kill the bad stuff, a probiotic to boost the good stuff.  I was strongly discouraged from taking antibiotics.  I did that supplement stack for 2 months before giving up with nothing to show  for it.

The actual solution was a complete accident.  I took a course of antibiotics (Z-Pack) to clear a suspected sinus infection.  I was still taking a probiotic daily.  Within a week my digestion problems cleared up completely and unexpectedly.  I took an enormous amount of satisfaction in my single well formed daily shit.  Now when I have digestive problems they are easily diagnosed – I did something dumb like drinking or eating tons of crappy food.

Messed-Up Thyroid

A wellness blood screening revealed a TSH of 11 (normal range .3->3).  This was my brain not-so-subtly screaming at my body to produce more thyroid hormones.  I didn’t have any of the typical symptoms of hypothyroidism (lassitude, weight gain, dry skin) -  but I may have been on my way.  Experimenting with synthetic thyroid hormone replacement therapy (sounds scary – but it’s a pill a day and with no side-effects) has brought my TSH down to 2.9 and I’m headed lower.  This week I had an afternoon of brain-dead lassitude – and realized I hadn’t taken my thyroid meds that morning.  May have been coincidence – but I’m glad my body isn’t red-lining on thyroid function anymore.

Lessons Learned

• Fix Your Body.  I’ve experience a substantial improvement in my quality of life just fixing my asthma and digestion.  It was worth the difficult path and expense to get to optimal health.
• You Are Responsible for Your Health.  Doctors and others do their best – but they aren’t in your body and they are crippled by a lack of good tools and a fucked-up medical system.  Numerous doctors told me to stopping complaining about something that was ‘normal.’  Most docs would never test the thyroid level on a young male with no hypothyroidism symptoms.  I listened to these folks for years – and I’m glad as hell I started listening to my body recently.
• You Need to Be Smart and Dedicated.  It took me a ton of intellectual horsepower, $$$, time, a few brilliant friends, and a quantified-self approach to fix these problems.  I really don’t know what to do for the tons of people out there without all those resources…

I’m happy to report that I don’t know of any major remaining issues in my health.  I am keeping a watch on a few things:

• I’ve injured both of my shoulders in the past and have occasional pain.
• My right knee occasionally gives me trouble on long down-hikes.
• I think I have to get up to pee more often than I should during the night – but I don’t want to drink less water and get dehydrated.
• A couple maybe-not-optimal blood markers remaining: Vitamin D, Ferritin, Homocystene, ApoB.  I’ve got some supplementation going on and some other stuff planned to watch/work on this stuff.

There are a ton of other things I’m working on – endurance, getting ripped, balance, etc. – but in all these areas I’m striving for enhanced performance rather than fixing a deficit.

I’ll be listening to my body carefully and acting quickly to fix problems in the future.

I’ve been thinking about doping up for a while.  Pretty much everyone I get advice from recommends supplementation of some sort.  And it’s confusing – they all make different recommendations

But I’ve got an ace up my sleeve.  By measuring my specific deficiencies using blood markers, supplementing to move the numbers, and measuring again – I’ve got a nice quantified system to move me in the right direction.  And even better – I’ve got expert advice.  After getting my bloodwork back I’ve had the chance to chat with Dave Asprey and Andrew Clark of http://www.bulletproofexecutive.com/ and Dr. Ross Pelton.  I’ve got a conversation scheduled with an MD to complete the set.

Here are the specific recommendation - starting with what’s deficient and moving on to what to do about it.

The Good

Let’s start with some good news.  Overall I am quite healthy.

Total Cholesterol 155, LDL 74, HDL 63, Triglycerides 42.  This is pretty awesome – here is Mayo Clinic on what to aim for.  I am particularly happy about these numbers because many people grumbled about my Paleo diet on the basis that is would cause high cholesterol.  Nope.  Most of the more detailed lipid measures also came back just dandy.

