better data, better results how to optimize your nutrition · a nutritionist in your pocket 55 10....
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© 2018 | Intake
BRIAN BENDER, PHD
The Complete Guide to Personalized Nutrition
BETTER DATA, BETTER RESULTS
How to Optimize
Your Nutrition
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Table of Contents1. The Current State of Nutrition 3
2. Why Personalize? 9
3. You Are What You Eat 15
4. Blood, Sweat, & Tears 19
5. Fitting Into Your Genes 24
6. Your Personal Cost to Living 31
7. Flushing Data Down the Drain 47
8. Get Your Sh*t Together 51
9. A Nutritionist in your Pocket 55
10. Diet-Tracking 58
11. Better Data, Better Results 67
12. References 69
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CHAPTER
1The Current State of Nutrition
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Global Nutritional HealthRates of obesity are rising in every country on Earth.1 Much of the developed
world has taken food for granted. Calories are now relatively easy to come by.
And with it, a host of preventable chronic diseases including cardiovascular
disease, type 2 diabetes, chronic kidney disease, many cancers, and an array of
musculoskeletal disorders.
Furthermore, micronutrient deficiencies continue to be widespread. Globally, 2
billion people suffer from low micronutrient intake of one or more essential
vitamins and minerals.2 Many of these are present in developing nations and
are due to more systemic problems surrounding social, economic, and political
issues. But low micronutrient intake is prevalent even in America, and certain
groups are at a high risk for micronutrient deficiencies.
5 Groups at Risk for Micronutrient Deficiencies
1. Vegetarians & Vegans: Vitamin B12 only exists in fortified and animal-derived products.
2. Prenatal: Fetal development adds specific requirements like extra folate, iodine, and calcium.
3. The Elderly: Altered metabolism and reduced diet-quality put the elderly at risk of several deficiencies.
4. Post-Op Patients: Certain surgeries, particularly in the abdominal region, can impair absorption of key nutrients.
5. Obese: Obese individuals often have higher rates of deficiencies in many vitamins and minerals, demonstrating malnutrition can happen even during overconsumption.
Deficiencies are a
major problem, but
overconsumption of
certain nutrients is a
major contributor to
the chronic diseases
that stem from
malnutrition. For
example, too much
sodium and sugar can
lead to hypertension
and obesity. The good
news? The vast
majority of these
diseases are
preventable.
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In fact, according to the World Health Organization,3
“…the major causes of chronic diseases are known, and if these risk factors were
eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would
be prevented; over 40% of cancer would be prevented.”
And more research continues to demonstrate the same lifestyle factors
(healthy diet, regular exercise, etc.) contribute to robust neurological health as
we age. According to Dean Sherzai, MD, PhD, a director of the Alzheimer’s
Prevention Program at Loma Linda Medical Center,
“Ninety percent of us can avoid getting Alzheimer’s.”
In order to get the world’s diet back on track, and to enable each and every
one of us to reach peak health and performance, 3 processes could help.
1. Identify the diet and nutritional needs that uniquely fit your body and
your mind,
2. Track and maintain these diets over the course of a lifetime, and
3. Monitor your health outcomes and adjust where needed.
Fortunately, new science is refining our understanding and new products and
services are being developed to make the process of collecting personal
nutrition data easier and more effective at achieving optimal health.
So what exactly is personalized nutrition? How can it help me? What products
and services can I use from home to personalize my diet?5
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What is Personalized Nutrition?
Personalized nutrition applies this logic to nutrition.
Emotions and preferences are heavily wrapped up in our diets, and culture is a
big part of the discussion. It may be a losing battle to ask Okinawans to give up
rice or Sardinians to give up wine. And despite their different diets, these “Blue
Zones” both have large populations that tend to live past 100 with relatively low
rates of chronic diseases.
But we also can possess different biochemical reactions to food as well.
Allergies are a clear example. Roughly 3 million Americans have coeliac disease
and cannot eat gluten, peanut allergies have more than tripled in U.S. children
over the last few decades, and you can even develop an allergic reaction to
meat through the spread of a virus from a tick bite.
At its core, personalized nutrition is a
diet designed to fit the physical, mental,
and environmental needs of an
individual.
Nutritional needs are much like people.
We’re similar in many ways, but we also
have differences in the way our bodies
have developed and the lives we each
live.
We have different preferences, different
cultures, and different biochemical
reactions to food.
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But it goes far beyond these obvious constraints.
Differences in genetics can alter predispositions for certain health outcomes;
one person may possess genetic qualities that predispose them to gaining
weight4 more easily, while another may possess inefficient vitamin B12
metabolism.5
And although these studies are too early to make definitive predictions, some
research has shown that individuals possess certain genes that have better
health outcomes on a high-carb, low-fat diet,5 while other genes suggest
better outcomes on a low-carb, high-fat diet.6 And other genes have shown
links to high blood pressure, appetite, and many other aspects of diet-related
health outcomes.7
Nature and Nurture
The lives we lead also greatly impacts our biochemistry and metabolism, each
affected by changes in things like stress,8 sleep,9 family eating dynamics,10 and
diet itself. Differences in lifestyles and environmental conditions can alter
epigenetic modifications to your genes and shift gut microbiota composition.
And these effects are likely not the same in everybody. A recent study in Cell
showed a widely varying glycemic response between individuals to the same
meals.11 In addition to clinical differences, like the amount of sleep they got
the night before, their gut bacteria composition played a substantial role in
their body’s response to food. And while your gut bacteria affects which foods
you should eat, your food in turn affects your gut microbiome diversity.
Epigentics may play a role too. Epigenetics refers to modifications in gene
expression. This means, certain lifestyle and environmental conditions may
change which of your genes are promoted or inhibited.
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Research is accumulating on the role epigenetics may play on nutritional
health outcomes, particularly for environmental conditions in early-life.12 And
although this was only a rat-study, an interesting finding showed obese rats
produced epigenetic changes that resulted in decreased leptin, the hormone
that makes you feel full. Epigenetics will be an interesting area of research to
watch.13
When it comes to weight loss, many diets of varying macronutrient
composition have been tried. A recent review14 and meta-analysis15 showed
they can all work to help lower weight. The biggest determinant was whether
study participants could stick to the diet.
Personalized nutrition recognizes that certain diets are individually better suited
for certain people. This accounts for variability in
personal preferences, dietary constraints, lifestyle, and
biological variations including genetic, epigenetic, and gut
microbiota composition.
But these studies in gut microbiome and gene expression are beginning to
shed light on the reality that the magnitude of these effects can vary quite
dramatically in different people.
Long-standing dietary advice from major health organizations still hold true.
Listen to the expert opinions on major macro and micronutrient
recommendations. Their advice will rarely lead one astray.
But often, achieving their targets and your own personal goals can be easier
said than done. Personalizing and optimizing your diet using nutrition data to
fit your unique biology and environmental conditions can help optimize and
accelerate your progress to help you meet your goals.
There are some broad commonalities.
Protein may increase satiety and thus,
make it easier for more people to
consume fewer calories because they
feel more full for longer. And
carbohydrates, in general, tend to
produce a higher glycemic response after
meals.
