Tuesday, August 6, 2013

The Quantified Self, Qualified

I've said on a few occasions here that the single biggest change I made when I began to get healthy was paying more attention. By that, I mean to my physical self as a whole. I started behaving as if I actually *am* a body made of flesh and bone and neurotransmitters. In my line of work, as an academic, it is surprisingly easy to go through days, weeks, months, and years doing otherwise. I call this "brain in a jar" syndrome. Over time, though, I found ways to pay attention to specific things about my physical self, specifically what I was eating, what activity I was doing, and how those things influenced my overall health and well-being in measurable ways.

I've talked about mindful eating, for instance, and how important the simple act of keeping track of what you eat each day can be. Tracking what you eat allows you to reconcile inputs with outcomes that you are trying to manage, like your blood glucose if you are controlling diabetes symptoms, or your blood pressure if you are managing cardiac risk. It can also, of course, help you adjust eating habits to meet goals related to body weight (losing, maintaining, or gaining).

Paying attention is, in itself, something that seems to have positive effects on goals many people share such as weight loss. My view is that paying attention is necessary, but not sufficient to be healthy. Others who posit a more direct relationship between paying attention and achieving healthy outcomes might say that the problem is one of a lack of knowledge due to insufficient information. My view is just a little different. My view is that it is a lack of *feedback* needed to determine if actions taken in the present are actually getting you somewhere. It's a subtle, but important difference.

Let's take weight gain/loss as one example. It doesn't happen quickly. That is a good thing and a bad thing when it comes to what you are eating on a given day. On the plus side, it means you can have birthday cake on your birthday. That piece of cake won't make you unhealthy, it likely won't contribute in a measurable way to your weight one way or another. If you have a piece of cake every day, well, that's another story. Unless you compensate for that in other ways, you might well see this new pattern start to produce new outcomes as time wears on.

Making changes that improve your health, especially lifestyle changes known to improve chronic disease symptoms such as high blood pressure, also may not have obvious effects very quickly. Even when you are on the straight & narrow, it is hard to know you are on the right path if there aren't any road signs. What paying attention lets you do, though, is keep track of the path. Even if you aren't seeing the destination (because it is yet over the horizon). The pattern of new behavior, itself, can begins to take shape on paper or, increasingly, on a computer screen.

Flying By Instruments
In the last several years, a range of new devices have been introduced designed to track activity, sleep, and other things. All of these can sync with computers and/or mobile phones, too, so that the data collected can be visualized and tracked with relative ease. Medical devices, too, can provide data streams. And because much of the logging work is passive, the act of paying attention to each little detail (such as how many steps one has taken) becomes easy enough to do routinely.

I've written about how I charted my eating & blood glucose levels like a mad scientist when I was first diagnosed with T2DM. That tells you how much I enjoy this sort of thing. So I've been looking forward to getting one of these tracking systems - I say system because we are really talking about one or more sensors + the log/visualization application - and seeing what it could do. I've been using one of these, a fitbit flex, for a few weeks now. And last week, I undertook to save some reports so I could reflect and share them a bit here. I had some initial trouble with the first flex I received, which was frustrating. It simply wouldn't wake up and track anything. But after a couple of weeks, the company sent me a new one and it has worked fine ever since. I really like it, in fact. But this is not a product review. My aim is to show you how the information allows me to pay attention to things and, importantly, what I try *not* to obsess over amidst all the data available to me now.

Broadly speaking, my goal in using the fitbit is to monitor how well my day-to-day, often subconscious choices about what to eat, drink, and how to move through the world might influence my health-related goals. Do they bring me closer to them? Do they take me further away? Or, more subtle, do my choices take me on a garden path rather than a beeline for my most important goals? That is, are there adjustments or course corrections I can make that could add up to something better? Since the course I'm navigating is long (in this case, there is no true destination or end state other than "being healthy"), I can't see where I'm going. In some cases, the outcome itself is invisible anyway because the indicator is an internal bodily state (e.g. blood pressure in a healthy range). No visual flight rules, in other words. Before, I was flying mostly by feel. Now, I'm flying with instruments.