My fasting insulin level is 5.0 uU/mL.    Medical science says stay under 9.0 uU/mL, a great blog post over here suggests 2-6 uU/mL.  So I’m good – we will see what my experiment with intermittent fasting does – may get my fasting insulin levels even lower.  Todd Becker suggest getting levels as low as possible.

Lot’s of other stuff – electrolytes, liver, kidney, renal, thyroid, none, hormones etc. all look good.

But let’s focus on what can be improved!

Inflamation

Inflammation is described as the scourge of the modern lifestyle – and a source of major problems – everything from arthritis to heart disease is implicated.  Dr. Ross calls inflammation ‘the core of all health issues’.

And it looks like I’ve got some.

Lp-PLA 203.0ng/mL

• High Risk > 236
• Intermediate 200 - 235
• Optimal < 200

hs-CRP 1.97 mg/dL

• High Risk > 3.0
• Intermediate 1.0 – 2.9
• Optimal < 1.0

The course of action?  Omega-3s.  I’ll be taking fish oil (and maybe krill oil).  One tablespoon a day.  I may overload for a few weeks with two tablespoons per day.  Aiming to get both Lp-PLA and hs-CRP into the optimal range.

Fibrinogen

A marker for blood coagulability - linked to blood clots.  Again I’m in the intermediate range.

Fibrinogen 444.0 mg/dL

• High Risk ? 465
• Intermediate 391 - 464
• Optimal < 391

The recommendation here – aspirin and fish oil.  I have some concerns about aspirin and I also have some digestions issues with it.  So I’ll stick with the fish oil and see if the marker moves just based on that.  Goal is to get into optimal range.

Homocysteine

Elevated homocysteine levels cause damage to arteries – increasing cardiovascular risk levels.  This is the sort of thing that can sneak up on you, plaque up your arteries, and cause a heart attack in 20 years.  Better to have homocysteine levels low.

Homocysteine 10.0 umol/L

• High Risk > 13
• Intermediate 10 - 12
• Optimal < 10

A cocktail of B Vitamins are called for.  Vitamins B6 (25mg twice a day), B12 (1000ug), and B9 (folic acid 800ugram) are helpful in metabolizing homocystene.

I’m going to lump Apo B in here as well.  I’m at 66 mg/dL,  Apo B of <60 mg/dL is optimal.  Extra vitamin B3 (Niacin) 50mg twice a day will help this.

I’m going to use a B-Complex supplement to combine all of that and add some other goodies.  Twice per day and it hits most of the above.

We are aiming for homocysteine levels of 7-8 umol/L going forward.

Vitamin D

Chronic disease prevention, immune system boost, etc.  Vitamin D delivers it all – and I am pretty deficient.

25-Hydroxy Vitamin D 27.0 ng/mL

• High Risk < 15
• Intermediate 15 - 29
• Optimal ? 30

On this Dr. Ross agrees with Dave Asprey and many others – the ‘Optimal’ range is really 60 mg/mL or higher.

Vitamin D can be obtained by spending hours in sunshine each day – hard with an office job and during winter months – or through supplementation.  I’ll be taking 10,000 IUs per day for a few weeks, then 5,000 IUs thereafter.

Since Vitamin A and D are both fat soluble – large levels of supplementation with D can interfere with A absorption.  Dr. Ross suggests taking vitamin A (25,000 IUs per day) to compensate.

Co-enzyme Q10

Suggested by Dr. Ross – this one is a bit more subtle.  Co-enzyme Q10 is a powerful anti-oxidant.   It impacts energy production at the cellular level – and may be especially important for me due to a particularly active lifestyle.  Dr. Ross says Co-enzyme Q10 is ‘the most important life-extension substance around.’

My B-Complex supplement has a tiny bit of this (500ug compared to the 10mg suggested) – but since I’m adding all of the drugs above at once – I’m not going to double down on this one yet.  There’s plenty of time to experiment with this later.