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CHAPTER
2Why Personalize?
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Increasing Healthspan & Peak PerformanceLet’s start from the beginning. The first law of thermodynamics says:
Energy can neither be created nor destroyed.
There’s no getting around that one. But – it can be transformed.
Enter, food.
Nutrition is our body’s fuel. We can’t live without it. But there’s a difference
between living with optimal health, and just living. For example, The Michael
Phelps Diet was 8,000 – 12,000 calories a day. He needed OLYMPIC-scale
energy. He doesn’t just train like the normal weekend warrior. He needs to
maintain peak energy throughout training as well as on race day.
Conversely, it’s easy to live on a poor diet for quite some time; all the while
building a lifetime’s worth of poor dietary habits that lead to many of the
chronic diseases facing us today.
Calories are directly defined as a unit of energy. Energy is locked up in the
chemical bonds within food molecules.
A good way to think of the energy you consume is by the ratio of your
macronutrients – fats, proteins, and carbohydrates. They all contain energy
your body can use, but in different ways. We’ll dive deeper into that later.
During digestion, these molecules get oxidized. Essentially, vitamins, minerals,
and other enzymes break these chemical bonds apart, releasing energy. That
energy is generally repackaged into ATP – the body’s energy currency.
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Unused energy typically gets stored for later, generally in the form of fat.
So, I’ll just track my calories, right?
Calories are important, yes. Those who track and reduce caloric intake
routinely lose weight and improve cardiovascular health.
And yes, if you ingest more calories than you burn, over time, you will gain
weight.
But the energy balance equation of calories in and calories out is riddled with
personalization that complicates the math. Some examples:
• Resting Metabolism: Just sitting on the couch, we all burn
calories at a different rate.
• Gut Microbiota: Different diets and environmental conditions
change your gut bacteria composition. For example, some
people can extract more calories from fiber than others.
• Genetics: Each person’s DNA is unique to them (except for
twins!). And just like hair color, they can change the way your
body reacts to food.
• Macronutrient Composition: Your body reacts to them
differently. For example, were your calories from protein or
sugar?
• Micronutrient Composition: Your age, gender, genetics, and
lifestyle affect which vitamins and minerals you may be in need
of.
This guide will dive deeper into where this personalization comes from, and
how to go about collecting nutrition data to personalize your diet.
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You Can’t Improve What you Don’t Measure
Optimization occurs along a particular dimension, so you must decide along
which dimension you are looking to optimize.
Body-builders may be going for bulk, long-distance runners may need to
ensure long-term fuel and adequate mineral ratios, and chess champions
require their brain to be firing on all cylinders.
You may be looking to simply find a consistent diet you love that allows you to
optimize long-term health and general wellbeing. Or perhaps you are looking
to lose weight efficiently, adhere to a dietary regime like veganism. or are
experimenting with something new like a ketogenic diet.
Whatever your goal may be, they all start with the same step.
To optimize your diet, you must routinely and reliably monitor
your dietary intake patterns.
Optimization requires experimentation and refinement
over time. And you can’t improve what you don’t
measure.
Therefore, optimizers must first start with reliable
nutrition data to provide a baseline for understanding
how their body reacts and make evidenced-based
decisions to adjust and track.
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You might feel like you have a fairly routine and repetitive diet (I have a protein
shake and two eggs every morning!). But few of us eat the same meals, in the
same quantities, every day. And we certainly don’t have the same amount of
physical activity, stress, or sleep everyday.
So when you are trying to remember your meals and compare content
between your best performing day and your worst, ask yourself: “What was my
macronutrient breakdown? Did the percentage of my calories coming from
protein change? What about magnesium? Or potassium?”
Odds are, you won’t even have the same performance if you did isolate a top-
performing diet. There are many factors that will influence peak performance,
like sleep and stress.
But this is a numbers game. If you continue tracking and monitoring
performance based on dietary intake, patterns will begin to emerge.
You first need to know how to quantify and categorize your dietary intake
patterns. Only then can you intelligently adjust, monitor, and optimize based
on your performance.
There are several different aspects of your nutritional health and eating habits
that can be tracked to personalize your nutrition. Some are immediately
available, while others are in the works. And some require only a one-time
test, while others are ongoing.
As new science continues to improve our understanding of nutritional health,
new products and services continue to crop up.
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This list is designed to be a comprehensive guide to at-home nutrition
personalization services available, as well as several that are coming soon and
are in the pipeline.
A couple of notes before we get started:
• Intake is not affiliated with the products or brands in this list, and
mentioning these products is not necessarily an endorsement. We simply
want to present some products and services that are available.
• Nutrition science is notoriously convoluted. We attempt to provide a mix
of the scientific consensus and emerging, yet promising, science. In areas
where nutrition data science is less well-defined, we do our best to
explain our current understanding, the potential it may bring to
personalized nutrition, and our approach we recommend to new
products and services that aim to use this data.
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CHAPTER
3You Are What You Eat
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What Counts as Fat?Body Mass Index (BMI) is a common measurement used across the diet world.
Simply put, your BMI is related to your weight to height ratio. So, the more you
weigh for your given height, the higher the ratio.
This is a useful, quick measurement for determining if someone is
underweight, in a healthy range, overweight, or obese. There are several free,
online BMI calculators you can use.
However, this doesn’t quite capture the whole story.
As you can imagine, muscle plays a much different role on your health and the
way your body metabolizes food than fat.
And taking it one step further, not even all fat should be treated the same way.
Studies show that visceral fat is worse for disease risk factors like
cardiovascular disease and diabetes than subcutaneous fat or brown fat.16
This distribution of fat within the body can produce some counterintuitive
health outcomes. For example, roughly 10% of obese individuals show no signs
cardiometabolic risk factors;17 conversely, 10% of normal weight individuals (18
< BMI < 25) possess a body fat distribution similar to that of obese
individuals.18 These so-called TOFIs (Thin on the outside, fat on the inside) are
at high risk for developing metabolic diseases like diabetes because the
location of fat is important.
In fact, this distribution of body fat may be the cause of the so-called
“overweight paradox,” where some studies have shown a similar risk of
cardiovascular disease-related morbidity and mortality to that of normal
weight individuals in the elderly.19
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So how do you know what your body fat composition is?
Bioimpedance spectroscopy can be used as an in-home method of
decomposing body-fat percentage. A quick Google or Amazon search will bring
up quite of few of these devices from different brands, usually sold as a scale
or handheld device.
These work by sending a small electrical
current (too small to notice) of varying
frequencies through your body and
measuring the voltage. Different body tissues
(i.e. fat, muscle, bone, etc.) change the
voltage by different amounts. Using some
clever algorithms, these device then
determine the breakdown of your body
composition.
Are they accurate? Not so much. Precise?
Somewhat. But they are getting better.
Like most biochemical testing procedures, it
is recommended to practice consistency
between measurements. Try performing the
test at the same time every morning
(exercise affects the test results) and after
using the restroom (hydration levels affect
this test too).