My Week with Fitbit
The graphs I'm sharing here are not the day-to-day visualizations from the fitbit dashboard. Those are cool, and they give you a sense of what you are doing on a given day. Those displays have altered my behavior already. I'm motivated to hit my step goal (don't ask me why...it's hard wired for some reason), so I'll work out ways to get an extra walk in. I'm also motivated to keep my calories in/out balance acceptable, even though I'm not terribly concerned about calories as a measure of what I eat. That balance is a pretty good indicator of my more general goal of "moderation." But when it comes to nutrition and its role in my overall health, I care more about the type of food those calories come from. In that regard, the chart below is very helpful for me.


Where did my calories come from?
With a weeks' worth of meals as input, this chart shows me that I'm achieving the balance I hope to with regard to carbohydrates, fat, and protein as components of my diet. I also see that I generally use more calories than I take in on a given day, but that this difference is not so extreme that I would see changes in my weight beyond a pound or so. My numbers for carbs and fats are low and high, respectively, the report notes. That's ok for me, though, since I'm doing diabetes. My fats tend to be the healthier ones too (Omega 6 & 3, which this report doesn't show).

The data to build the chart above comes from self-reporting via the fitbit dashboard food log, not the sensor I wear on my wrist. Maybe one day soon, I'll have an implant that allows for passive collection of nutrition data, but not yet (hey, a geek can dream, no?). So let's have a look at how I used up calories last week using data the sensor does collect.


Overall Activity Compared to My Gender/Age Group (U.S.)
I know that some of my friends and family think I'm some sort of crazed exercise freak. Probably due to all those 100 mile bike rides. But really, in an average, week, I'm not spending hours and hours exercising. Last week was pretty typical. And it puts me on the high side of the curve for my age and gender demographic...but not way, way out there in terms of overall activity (measured by calories burned). What is more interesting is how I achieve that. I don't have a job that has me moving very much. In fact, my line of work may well pose the single biggest threat to my health these days given that I manage everything else pretty carefully.

My point is that I have to get to an "active" lifestyle by being very conscious about moving during a given day. I have to make time for it and make it a deliberate part of my routine. Sometimes this involves making small changes in my habits like parking farther away from a building rather than closer. It also means I need to plan for some "very active minutes" to offset my hours of butt-in-seat time at work. And fitbit helps me track those very active minutes too.
My Very Active Minutes Compared w. U.S. Population
Ah...now we see a big difference. I averaged 78 very active minutes per day during my week, which puts me way out on the long tail (so far, you can't see my little green line very well in the graph on the right). A couple of things are also worth noting. This reflects not only my walking, but also my planned exercise, which included two runs and two bike rides. This is a pretty normal number of exercise sessions per week (four) but is a slightly higher amount of overall minutes because it is summertime. I am not training or preparing for any events, though, so this is about as baseline as we can get. A good overall picture of how I try to stay active in a job that doesn't involve much movement.

Something new to pay attention to, for me, is sleep. The Flex tracks sleep patterns, including how long it takes me to fall asleep and how many times I am awake and/or restless overnight. It uses those to compute a sleep efficiency score, which I really had no reference for prior to seeing the results on my dashboard. I have always been - knock wood here - a good sleeper. I can fall asleep easily and wake up easily. I sleep soundly, rarely get up during the night, and can sleep in all kinds of different conditions (hot, cold, noisy, bright, etc.). No complaints. And I don't take this for granted. Sleep is awesome. Thank you, sleep.

With the data I can see, I am somewhat validated in my sleep identity. I'll spare you the charts, as they are kind of boring, but I'll say that I sleep about as much as others my age and gender (about 7hrs per night last week, on average) and that's in the recommended range. I sleep a little more soundly than most (with 96% efficiency, meaning that I don't wake up often once I nod off) and I go to sleep quickly compared to most (within 7 minutes, on average).

Result: Steady as (s)He Goes
So what's the point of all of this? It's a happy and relatively straightforward one for me, at this point: my actions are in line with my goals. I'm doing what I hope to be doing, for the most part. And I'm doing it consistently. I'm not trying to lose or gain weight in significant quantities, and I'm not likely to based on my activity last week. I'm looking to stay active through the day even when I'm spending lots of hours sitting. My active minutes are good, but my overall activity shows that I have to remain vigilant given that my workday makes it all too easy to be sedentary.

All of this gives me confidence, via the feedback loop established here, that my choices are good ones. If I keep making similar choices, I'll likely see the results I want to see. This, to me, is the real benefit of the "quantified self" technology craze. It is not something to be found in the volume of information itself. It is the confidence that comes from seeing evidence that your actions are aligned with your goals. That's a qualitative thing from all this quantitative data.