Mind-Enhancing Drugs

Almost everything related to blood markers is working on the body.  What about the mind?  Building a bulletproof mind is next.  I’ve got an eMwave 2 on the way, Dr. Ross’s book Mind Food & Smart Pillls ordered, and I’m ready for researching this next frontier.  Expect a future blog post.

Multi-Vitamin

It’s also been suggested that I take a ‘good multi-vitamin/multi-mineral.’  Im honestly not even sure what that means – so I’m punting on it for now.

Summary

I will be adding the following supplements to my diet – from now until my next blood test (2-3 months from now?):

• Fish Oil/Krill Oil – 2 tablespoons per day for 3 weeks, then 1 tablespoon per day
• Vitamin D – 10,000 IUs per day for 3 weeks, then 5,000 IUs per day
• Vitamin A – 25,000 IUs per day
• B-Complex – 1 pill twice per day (question – can I just take 2 pills once per day?  Easier compliance!)

Good luck to me – I’d love feedback on this new protocol and on what to try next!

You know what would be fucking awesome?  If I looked like this:

And I think I can make it happen.  I  just need to change the strategies I am using to achieve the results I am looking for (throw in a bit of Tony Robbins…).

A Bit of History

About two years ago I topped out at around 200 pounds.  I wasn’t particularly overweight – just not in great shape.

My first Withing measurement a year and a half ago in October 2009 showed me at 187 lbs, Lean Mass 157.7, Fat 29.2.

Then I started eating a BulletProof/Paleo diet in July.  I started with Crossfit around January 15th.  As of February 11th I was 168.2, Lean Mass 155, Fat 13.2 (7.8%).  Around the same time we used calipers to measure fat percentage and came up with 9.9%.  Now I am not sure if those are correct – but at that point I was a bit leaner but still nowhere near fucking awesome.

As of today 173.6, Lean Mass 157, Fat 16.6 (9.5%).  So I added 2 pounds of muscle and 3.5 pounds of fat.  This feels about right.  I am not going to measure with calipers again for  week or two – but if the corresponding increase was about right it would show around 12%.

Where I Want to Get

Bodybuilding.com has a good article with pictures of different body fat levels for men and women.  According to this – my 10-12% puts me in the lean category – which is right where I’d like to be.  In reality I am somewhere between the lean and moderately lean categories.  I can grab plenty of fat around the waistline – which indicatesto me that achieving the body composition I want is primarily a matter of dropping that fat – rather than ‘this kid is just skinny as hell and needs to add muscle’.  Or at the least – I should drop that fat then add more muscle.

So I am a bit uncertain about the exact bodyfat percentages that my various measurement techniques are giving me – but it doesn’t much matter.  I’ll know the result when I see it in the mirror.  But I feel I need to be specific – at least with myself this will help.

So here goes.

Body Composition Goal

Not Muscular Enough

Not Lean Enough

Too Lean

Too Muscular

OK – enough staring at guys torsos – you get the idea.

My goal in terms of the numbers Withings is giving me:

Weight 170, Lean Mass 160, Fat 10 lbs.

So gain 3 pounds of muscle and lose 6 pounds of fat.  I’ll use that as a guide – but the visual is going to rule the roost.

Now here is my starting point:

Current Strategy

Let’s review what I have been doing for the last few months – then jump into my new strategy.

Food

I’ve been eating meat (grass fed beef, chicken, fish, pork, eggs, bacon), vegetables (onions, broccoli, asparagus, sweet potatoes, carrots, mushrooms) , good fats (grass-fed butter, olive oil, coconut oil), nuts, some dark chocolate, drinking 1-2 a week (2-3 drinks), once a week doing a eat-whatever cheat meal.

I have been eating around 4 times a day – - 7:30am, 1pm, 6pm, 9pm.  When I eat – I go for gold and eat tons.  I’ve been describing vegetables as ‘butter-delivery mechanisms’ for some time now (for reference – sweet potatoes can soak up an amazing amount of butter).  Why eat tons?  First off – I generally like to binge eat – and second – I’ve justified this because I have been working out and need to fuel muscles.