The technology is improving, but studies in
obese patients and in children continue to
show statistically significant errors when
compared to gold standard measurement
techniques like dual x-ray absorptiometry.20
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They can be useful for group analysis, but individually the accuracy is not quite
good enough. This goes for body fat distribution measurements, as some
devices purport, as well.
Is bioimpedance still useful?
Despite some error, they can be somewhat useful for qualitative analysis.
Providing a rough estimate, and monitoring change over time, may provide
useful ballpark figures for trends.
Your body fat percentage, fat mass, and fat-free mass are important for health
implications, as well as understanding how your body is metabolizing energy
(we will go into more detail on this later).
Being overweight or obese increases your risk of several chronic diseases,
including type 2 diabetes, cardiovascular disease, and some cancers. However,
body composition does impact the magnitude of that risk, and it can put
normal weight individuals into high risk categories.
In the pipeline
Improvements to bioimpedance analysis hardware and algorithms may
continue to refine the sensing techniques for determining body fat
composition and fat distribution. Until then, home-based tracking is relegated
to waist-to-hip ratios and inaccurate bioimpedance scales.
While medical labs and nutrition facilities often have equipment to help you
determine these numbers, home-tests for body fat distribution are still in the
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CHAPTER
4Blood, Sweat, & Tears
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There is a small but growing group of healthy individuals who wear continuous
blood glucose monitors to quantify their body’s response to food. These small
patches have tiny needles that detect blood glucose and transmit the readings
to your smartphone.
After a meal, metabolism begins harvesting energy from the food you ate. This
results in a rise in the amount of glucose circulating in your blood (blood
glucose). This is called the glycemic response.
Some food groups cause a sharp
spike in blood glucose. Sugar is a
prime example.
Other foods, often high in fiber,
cause a much smaller and gradual
rise in blood glucose.
Any rise in blood glucose levels cause a rise in the release of a hormone called
insulin. Too much glucose in your blood will cause you some serious problems.
One of insulin’s jobs is to regulate glucose levels by decreasing its
concentration in circulation.
It is interesting to track the behavior of your blood glucose response to foods
for a few reasons. First, is to spot and monitor pre-diabetes so as to manage
and possibly reverse the disease early.
Chronic hyperglycemia (high blood glucose levels) is a sign of pre-diabetes and
diabetes. Chronic hyperglycemia is also associated with many of the ill-effects
of diabetes, including injury to the heart, nervous tissue, retinas, and kidneys.
Monitoring blood glucose levels can help spot and diagnose pre-diabetes with
enough time to potentially halt and reverse the disease, as well as for
maintenance of symptoms for sufferers of the disease.
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Second, it can also be useful to track your blood glucose response to foods to
better understand the unique way your body responds to food. A recent article
in Cell showed that the glycemic response can vary significantly between
individuals, despite eating the same types and quantities of foods.11 This may
eventually help you gain insight into the health of your gut microbiome (which
we will discuss more later) and better personalize your diet.
Micros Have a Macro Impact
Another major component of your diet that can be partially interrogated via
blood testing is your micronutrient levels.
Micronutrients consist of vitamins and minerals. They are essential for life,
being used in numerous biochemical pathways as catalysts and coenzymes.
Deficiencies in any one of these can cause both acute problems (when the
deficiency is severe), and chronic (when persistent undernutrition occurs).
Unfortunately, micronutrient intake in modern diets is routinely too low.
So while your body can handle short term deficiencies, long-term deficiencies
should be avoided. Invasive blood testing is one option for determining recent
micronutrient intake levels.
SpectraCell is one of the leading blood-testing service providers for
micronutrient testing services. A few others, like WellnessFX and LifeExtension,
also perform these tests.
However, an at-home product that draws and analyzes blood requires FDA
approval and isn’t yet on the market; although a few seem to be in the works
(in the pipeline, below).
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The next best thing comes from ZRT Labs, which provides at-home kits that are
mailed back to a central lab for analysis. ZRT provides dried blood spot tests
with a finger-pricking tool to draw blood and mail away. One prime example is
to look for vitamin D deficiencies.
Additionally, ZRT has saliva kits. Although looking for different biomarkers,
these tests primarily look for hormones that reveal information such as thyroid
function.
Other companies like Meridian Valley Labs also provide home blood kits that
test for hormones, but they also assess food allergies which can be extremely
useful for identifying the source of major food reactions.
In the pipeline
A few companies working on at-home blood testing devices for nutrition-
specific biomarkers include Vitameter and KalibrateV. These aren’t yet on the
market, and it’s not yet sure if they’ll make it. But be on the lookout for these
and others. They will surely start to crop up soon.
The Kenzen patch is a new product used to monitor hydration levels and
electrolyte imbalances. This may be useful during training, where making sure
hydration stays at the top of mind. Ultra-endurance athletes may find this
particular appealing. Kenzen also suggests their product can be used to assess
electrolyte imbalances.
X labs (Google) made a bit a press when they were working on a contact lens
containing microelectronics designed to measured glucose from tears. But as
the CEO of Novartis, a partner on the project, says, “It’s a high risk project.”
Many researchers claim the correlation of glucose in tears is not as robust as
blood, and therefore will never provide clinically useful information for diabetic
patients. We’ll have to wait and see about this one. It will likely be years before
a product like this demonstrates any breakthroughs.
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Saliva is an enticing biological medium because it is non-invasive and easily
acquired. And while some markers of diet and nutrition can be discovered in
saliva, its reach is limited.21
One interesting area might be related to teeth health. Diet has a profound
impact on tooth and jaw development. Foods like sugar and starch are known
to cause cavities and other problems with teeth. But saliva may provide insight
into the current health of your teeth and the amount of resident bacteria.
But since your DNA is the same in every cell of your body, saliva does provide
an easy access point for genetic testing. We’ll dive into that, next!
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CHAPTER
5Fitting Into Your Genes
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DNA testing is an exciting, emerging field brought on by the dramatic
reduction in DNA sequencing costs. The Human Genome Project took 15 years
and $2.7 billion to sequence the first human genome in the year 2000. Now,
we are close to a $100 genome sequencer that will only take a an hour! And it
will only continue to fall in the future.
Sequencing your DNA has myriad medical uses, especially with new gene-
editing techniques like CRISPR. There are other interesting uses too, like
tracking your ancestral line using services like 23andMe and Ancestry.com. But
for now, we’ll focus on how they relate to your diet and nutritional health.
Your DNA is unique to you. It is present in all of your cells, and it contains the
information needed to make you you. It directs everything from how to build
your hip bone when you were in the womb, to how your body is going to treat
gluten once it enters your digestive system.
Genes are sequences of DNA that decide how your body is going to produce
different proteins. These proteins then go off to do all of the different things
they do to make life happen.
Sometimes mutations occurs. If a mutation within a gene occurs, that may
change the ability of that gene to produce its corresponding protein. And since
these proteins go off to make life happen, you have a chance of experiencing
life differently if those same proteins are produced in different ways or
different amounts.
Often genes work together through a cascade of biological processes to get
work done. In these cases, genetic mutations must be thought of as changing
probabilities.
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And example is the BRCA1 gene. Mutations in these genes are associated with
an increased risk of developing breast cancer. But they demonstrate how they
should be dealt with when thinking about probabilities.
