What You Should Measure that Your Doctor Doesn’t

Jim McCarter, MD, PhDQuantified Self St. Louis Meetup

January 21, 2014

Medical Discoveries…

• … can take a generation to become mainstream standard of care.

• The Quantified Self Movement is out ahead.

Measure What Matters

Business Maxims …• “What gets measured gets managed.” • “You become what you measure.”But also …• “Be careful what you measure because that’s

what you’ll get.”

I think our challenge in QS is to figure out what is worth measuring.

What do I measure?

• Work• Sleep• Mood• Weight• Steps• Stairs• Exercise• Heart Rate• Blood Pressure• Food Log• Body Dimensions • Body Fat• Blood Chemistry …

– Glucose & – Ketones (beta-hydroxybutyrate)– Triglycerides, – LDL & HDL cholesterol particles– Omega 3 & 6 fatty acids

What do I measure?

• Work• Sleep• Mood• Weight• Steps• Stairs• Exercise• Heart Rate• Blood Pressure• Food Log• Body Dimensions • Body Fat• Blood Chemistry …

– Glucose & – Ketones (beta-hydroxybutyrate)– Triglycerides – LDL & HDL cholesterol particles– Omega 3 & 6 fatty acids

Daily

As Needed.

What do I measure?

• Work• Sleep• Mood• Weight• Steps• Stairs• Exercise• Heart Rate• Blood Pressure• Food Log• Body Dimensions • Body Fat• Blood Chemistry …

– Glucose & – Ketones (beta-hydroxybutyrate)– Triglycerides – LDL & HDL cholesterol particles– Omega 3 & 6 fatty acids

Daily

As Needed.

Today, I’ll discuss omega 3 fatty acids & why they are worth measuring.

• Omega 3s are essential polyunsaturated fatty acids (PUFA). • Omega 3s originate in algae, are high in oily fish, and

underrepresented in western diets.• Omega 3 consumption reduces cardiovascular disease risk in

prospective randomized controlled trials & epidemiological studies.• Other benefits may include decreased risk of stroke, prevention of

cognitive decline & arthritis, decreased inflammation, etc.• American Heart Association recommends 2 servings of fish weekly,

1 gram DHA & EPA daily for patients with Cardiovascular disease

Omega 3 Fatty Acids

DHA - Docosahexaenoic acid, 22:6(n-3) EPA - Eicosapentaenoic acid, 20:5(n-3)

I eat fish so I’m probably fine, right?

• But do I eat enough, often enough, and the right species?

• And if I supplement, how do I know that it’s the right amount? (Overdosing is possible in animal models – immune modulation)

• Omega 3 is not part of a standard medical blood panel.

Simple Hypothesis-Driven Science

• Measure, Supplement Diet, Measure Again

• Vital Choice Omega 3&6 HUFA Blood Test(October, 2012)

• 900mg Omega 3 Daily– 300mg Algal DHA X 2 – 300mg Algal DHA & EPA

(6 months, algal – sustainable, no fish odor)

• Repeat Blood Test(April, 2013)

Before Supplementation, EPA and DHA Levels Were Slightly Above US Average

% FA US Ave JimBefore

EPA 0.59 0.88DHA 2.59 2.88Total Ω3 4.82 6.72%Ω3 in 24.12 33.04HUFA

Still in the range of cardiovascular disease risk.

After Six Months of Supplementation, EPA and DHA Levels Increased About 80%

% FA US Ave JimBefore After

EPA 0.59 0.88 1.61DHA 2.59 2.88 5.14Total Ω3 4.82 6.72 10.01%Ω3 in 24.12 33.04 42.00HUFA

Is this enough to matter? Actually yes.

A 9% Increase in Omega 3 Decreases Cardiac Risk 25%

33% (before)

42% (after)

What About Other Health Indicators from 2012 to 2013?

Triglycerides

139

75

• While not all attributable to omega 3 as I was making other dietary & lifestyle changes, trends were favorable.

• What’s Next? … From 2013-14, increased daily Ω3 supplement from 900 to 1200mg, added flax cereal to diet. Results pending.

LDL

98

91

HDL

78

46

Resting Heart Rate

65

55

Quantified Family – My Wife’s Experiment

• How do sardines & rice as a late night snack match up to supplements? Pretty well!

• What’s next for the Quantified Family? – Let’s measure the kids.

33% (before)

42% (after)

44% (sardines)

Omega 3 is Becoming Big Business

• $2.1B in Supplements, Growing at 15%

• 2011, DSM buys Martek for $1.1B• 2012, DSM buys Ocean Nutrition Canada for $140M• 2012, BASF buys Pronova for $920M• 2013, FMC buys Trygg for $345M

• Omega 3 is showing up all over

From Quantified Self to Action• “Quantified Us” – Shared Data, Crowd Sourced Experiments• “Altered Us” –Change based on “actionable intelligence”• This experiment is currently too expensive to scale.

• Algal DHA $0.27, Algal DHA + EPA $0.83 = $500/year• HUFA Testing $129 X 2 = $258 (mail order, 1 month plus turn-around)

• My wish-list to see a big effect• DHA & EPA supplements or in diet for $10/year• HUFA Testing $5 X 2 = $10 (1 minute turn-around)

Increased Omega 3 levels could substantially decrease US heart disease deaths from the current 600,000/year.

Thanks!