Exercise

Crossfit 2x a week – generally one metabolic beat-down and one powerlifting workout.  Once a week strenuous Vinyasa yoga, 3-4 times a week some combination of light skiing, climbing, cycling, jogging, etc.

Supplementation

Nothing.

New Strategy

This is where things get confusing.  What do I do to achieve my goals?  I’ve heard everything in the world – here are some of the options (some conflicting):

• Intermittent fasting
• Calorie count – eat less
• Calorie count – eat more
• Go low carb – less/no sweet potatoes, carrots, beets, etc.
• Supplement – so many options, fish oil, caffeine, Vit D, MCT oil, etc.
• More crossfit
• Switch to power lifting
• Do lot’s more cardio
• Food combination
• Eat more good fats
• Eat more protein

It’s very confusing.  I’ve done some research, gotten advice from my coach Johnny and from Dave Asprey and Andrew Clark (Bulletproof guys).  Here is the plan – feedback needed!

What to Eat

Stick with Paleo/BulletProof – but with the following modifications:

• Tons of veggies – and focused on the veggies to the left of the Bulletproof Diet chart.  So more broccoli, asparagus, spinach, Brussels sprouts, avocados etc. – and fewer onions, mushrooms, tomatoes, peppers.
• Plenty of protein from grass-fed beef, pastured pork and chicken, fish, pastured eggs
• Plenty of fat from the above meat sources, plus grass fed butter, coconut oil, olive oil, fish oil, MCT oil.  I am going to lay off massive amounts of bacon and butter – they are still part of the diet but I’ll do much more coconut oil/eggs etc rather than relying on butter for half of my calories…
• Small amounts of dark (75%+ cacao) chocolate are allowed – try to consume post-workout
• One cheat meal per week – anything goes.
• Carbs will come post-workout, and from sweet potatoes, carrots, beets, and berries.
• No other fruits (bananas, apples, pineapple, etc.)
• Limited nuts (on a salad, etc. is fine – but not otherwise)

When to Eat

I really liked the trial I did of intermittent fasting.  If implemented correctly I’ll be able to eat bigger meals when I do eat, lower my insulin levels , and be able to better regulate what I eat and how much since I am in control of my hunger and not the other way around.  I’d like to eat for two reasons: Fueling my body and for enjoyment.  I’d like to cut out eating because my insulin level has dropped and is making me ravenously hungry – this leads to poor food choices and overeating.

So I’ll give IF another try – this time for a full 30 days.  I’ll be following the leangains.com guide again.  Basically this:

• Eat only between ~12-8pm
• Have 10g of pre-workout BCAA if training fasted
• Eat more on workout days and less on non-workout days

How Much to Eat

This one I am conflicted on.  I’ve been eating a TON.  Like ‘how much butter can I eat with breakfast!’ a ton.  I think I should eat a bit less.  Especially on days when I am not lifting.  Save the ‘eat as much as I can’ meals for post-workout.

My worry here is as follows.  If it’s really the case that food quality is the important variable – then by limiting caloric intake a bunch of bad stuff will happen.

• Body starts thinking it’s starvation time – better store up some fat
• Start breaking down muscle
• Have less energy generally
• Get so hungry that I binge on bad stuff

But if I continue to pig out – will I lose those pounds of fat?  I just don’t know.

So here is what I will be trying:

• Track my food intake specifically for a week or so.  I will be using http://dailyburn.com/ to do this.  For instance, today:
• Don’t try to slam as many calories as I can – EXCEPT after a big workout.  Then eat like a king.
• Re-evaluate this in a few weeks.

Supplements

I experimented with supplementation a few months ago – I tried fish oil, vitamin D, magnesium, ALA, Acetyl L-Carnetine, and a few more.  I didn’t notice any major differences – so instead of sticking with it I just stopped.  I’d like to really determine what makes sense to supplement with.  It will take some time as I try things one by one for the most part – and measure the changes.