Having a mutation in the BRCA1 gene, for example, does not change your risk
of developing breast cancer from 0% to 100%. But, it can still be significant. A
typical American woman has a 12 percent chance of developing breast cancer
in her lifetime. But a woman with a BRCA1 mutation has a 55 to 65 percent
chance of developing breast cancer.22
Not insignificant, by any means. But also not certain.
These are population-wide statistics, and other contributing factors are
required for the disease to actually develop. Many are unknown, often
requiring some combination of environmental factors, lifestyle choices,
triggers, and pure chance.
The same logic applies to most dietary intake needs.
For example, the FTO gene correlates to a propensity for obesity, and the
CYP1A2 gene correlates with your ability to metabolize caffeine. But it’s
important to keep in mind, that it’s believed that well over 40 genes correlate
to obesity; and the genetic loci discovered to have associations with obesity
are only shown to account for about 2-3% of obesity risk.23 So analysis and
recommendations based on the presence or absence of genetic markers
should be viewed cautiously, and sometimes modestly.
But, predispositions can help you personalize your diet in very real ways. Many
issues like obesity or cardiovascular disease are issues that accumulate through
small differences incurred over a lifetime. And 3% can add up over time.26
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Knowing your predispositions, then, does not dictate your fate. This is usually
some combination of genetics, your environment, some trigger, and chance.
Some genes, on the other hand, have what is called high penetrance. Unlike
the predispositions mentioned above, mutations in these genes do have close
to a 0-to-1 effect.
The LCT gene, for example, produces an enzyme called lactase. Some
mutations to the LCT gene are known to produce lactose persistence in
practically everyone with that mutation, while other mutations can render
your chances of being able to tolerate lactose at 86 to 98 percent.24 This gene,
in other words, has high penetrance towards lactose intolerance.
Lactose intolerance often develops as we age out of the weaning process. This is an interesting example of a relatively modern form of human evolution based on a cultural shift to an agrarian lifestyle with livestock milk and shorter weaning periods.
But your hair cells and liver cells behave quite differently. This is because they
are expressed differently. Some genes are turned on, while others are turned
off. One cell uses part of your DNA, while another cell uses a different part.
This change in expression can indeed change based on lifestyle and
environmental factors. Even more odd, is that these changes to DNA
expression sometimes can be passed down through generations. This is the
field of epigenetics.
Your DNA doesn’t change (with the
exception of mutations). But, the way
your DNA is expressed can change.
Your DNA carries information about how
to build proteins, and it is the exact
same DNA in every cell of your body.
That means, your hair cell, your muscle
cell, and your liver cell all have the same
DNA.
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Genetics refers to the sequences of DNA that are heritable (they pass from one
generation to the next). But epigenetic changes may be heritable too. The
mechanism for epigenetic inheritance is still not well understood, but it may
provide some interesting insights into how diet and exercise can change gene
expression.
For example, a recent study published in Cell Metabolism showed that the
epigenetic profile of sperm in obese and lean men were markedly different,
particularly among genes known to be associated with obesity like FTO.25
What does this mean? Poor weight management decisions don’t just affect
your own health. You may be setting your children up for uphill battle.
One classic epidemiological example of this is the “Hunger Winter.” Children
born during the Dutch famine of 1945 resulted in higher rates of diabetes and
obesity later in life; and potentially even resulted in similar trends in their
children.
The good news about epigenetics, is that the changes to DNA expression do
appear to be reversible. So, if you stop smoking,26 begin exercising and change
your diet,27 epigenetic modifications may shift to a more favorable profile.
Your Personal Meal Plan
Your genetic (and potentially in the future, epigenetic) profile can help you
produce a unique, personalized food plan that caters to you. Learning about
certain predispositions may also help you justify certain lifestyle choices.
We should all eat nutritious foods. But if you discovered you are predisposed
to developing insulin resistance from over-consumption of starches,28 you just
might be more inclined to adjust your eating habits to help ward off diabetes. 28
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How do I use this nutrition data to personalize my diet?
One inherent downside to genetic testing, is that the ongoing tracking and
monitoring of diet and behavior isn’t possible. Your DNA doesn’t change.
DNAFit, Nutrigenomix, Anabolic Genes, Orig3n, and Fitness Genes are
examples of popular solutions for using your DNA to help guide your diet and
exercise regimes. With a quick saliva swab, your DNA gets sequences and
particular genes known to be associated with particular dietary concerns like
lactose intolerance and carbohydrate sensitivity are identified.
Others, like Habit, use a combination of DNA testing and a series of blood tests
in order to provide personalized meal plans.
Information about these genes present in your DNA help you determine the
likelihood of expressing each particular trait.
How would you use this?
Think of these results like a personal guide. These results can help steer your
dietary needs in a direction that may prove to be a better fit for you body and
help you optimize your health and performance.
Are there any home epigentic testing services?
Not yet. The closest is likely Episona’s home sperm testing kit for measuring
male fertility.
But diet is likely a factor that shapes your epigenome. However, it may be
some time before enough science has been collected to use epigenetic
profiling for personalized nutrition.
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In the pipeline
Genetics is uncovering relationships our genes have with diet and nutrition,
but so far their effects tend to be rather small with low penetrance. Take any
guidance with caution.
But this is a rapidly changing field of research with new science sure to come
in droves. Take new studies with a grain of salt, and wait for convergence
among the experts before you try any major changes.
And be on the lookout for the first epigenetic testing services. They may crop
up soon. But the advice on skepticism goes doubly for epigenetic tests. The
field is sure to bring more understanding to personalized nutrition data, but it
is extremely nascent. Give this one another decade.
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CHAPTER
6Your Personal Cost to Living
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What is Metabolism?According to Mitchell (1962),29 your basal metabolic rate (BMR) is simply,
“the minimal rate of energy expenditure compatible with life.”
When you run, jump, swim, and talk, energy is used. This isn’t too hard to
conceptualize. But sometimes we forget about the other work going on behind
the scenes. The work to keep you alive.
Beating hearts. Breathing Lungs. Thinking Brains.
Your body is constantly using energy simply to keep organs functioning and to
keep you alive. This minimum amount of energy required to keep those
internal organs functioning is your BMR.
In fact, roughly 70% of your caloric intake is used for this basal cost of living.
According to an FAO review,30 your total metabolic breakdown roughly follows:
• Liver 27%
• Brain 19%
• Heart 7%
• Kidneys 10%
• Skeletal Muscle 18%
• Other Organs 19%
And because 10% of caloric intake is used for thermogenesis (keeping our
bodies warm), only around 20% of our calories are used for the physical
activities we pursue throughout the day.32
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Is my BMR
unique?
There is a decent amount of
variation among the
population with respect to
BMR. So what’s causing this
variance?
This is an area of ongoing
research, but there are
some studies that suggest
where this variance comes
from. Largely, it comes from
your body composition.