In chatting with the Bulletproof Executive – I showed him some recent blood work (from a super-secret startup).  We discussed some of the numbers – and while many comments were made – only one caused a gasp.  Both Dave and Andrew gasped at my Vitamin D level.  My 25-Hydroxy Vitamin D is  27 ng/ml.  This was flagged as of ‘Intermediate’ concern – with >30 being Optimal.  Their response was ’30 is super low for optimal – aim for 90 – mine is 115 (or something along those lines).’  So what should I do?  Either spend a few hours sunbathing every day (unlikely) or supplement with Vitamin D.  Dave suggested about 10,000 IU per day for a few months until levels normalize.  This feels like a ton – but I’ll roll with it for now.  Although an immediate effect will not necessarily be felt – immunity, resilience, and general health will improve.  Check out some of the benefits of Vitamin D here.

Exercise

I’m not going to change my exercise routine much.  I think it’s pretty much right-on:

• Crossfit 2-3x per week.  At least one metabolic and one strength workout – with the third my choice.
• Yoga 1-3 times per week.
• A bunch of low-level general activity: light cycling, jogging, rock climbing, hiking.  Try to do quite a bit of this – but not at high intensity.

What may throw all of this into confusion in a few weeks – I am going to have to start training for my Half-Ironman if I intend to do it.  Not thinking about that yet…

Compliance and Advice

I wish I was 100% sure of the strategy – but I’m not.  Please help out in the comments if you have suggestions.

In order to maintain compliance I am changing the Franklin Tracker to measure:

• Food – Stuck to What I Said I was Going to Eat
• Intermittent Fasting
• Daily Exercise
• Vitamin D

Last point.  I feel a bit vain choosing this as a goal.  Part of me doesn’t feel it’s a ‘worthy’ goal.  Well – fuck it.  Many of my goals are more worthy: strengthening family ties, volunteer, grow spiritually.  So I feel completely justified.  It shall be fucking awesome – and if want something – I’m not going to give a fuck what other people think.  Check that link out – The Complete Guide to Not Giving  Fuck – awesome post by Julien Smith.

Good luck to me!

My recent quest to become fucking awesome has got me thinking about the power – and challenge – of a 5% improvement.

Image: Salvatore Vuono

Here’s the rub.  Most changes you can make – let’s take nutrition/exercise as an example – will result in a small change.  Let’s say you add a protein shake after a workout.  This is unlikely to result in an immediate and noticeable change.  If an enhancement occurs it will be gradual and subtle – say a 5% change.  Unless you are carefully controlling the rest of your life and fastidiously measuring everything – a 5% change will feel like no change at all.  One could easily come to the conclusion that the protein shake didn’t work.  And even if you did notice – what’s a 5% improvement anyways?  I’m looking for MASSIVE changes.  Next!

5% Matters

But a 5% change is massive – if you can pile a few on-top of each other.  In the same way that compound interest makes us rich – pilling small gains on-top of each other makes us fucking awesome.

Five 5% changes = 27% gain

Ten 5% changes = 63% gain

Twenty 5% changes = 163% gain

And the reality is – once you are past the beginning stages of change in a given area (where it’s easy to make huge progress) – it’s much more likely that you can find a few handful of small changes that work rather than one huge change.

It’s also the case that a single change can take place extremely slowly – 5% at a time – until eventually you can see it’s work.  Improving your eyesight works like this.  Saving a few seconds on lots of things saves your time and effort for what is important.

The challenge of 5%

OK – so we have established just how important those 5% changes are – but there is a huge problem associated – that of measurement.  How can one adequately detect 5% changes?  Unless the effect is immediate and the object of measure is extremely predictable and measurable – a 5% change can be impossible to detect.

So if you lift a barbell at X weight with Y reps under the same conditions every morning – and max out consistently at Y – perhaps a 5% change can be detected from a supplement or routine change.  But for most of activities and for most people who don’t exquisitely control their circumstances – a 5% improvement will go unnoticed.  So much for the ‘try this and if it works for you keep it’ mentality – it will not work here.

This is the point in the blog post where I am supposed to have a solution to the question laid out.  Tough luck – I’m still struggling with this one.  Here is what I am thinking about:

Bundle it

So one 5% change doesn’t make a measurable difference – but a bunch together will.  Take the supplement list in my fucking awesome plan.  I don’t expect most of the supplements to make a huge difference individually.  But with the right bundle I think substantial progress can be made.  So instead or trying each sequentially in a controlled fashion – I’ll be bundling supplements together – measuring effect – and then taking them as a group.  For now I won’t attempt to tease them apart too much.  I’ll be organizing bundles of supplements that should effect the same systems – like energy, digestions, mental clarity, etc.

There is a chance that some of the inputs will work at cross-purposes to each other – but I feel pretty safe applying 5-6 variables as one and determining whether they worked as a bundle.

If it’s a Good Idea – Just Keep It

I’m not a fan of supplementing nutritionally where it isn’t doing me any good – and could easily be doing me harm.  But there are some changes that I should just adopt – they have a possible upside and no downside (and little/no effort beyond the initial change).  So don’t worry about how the measurement turns out – just adopt.  Example:  Follow my dentist recommendation and get an electric toothbrush.  Small cost, then same routine – and maybe better results.

I am not quite satisfied with either of these methods – but I’ll let you know as I experiment how they go – and let me know if you have suggestions!

I recently posted about that magical place on the web where we all store of health data – the Personal Health Record.  Except we don’t.  What about compatibility at the device level?  Shouldn’t my heart rate monitor, weight scale, and blood pressure cuff all speak the same language?  That’s the idea behind the Continua Health Alliance.  Continua has a wonderful vision – but my prediction?  It isn’t going to happen.

Top Reasons Continua is Going to Die

1. Continua is a closed standard.  You need to be a member and pay real $ to get access.  It isn’t big bucks – but this is the WRONG way to build a standard these days.  World-changing organizations start in the garage these days and by the time they join standards organizations their products are already built.
2. Continua is bloated.  Want your Bluetooth health device to be Continua compliant?  You’ll need to support the Health Device Profile.  This is a higher-level protocol that many Bluetooth stack vendors do not support – and if they do it will cost you $, memory, and complexity.
3. Meager support from hub devices and smart phones.  OK – so you went through the pain of making a Continua supported device.  Now life will be good an your device will connect to a bunch of cool stuff – right?  Nope.  iPhone 4 doesn’t support HDP.  Droid doesn’t support HDP.  In fact – after four and a half years of operation there is only ONE hub device and ONE cell phone that support Continua standards for Bluetooth.  Fail.
4. It’s easy to get your data to the cloud in other ways – and once it’s there you can use Open Web APIs to connect it all together.  How do health devices get their data up today?  Bluetooth SDP, Ant+, WiFi, 3G, PCs, smart phones, home routers, and dedicated devices – the list is endless – almost no one uses Continua standards – but data still moves.
5. It’s not cheap to get tested for Continua compliance.  They appear to be taking the a heavier regulatory approach to certification – ala FDA, FCC, and Apple.

What do we really need?

1. Truly open standards that are freely published and free to use.
2. Adopt the an Android-like self-certification process for Continua devices – like this: “There is no cost to obtain Android compatibility for a device. The Compatibility Test Suite is open-source and available to anyone to use to test a device.”
3. Both devices and services for health should be open.  That way if standards compatibilities arise (as they inevitably will) – individuals or groups can adapt the software and hardware to suit their needs.

I share the Continua vision - seamless connectivity and data transfer between consumers, patients, doctors, social circles, services, etc.  And for all the knocking – Continua has made admirable efforts to move us all in the right direction.  Let’s hope they pivot the standard more towards open – and we may see progress on adoption.

The Personal Health Record is Dead.  Long Live the Personal Health Record.