A 2005 study in the
American Journal of Clinical
Nutrition investigated
potential sources for this
variance.31 Here’s a
snapshot of their findings:
• 63% of BMR variance
came from fat free
mass
• 6% came from fat mass
• 2% came from age
• 2% came from intra-
subject variability and
analytical error
• 26% was unknown
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What characteristics were not associated with BMR variance?
• Height
• Sex
• Bone Mineral Content
The researchers also investigated the effect of three hormones on this
variance, and found no significant variance associated with leptin or
triiodothyrionine; but thyroxine seemed to account for roughly 25% of the
unknown variance in men, but not women.
This leaves us with two major takeaways:
1. Your body composition is the major player in your basal metabolic rate;
however
2. Roughly a quarter of the variance is due to “other,” unaccounted factors.
Another 2009 study estimated that body composition accounts for roughly
80% of BMR.32 What’s causing the 20-25% of variance?
There are a few hypotheses. One, as noted in each study, is that the different
tissue components of fat free mass are not accounted for. Studies show that
resting energy expenditure can vary quite significantly between organs, tissues
within organs, and organs between individuals.33 The size of organs vary, and
the composition of organs can vary.
Other variations may compound as well. The brain uses slightly different
amounts of energy during neural activity like visual stimulations,34 and
temperature, stress, and sleep are all known to alter BMR.35
And certainly, genetic variations may play a role as well. As we inevitably
uncover more information about the genes involved with regulating different
organ, tissue, hormonal, and cellular metabolic pathways, we will likely
discover more insight into subtleties of BMR variance.
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What is Your Respiratory Quotient?
The respiratory quotient is a number unique to your lifestyle and body
composition that shows up primarily in the world of fitness and nutritional
health. Used to gain a better insight into the inner workings of your
metabolism, this number can help you gain insight into how your body is
processing your diet and harvesting energy.
In addition to your BMR, most of us move around throughout the day, adding
extra caloric expenditure into the mix.
You need to get this energy from somewhere.
Usually, this energy comes from food. When you haven’t eaten in awhile, your
body uses stores of energy from stored glycogen and body fat.
Your body oxidizes these various substrates to harvest energy for your cells to
reproduce, muscles to grow, brains to think, and so on.
Your respiratory quotient is the direct measure of carbon dioxide production
against oxygen utilization. What this information provides is a measure of
where your body is primarily getting its fuel from.
In other words, which substrate is being oxidized more for your body’s energy
needs: carbohydrates or fats?
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How do you Measure your BMR and Respiratory
Quotient?
Many fitness centers and wellness clinics will perform respiratory quotient
tests, because unfortunately this is not something you can easily do at home. It
requires a bit of equipment and a trained professional.
You typically need to fast for some amount of time. For my test, I fasted for at
least 12 hours before the test. This is because recent intake of any foods can
significantly alter the results.
It’s also important not to do much physical activity beforehand. This, too, can
impact the test results.
The test itself is rather simple. You sit still. While you sit, recline, or lay, you
wear a mask that covers your mouth and nose. You’ve likely seen these kinds
of masks on people performing a VO2 max test. The mask connects to a hose,
which is connected to a computer and a machine. You also wear a heart rate
monitor.
And that’s it! You sit and breathe for around 20
minutes, because it is useful to have some time
to get relaxed (usually only around 5 minutes of
continuously clean data is needed).
This test is also the same conditions required to
assess your basal metabolic rate (or, resting
metabolic rate). So, make sure both numbers
are calculated and you can kill two birds with
one stone!
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What Do the Results Look Like?
Your respiratory quotient is a decimal between 0.7 and 1.0. A normal range is
typically around 0.8 – 0.85.
The results may also be broken down by macronutrients to represent how
much of each substrate your body is deriving its energy from. Here is a pie
chart of my recent test results showing the breakdown.
What Do the Results Mean?
A respiratory quotient of 1.0 essentially means that all of your energy is
derived from teh metabolism of carbohydrates.
The reason for this number takes one back to college chemistry. Remember,
the respiratory quotient is the ratio of oxygen consumption to carbon dioxide
expulsion. Glucose metabolism breaks down in a 1-to-1 equivalent of oxygen
to carbon dioxide. The equation below shows that 6 oxygen molecules are
used to produce 6 carbon dioxide molecules.
C6H12O6 + 6O2 → 6CO2 + 6H2O
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A respiratory quotient of 0.7 is the opposite, meaning that all of your energy is
derived from the metabolism of fat. While different fatty acids have different
ratios, palmitic acid gives an example of producing a respiratory quotient 16
CO2 / 23 O2 = 0.696.
Complete protein metabolism has a respiratory quotient of around 0.81.
Similar to fat, this is an average because protein as a term embodies all of your
amino acids. The body doesn’t contain large stores of protein for energy
metabolism. However, some protein is metabolized internally. And the rate of
protein turnover does not differ significantly between undernourished and
well-nourished individuals.
These numbers for each macronutrient constitute energy being derived solely
from these categories. But because we almost never exist in this state, the
number falls somewhere between them and exists as a combination of these
macronutrient substrates.
Body Composition
Some studies how investigated the relationship between various aspects of
body composition, like body weight, fat mass, and fat-free mass to the
respiratory quotient and found significant correlations to all.36 Generally, the
higher the body weight, fat mass, or fat-free mass, the lower the respiratory
quotient; lower body weight and fat mass led to higher respiratory quotients.
The logic here follows that fat oxidation is directly related to the amount of
free circulating free fat acids in your body. The less you have, the less your
body can metabolize and derive energy from them. Thus, carbohydrates and
glycogen stores occupy a greater percentage of your energy source. 38
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Dietary Patterns
The food quotient is a number that is similar to the respiratory quotient. It is
designed to represent the macronutrient breakdown of your diet. Some
researchers have hypothesized that the food quotient should equal the
respiratory quotient for those with stable weight and in energy balance.
Correlations have been found, but this relationship is not always clear.
One stark example comes from Jewish physicians investigating metabolism in
the Warsaw ghetto of the 70s. Chronically undernourished individuals had
respiratory quotients over 0.95. Later, other researchers also showed that
individuals at stable weight but that are chronically energy deficient have
higher respiratory quotients, typically over 0.90 (whole well-nourished
individuals were closer to 0.83).
However, in all cases, increasing carbohydrate consumption has a percentage
of one’s diet increased the respiratory quotient. So, a high respiratory quotient
also reflects recent dietary patterns alongside body composition.
Body Mass Change
One study investigated the relationship of the respiratory quotient to the food
quotient, to determine whether the respiratory quotient correlates well to
measures of recent dietary patterns.37 They did not find a good correlation
during their 10-week study.
Rather, they found a strong correlation between the respiratory quotient and a
recent change in body mass. Having lost body mass in the past 5-7 days was
correlated with a lower respiratory quotient (closer to 0.8 and below), while
increasing body mass was associated with a higher respiratory quotient (closer
to 0.9).
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Another study showed similar results in obese women.38 This, in part, explains
why it is difficult to keep off fat after weight loss. As your body loses weight,
your degree of fat oxidation decreases and thus your propensity to store the
fat you ingest rises.
Genetics
However, some of your respiratory quotient may be genetic. Your body’s
tendency to oxidize fat has been shown to follow familial lines to some
degree.39 And other studies have identified particular genes that are
associated with high and low fat-oxidation. Thus, some variability is to be
expected, despite similar body compositions and dietary patterns.
How Do I Use My Respiratory Quotient?
Your respiratory quotient gives you insight into your dietary patterns, your
body composition, and your metabolism. Currently, one of the best ways to
use this information is to help inform future personalized dietary patterns that
may be more beneficial for your dietary goals.
Identify Potential Sources of Weight Management Issues
Most well-nourished individuals will exhibit similar respiratory quotients and
basal metabolic rates. This is, usually, a good thing.
But sometimes individuals may be outside of the norm. This is useful to
identify and may indicate either skewed dietary patterns, rapidly changing
body composition, or potentially chronic undernutrition.40
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Adjust Dietary Patterns to Meet Your Goals
For example, studies have shown that low fat oxidation (high respiratory
quotient) is associated with future weight gain.40 The theory being that those
who metabolize carbohydrates better than fat will naturally store more fat over
time, leading to weight gain.
And another review article corroborates this research, connecting genetics and
recent body composition changes to your respiratory quotient as a measure of
past and predictor of future weight maintenance.41
Particularly in obese individuals, their metabolic “flexibility” (ability to switch
metabolic oxidation easily from carbohydrate to fat) is diminished and makes
losing weight and keeping it off more difficult. This may imply certain diets or
fat oxidation stimulants may be beneficial for these individuals.
Trend Analysis
Due to the inherent variability among individuals and their respiratory
quotient, it is sometimes difficult to identify the precise mechanisms behind
skewed, but not extreme, values. What can useful, is monitoring your own
value over time.
By tracking your respiratory quotient against possible changes in weight and
diet, you may be able to verify healthy and stable metabolic activity, or
potentially identify issues that are a cause for concern or help better
understand the results you are seeing with weight management.
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A few handheld indirect calorimeters are available for home use. These
operate similarly as a breathalyzer. After breathing into the device, out pops a
rate of calorie burn.
One is the MedGem by Microlife. While simple and relatively inexpensive, the
MedGem only tracks O2. By not also tracking CO2, it misses the complete
picture.
As mentioned above, the respiratory quotient varies person to person based
variables like body mass, age, gender, and others. The MedGem approximates
the R.Q. as 0.85 for everyone. This can result in a decent amount of error.
However, it still provides a decent snapshot of your BMR and can help you
refine your diet based on your metabolism.
Another option for a home-use indirect calorimeter is offered by Breezing.
Although more expensive, the Breezing monitor does take both O2 and CO2
measurements using disposable biosensors and has been shown to be
equivalent to clinical lab-scale tests.
Can I Change my BMR?
First, your BMR will give you a guide as to your minimum caloric needs. The
average is typically around 1,500 kcal per day.
This can, and does, shift. Albeit, minimally.
Prolonged undernutrition will typically lower your BMR. This is one of the
factors for why dieters often gain weight back once the diet is over, and why
other dieters seem to “plateau” while trying to lose weight.
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Your body does this in an attempt to self-regulate energy balance.42 Imagine
yourself as a hunter-gatherer several thousand years ago. When food was hard
to come by, it was useful for your body to slow down metabolism so you didn’t
starve as quickly. Your caloric intake decreased, so you body’s energy demands
decreased along with it.
Similarly, when your fat stores are increased during prolonged
overconsumption, your BMR will increase by a small amount.
And the majority of your BMR is dictated by your fat free mass. Hitting the gym
and gaining muscle mass, therefore, will increase your BMR.
Moving requires energy. That means, the more you move, the more calories
you burn.
But there are some subtleties here worth noting.
Moving might not impact calorie burn as much as you think; and
Physical activity changes other diet and nutrition-related physiology “under
the hood.”
Here’s an example to put things in perspective. Although this depends on
many factors, such as weight, an average person burns about 100 calories for
every mile they jog.
Let’s think about that. If you run 10 miles a week, you will burn an extra 1,000
calories. On a 2,000 calorie per day diet, that’s only about 7% of your weekly
calorie budget.
Then, you must contend with hunger. Exercise releases cortisol. Among other
things, this hormone tends to stimulate appetite.
Is exercise worth it, then? Absolutely.
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In addition to burned calories, exercise still works wonders for things like
cardiovascular health, mental health, stress reduction, bone health, lean-
muscle development, and so on. And as we’ve discussed, lean muscle
development will increase your BMR.
Calories for Calories
Diet induced thermogenesis occurs after you eat food.43 Any food.
Your body requires the use of calories – aka energy – in order to digest and use
calories. You read that right. It may sound odd, but digestion is work for the
body. So some calories are still required in order to digest food.
Macronutrients require different amounts of calories in order to be digested.
Proteins increase thermogenesis the most (30% of calories burned), followed
by carbohydrates (5-10%), and then fats (0-3%). A typical, balanced diet
usually renders thermogenesis at around 10% of your total calories burned
throughout the day.
The Obvious One – Moving Requires Energy
The final part of the equation here is how many calories you burn per day from
your daily activities.
Do you move around a lot? Do you exercise?
Or do you sit in your car, take the elevator to your office, sit for 10 hours, head
home to the couch, watch tv, and fall asleep?
In addition to your BMR (on average around 1,500 kcal/day), you may burn
anywhere from 500 if you’re an office worker or another 5,000 if you’re
training for a marathon.
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To bring the discussion full circle, we’ll use your goals and a simple equation to
help give you a guide to how many calories you should eat every day.
Losing weight?
When you take in less energy than you expend, you will burn adipose tissue
(fat, plus about 10% water per cell) for energy and lose weight. It won’t be
much, but like saving for retirement, this will accumulate over time.
But keep in mind, how much you expend will change. As we’ve seen, your BMR
will change as you consistently eat fewer calories than you expend and as your
body composition changes. So maintaining consistency will require your food
intake levels to change over time as well.
Gaining weight? A similar approach exists. But again, adding muscle weight or
fat weight will affect your BMR in different ways.
Maintaining weight? Simply do your best to maintain energy balance. Like
we’ve seen, your body has some incredible homeostatic mechanisms in place
designed to help regulate your body during brief fluctuations. It’s a consistent
over- or undernutrition that will slowly accumulate over time. But don’t worry.
The process can always run in reverse!
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In the pipeline
Breath can be used for identifying your BMR, but can it be used for other diet-
related tracking purposes?
A limiting factor of all biological medium is the library of physiological
biomarkers available. For example, if your breath doesn’t contain any
molecules that relate to how much vitamin B12 you’ve recently consumed, no
new technology will be able to “track” it.
But new research continues to expand what nutrition data is possible to track
using breathe.
In the meantime, advances in breath analysis may be limited to better BMR-
testing devices.
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CHAPTER
7Flushing Data Down the Drain
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The first thought that comes time when you hear “urine test” is likely the
home pregnancy test.
These tests typically use a technology known as a lateral flow assay. Here,
capillary forces pull urine up a paper strip. You can try this experiment at
home. Take some paper, carefully dip it in water, and watch the moisture creep
upwards.