We are generating increasingly large amounts of electronic health information.  Runs tracked using GPS, blood glucose on our smart phones, sleep tracked using a headband, your hospital records in an Electronic Medical Record, etc.  It seems obvious that all of this information should end up stored in one place and accessible to whomever you choose to give access to.  And all of this data needs to be connected to various services that make use of it. Upon this premise the Personal Health Record was built.  Microsoft HealthVault and Google Health are the two most notable contenders - and most people use one or the other to store their health data.  Wait.  What?  Actually – NO ONE uses Google Health.  Or Microsoft Healthvault.  Or any other PHR.  What gives?

People ARE tracking their health and generating enormous amounts of data.  But they are NOT using PHRs.  I spoke with a very well known provider of athletic services (data analysis, coaching programs, etc.) this week who had integrated his product with Microsoft Healthvault.  They jumped through numerous hoops to get their service linked up – all for a less than 100 users who linked accounts.  I personally have both a Google Health and Microsoft HealthVault account.  I use neither.  Why?

Chicken and Egg

A Personal Health Record needs three key components to be successful.

• Data – Automated data entry – health records, fitness metrics, weight, sleep, etc.
• Services – Data is no good by itself – it needs to be connected with smart analytics, advice engines, content, community, doctors, etc.
• Customers – Someone must be using all this stuff together.

All three must be present for a healthy ecosystem – and a classic chicken and egg situation emerges.  It can be hard to get initial traction.  No one will build services without data streams and customers.  Device manufacturers don’t bother to hook up to take advantage of no customers and services.  We aren’t there yet – of the three the data sources are the most connected – with services and especially customers lagging.

Skip the middleman

In new industries ‘compatibility’ with other solutions doesn’t matter.  There is nothing to be compatible with.  One must create the entire customer experience from soup to nuts.  Hence the first Ford cars had most of it’s parts made by Ford.   As industries grow and mature different companies find their niche and begin specializing.   Nowadays your Ford car has parts from thousands of independent suppliers – Ford tied it all together for you.

We are in the early days for digital health services.  For the most part – today – if you want to offer a solution to a customer you need to build the WHOLE product out.  A good example is Zeo.  When we started designing the product years ago it became clear that we needed to cover the whole value chain from sensor -> electronics -> data analysis -> coaching.

In a more mature ecosystem companies have a choice – they can specialize.  Consumers can mix and match hardware, software, and services.  In this more mature ecosystem there is definitely a place for a central data store/PHR.

What happens now?

In the short-term devices will begin to open up, services will begin to emerge to take advantage of these open platforms, and customers will connect their individual devices to individual services and make use of both.  This will work well for quite some time.  Then – eventually – things will start to become unwieldy.  Two or three data sources and a handful of services will turn into a dozen data sources and a dozen services.  And the PHR will be there – ready to tie things together.

The PHR is dead.  Long live the PHR.

I wrote this article for the Burrill Consumer Digital Health Conference:

http://www.burrillandco.com/digital_health/

Zeo has been asked to present on March 23rd 2010 in San Francisco alongside other innovative companies and thought leaders in the burgeoning new Consumer Digital Health market.

“Sleep Unbound”

From smart phones to social networks to sensor platforms, a wave of technology innovation is revolutionizing the way that we care for our health.  The potential to enhance care has never been more present, but often tantalizingly out of reach.  Our formal healthcare institutions are becoming ossified – regulators are wrapped in a legislative bind, payers are cautious about adopting new technologies, and hospitals’ and doctors’ traditional role in the center of the healthcare industry is threatened by new technology that puts the patient in the driver’s seat.  As a result, key new advances are moving slowly from the lab bench to patient care.

Contrast the outdated healthcare system with a vibrant market for consumer digital health.  In consumer health, new technology and consumer needs are being brought together by a new wave of innovators and entrepreneurs.  The barriers to adoption are simpler to understand – usability, value to the customer, awareness – and these barriers are easier to overcome.  The friction encountered is that of any new product entering a market – free of artificial friction created by embedded interests, bureaucracy, and regulation.  As a result big companies and brands will be built in consumer digital health, and the benefit will extend beyond consumers back into the healthcare system as people take control of their health and wellness.