Urine is non-invasive and is an end product of the digestion process. This
means it is directly affected by your diet.
Urine is also a very complex mixture,
containing a slew of small organic and
inorganic molecules that come from
upstream metabolic processes.
In lateral flow assays, molecular probes are
places on the strip that find one of these
particular molecules of interest in urine,
and bind to it. They only bind to that a
single molecule, and do something special
when they do find their binding pair.
They change color.
The color change indicates the presence of the molecule, and there you go.
There are other urine tests, like pH test strips, or strips that look for ketone
bodies. These work using a similar principle.
Hydration levels can be measured via urine pH. Many vendors sell disposable
pH strips that can be easily used by dipping into a pure urine sample. After
waiting around 15 seconds, the strip changes color and can be compared
against a color guide to provide an estimate of pH.
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Ketone test strips are available from a variety of vendors and operate similarly
to pH strips. After dipping them into a pure urine sample and waiting around
15 seconds, the strip changes color. Comparing the color to the color guide on
the box allows you to identify the concentration in your urine.
Home-urine collection is another option.
One example could be of interest to vegans. Vitamin B12 is only found
naturally in animal products. However, in today’s world, we not have several
kinds of foods that are fortified with various vitamins and minerals, including
vitamin B12.
Your body can store excess vitamin B12, so if you aren’t eating enough, your
body can handle the drop in intake for a while. But eventually, if not
replenished, you will become deficient. This can come with a host of problems
from anemia to birth defects.
The Norman Clinical Laboratory provides urine testing for methylmalonic acid
(MMA). In B12-deficient individuals, MMA is elevated. Therefore, within a few
days of mailing in your urine sample, you will have a decent understanding of
whether your vitamin B12 levels are where they should be. And ZRT Labs
provides at-home, dried urine sample kits for testing an array of different
hormones like estrogen and cortisol.
But much more possibilities lie ahead, because urine is a complex fluid with a
slew of metabolic end-products. Many macronutrient, micronutrient, and food
groups possess statistically significant correlations that trend with recent
dietary intake patterns. Others can help identify whether your body is
metabolizing the nutrients you are eating and whether your body is currently
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In the pipeline
Intake is developing next-generation urine analysis technologies designed to
instantly and quantitatively measure biomarkers of dietary intake. In a few
seconds, you will have an entire day’s worth of data regarding calorie, fat,
protein, carbs, and sugar intake. Furthermore, Intake is also working on
quantifying key vitamins and minerals!
Sign up here for updates and pre-order promotions!
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CHAPTER
8Get Your Sh*t Together
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If you had an interest in this book, there’s a good chance you’ve already heard
of, or know a lot about, the gut microbiome.
It’s a pretty hot area of research these days. More universities and medical
facilities are opening research centers devoted to the gut microbiome, and
we’re already seeing clinical procedures like fecal microbial transplants (FTM)
at major hospital centers.44
Sure, it may sound like an odd procedure, to say the least. But a New England
Journal of Medicine randomized control trial found that FTM treatment cured
94% patients of C. difficile infections.
Where might you get this infection? Often, after antibiotics use.
Clearly, antibiotics are immensely beneficial to society, having saved millions of
lives throughout the years. The issue here, is when too much gut bacteria gets
cleared away and C. difficile grows and spreads in this wake.
Your gut microbiome is a complex and active ecosystem. There are over 100
trillion bacteria cells in your gut of over 2,000 varieties. In fact, there’s more
bacterial cells living inside you right now than your own cells!
Don’t think about that one for too long…
Gut flora numbers and distributions are controlled by a number of factors,
including your genetics, your environment, your stress, and your diet.
Different diets produce different microbiota. For example, shifting from a
vegetarian diet to one with meat changes the gut bacteria diversity within only
two days.45 52
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Stress? Believe it or not, that gut feeling you have may be more real than you
thought.
The gut-brain connection has been undergoing some serious research lately.
And the findings are fascinating. In short, the gut microbiota affects your brain
– from mood to function. Some research is even starting to connect maternal
nutrition to the rise in developmental neurological disorders, like autism
spectrum disorders, from a change to gut microbiota in early childhood.46
But a diet personalized based on your gut microbiota has potentially important
ramifications for things like obesity and diabetes. A recent report in Cell
showed that a person’s glycemic response (their spike in blood sugar levels
after a meal) can vary significantly between individuals – even after the same
meal.11 They developed an algorithm that took certain clinical and microbiota
data into account that successfully modulated their glycemic response on an
individual level.
This type of personalization is very exciting, as glycemic response and insulin
sensitivity are important metrics for diagnosing and monitoring diabetes. And
other research on gut microbiota in mice show similar effects towards the
development of obesity.47
Day Two allows you send in a stool sample, by mail, for analysis of your gut
microbiome. They specifically look for a HbA1c, which correlates to average
blood sugar levels over the past few weeks.
In combination with dietary intake tracking, this may provide a window into a
personal diet that accounts for glycemic response. However, being an average,
it needs to be compared to your average dietary intake. This may be tough to
parse out what to change.53
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uBiome offers an at-home testing kit designed to sequence your gut
microbiome DNA profile. Like DNA and epigenome testing, the science here is
early and in all respects has a higher value for research than practicality at the
moment. But you can still find interesting correlations than you may find useful
for understanding changes wrought by dietary change.
Viome is another new company looking to analyze your gut bacteria using
artificial intelligence to personalize your diet.
In the pipeline
While consumer companies like Day Two and uBiome provide some
microbiome diversity analysis, the science is too new for extensive diagnosis
and treatment regimes to be developed with significant confidence. But we
will surely to see a lot of future activity in the microbiome arena.
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CHAPTER
9A Nutritionist in Your Pocket
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Nutritionists and registered dietitians have studied and trained specifically to
help you meet your dietary goals. They will often begin the relationship with
an assessment of your dietary intake. Typically, a food journal is used.
And as we’ve seen, technological improvements along a variety of biological
mediums are increasing the accuracy, the breadth, and the ease of use for
much of this data collection and ongoing monitoring.
But collecting the data is only part of the journey.
Using nutrition data to make informed decisions about how best to adjust your
diet, make smart food choices, and monitor performance are all important
steps towards optimizing your nutrition and meeting your goals.
Several nutritionists and wellness clinics provide online counseling services to
help personalize meal plans and supplement regimes.
But will artificial intelligence democratize personalized nutrition for the
masses?
Artificial intelligence, or AI, is one of the most watched technological advances
these days. (Here’s a great intro video for those really interested in diving in.)
Some argue that as many as 47 percent of jobs could be automated away.
But the devil’s in the details.
Typically, analysts and futurists suggest routine, predictable work will be
automated much faster than service jobs that require a human, personal
connection.
The nutritionist’s role then, may splinter. Or at least, shift. As they say, AI won’t
likely automate “jobs,” but it will automate “tasks.”
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With the rise in better data collection and analysis of nutritional health
metrics, a diagnosis and personalized treatment plan may achieve automation
relatively soon. This could democratize nutrition advice for the masses, and
help put a nutritionist in every pocket.