The world of consumer sleep is particularly ripe for innovation.  Over 25% of Americans experience inadequate sleep on a weekly basis.  The average time spent in bed is 6.9 hours, which is far less than the 7-9 hours recommended.  The result is a chronically sleep deprived population.  In addition to fatigue, lack of sleep has recently been linked to virtually all major disease classes, including obesity, diabetes, and cardiovascular disease.  We need to take our chronic sleep loss more seriously – and new technology can help us begin to take back control.

The SoftWave sensor technology invented by Zeo allows simple in-home measurement of sleep, including the critical restorative Deep and REM sleep phases.  Zeo is revolutionizing the way people sleep by connecting consumers with objective data on their sleep patterns and offering them personal coaching advice to help them make improvements in sleep.  Forrester coined the term “healthcare unbound,” described as “Technologies in, on, and around the body that free care from formal institutions.”  Zeo is enabling sleep unbound – the ability to measure sleep in the home opens up unlimited possibilities for self-care and behavior change.  As Dr. Quanta Ahmed said recently in the Huffington Post, “Products such as the imaginative Zeo will play a key role in raising the national consciousness of a fundamental principle: the more America knows, the better America sleeps.”

Zeo is well positioned to become the consumer health leader in measuring and improving sleep.  We believe many of the same factors that make the consumer sleep market so attractive apply broadly across consumer health and wellness.  Just witness innovative work by consumer-driven companies such as 23andme for genetic testing, or Nintendo with their Wii Fit products.  New technologies are for the first time able to address powerful health and wellness needs.  The consumer market lies open… while roadblocks are plenty for patient populations.

This blog will focus on entrepreneurship, the world of self-tracking, technology, and other random topics.

Here is what I hope people will get out of my posts:

• I am deeply involved in ‘tracking everything’ – its a powerful way to learn about your life and make positive changes.  This blog can become a resource for people interested in following a similar path – I will talk about what works for me, what doesn’t, and make suggestions for the future.
• The last six years at Zeo have taught me a great deal about entrepreneurship, product development, manufacturing, hiring, financing, etc.  My posts about what I am experiencing and what I have learned may help others.

Here are a few of my goals for becomingawesome.com:

• Begin discussions with interesting people – entrepreneurs, self-trackers, partners for Zeo, etc.
• Have a forum to expound on issues that matter to me, generally entrepreneurship related but also other topics from time-to-time
• Evangelize Zeo
• Create a nice incentive for myself to begin ‘tracking everything’

As the content and readership here develops I would appreciate any and all feedback, either through blog comments or to ben@becomingawesome.com

About me:

I started as an entrepreneur early – in 9th grade an interest in computers led to forming a computer hardware and services company – PCsforYOU. I was bitten by the entrepreneurial bug and believe I will be happy founding companies for quite some time. I am currently the Chief Technology Officer for Zeo Inc. – a technology startup that has created the world’s first personal sleep coach.

I went to school at Brown University and graduated in 2005 with a degree in Computer Engineering. I began my career working for BBN Technologies as a Systems Engineer. BBN was a technology playground (they invented the Internet!) and while there I worked on robots, embedded Linux, and ad-hoc mobile networking.

During my junior year at Brown (2003) I co-founded Zeo – the goal was to create a product that made groggy mornings a thing of the past. Our breakthrough SoftWave sensor technology measures brainwaves comfortably in the home and accurately tracks sleep phases throughout the night.

We launched the Zeo Personal Sleep Coach into the market in 2009 to rave reviews. We have since been featured in the Wall Steet Journal, the New York Times, the Today Show, etc.

Outside of work I spend my time climbing and skiing mountains and maintain a strong interest in world politics and international relations as a carryover from my Model United Nations days at Brown.