But nutritionists will remain for quite some time. Particularly for the emotional
support they provide.
Diet is full of emotion. What we eat is tied to culture, image, self-worth,
health, and disease. AI might be able to help optimize your diet better than a
human; hell, it might even be able to predict which eating habits you are more
likely to stick to and recipes you will enjoy.
But nutritionist can connect on a human level. And its similarity to psychology
and human support means it likely isn’t going anywhere soon – in fact, their
numbers may grow in the short term.
In the pipeline
Artificial Intelligence? This might not be as far off into the future as it might
sound. Expect to see rudimentary services emerge soon that combine the
emerging influx of personal health data like genetic, microbiome, metabolic,
sleep patterns, and dietary intake patterns to be integrated and analyzed into
personalized nutrition recommendations.
It might be quite some time (if ever) before AI provides the emotional coaching
that only an expert nutritionist provides, but it will almost certainly become a
useful assistant!
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CHAPTER
10Diet-Tracking
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Sometimes tracking one’s diet as very direct consequences on immediate
health. Allergies are a prime example. Nima has built an at-home food allergy
testing device to measure gluten content, and they plan on expanding into
more allergy testing soon.
Other tracking systems are useful for meeting weight loss goals or optimal
athletic performance.
Fitness trackers have been a step in the right direction. Understanding your
caloric expenditure is very useful. And many in the fitness world are early
adopters for other tools like heart rate monitors. But while heart rate
measurements are getting much better, calorie expenditure is still very
inaccurate.48
And what about the other side of the equation – nutritional intake?
Nearly three decades of academic, peer-reviewed literature have
demonstrated, time and again, that tracking your dietary intake can
substantially help you lose weight and meet your nutrition goals.49
There’s just one problem. Nobody does it.
At least, not continuously. And if you’ve ever tried one, you probably know the
reasons. As one researcher commented, “Data entry is a fine job…if you get
paid to do it.” They’re painfully tedious, time-consuming, inaccurate, and
difficult to maintain. One study found that less than 3% of people who
downloaded a free diet-tracking app continued to use it after one week.50
Why Do Food Journals Work Poorly in the
Real World?
Studies have investigated the reasons why food journal users decide to use,
and not use, routine diet-tracking.51 Here are the major reasons. If you’ve tried
one before, chances are you also fit into one or more of these categories.
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It’s Too Tedious
The general complaint of tedium usually tops the list for complaints around
food journaling and food diaries.
We eat a lot! Generally, we eat at least three meals a day, and snack along the
way. Lest we forget what we consumed, we need to login to our apps, search
for an find the food, quantify how much we ate of it, for each ingredient.
We need to do this for everything we eat everyday? And if we forget, then the
whole day’s data becomes much less useful? It’s no wonder this is the primary
cause for quitting food journals.
Time-Consuming
Going hand-in-hand with tedium, is the time-cost. Food journal apps have
dramatically reduced the time associated with written journals for
documenting and calculating various food intake metrics, but it still requires
quite a bit of time after every meal, every day, to maintain this habit. It’s also
one of the top-cited reasons for quitting.
Which Food? And How Much of it?
Food journaling requires you to look up nutrition content of ingredients from
databases stored within the app or somewhere else online. These tools have
certainly gotten better over time.
But sometimes, it is difficult to know which food you have based on the
database entry for those kinds of foods. An incorrect selection can hurt the
accuracy of your documentation. Plus, not even identical foods are created
equal.
Then, you must document the quantity of each food you ate. When you are
eating processed foods with a nutrition label, this is much easier to estimate.
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But when you prepare your own meals, or eat prepared meals, it becomes
very difficult to know how much food you prepared and ate. One cup? Three-
quarters of a cup? This difficult often leads to trouble with food journalers.
And what are meals from restaurants, a friend’s house, or your coworkers
made of?
Food journaling requires you to log all of your meals. That includes meals
eaten out at restaurants and meal prepared by friends and family. But how do
you know the contents of these meals?
Without asking, it is nearly impossible to know. And asking can feel awkward. If
you eat out frequently, this can really impair your food journaling practice.
Not Remembering Everything You Ate
What did you eat for dinner yesterday? For many of us, this seemingly simple
question can draw a blank. Let alone, what did you have for dinner two days
ago.
Without logging every meal, while you are eating it (which most of us will
probably not do), our memory starts to become the harbinger of inaccuracy.
Then, you need to document how much you ate, too. Forgetting these pieces
of information undermine the whole process. And if the day’s data becomes
less useful, it becomes easy to drop the process altogether.
Quitting the Habit
Sometimes you remember to log your meal, but you forgot exactly what you
ate. Other times, you might simply forget to log the meal entirely!
This happens quite frequently for many users. And when your day is only a
patchwork of food logging, the data becomes much less useful. Calorie counts,
macronutrient ratios, micronutrient thresholds…they all remain inaccurate and
can hurt the day’s data as well as any long-term trends you are hoping to
monitor. This unsurprisingly leads to quitting entirely.
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The Act of Journaling Can Feel Obsessive
Food is a central component to a happy and healthy life. We dine with friends
and family for nourishment of bodies, but also for spending time with loved
ones.
Chronic food journaling, for some, begins to impair their relationship with food
in a negative way. The need to remember your meals in rigorous detail, and
constantly log each item multiple times a day, day-in and day-out, can start to
feel obsessive. Furthermore, it can start to lead to a decline in the quality of
your food-related life (which can directly impact your overall life satisfaction).52
Feeling Guilty about Logging Unhealthy Foods
Just as it can be difficult to admit to a real-life nutritionist you’ve binged on
cake last Saturday, food journaling can invoke a similar guilt. Whether it is
conscious or subtly sub-conscious, we tend to want to omit (or downsize)
logging of foods we deem to be unhealthy. Again, undermining the accuracy of
your food journal and your own dietary goals.
Lack of Discretion
Many of us don’t feel comfortable logging our food unless we are alone.
Sometimes, we simply may not want others to know we are tracking our diet.
It may spur a conversation about weight or habits we simply don’t want to
bring up and discuss.
But we often eat in the company of others. Friends, family, coworkers. And if
you don’t log your food during, or shortly after, a meal, it is difficult to
remember everything.62
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In addition, it can be awkward to ask a friend or coworker about the
ingredients of a home-cooked dish to log the meal properly.
How Do Food Journals Work then?
If there are so many reasons why people quit food journals, do food journals
work at all? How are there so many success stories out there, and how do
peer-reviewed research articles keep showing that they work?
In short, they work when people use them. Many people quit due to the
reasons shown above. Been when food journals do get used, they work. Here’s
why.
We Are Bad at Estimating our Intake
Diet-tracking works, in part, because studies routinely show that we are
woefully inept at estimating our nutritional intake.53 He eat many more
calories than we think we consume by a wide margin. We often estimate
calories based on the size of a dish, and calorie density is completely ignored
from the mental equation.
On a more granular level, we do the same for various nutritional components
as well. For example, we underestimate sugar intake largely because we aren’t
aware of how much sugar is packed into our foods.54
Clever studies from Dr. Brian Wansink of Cornell’s Food and Brand Lab have
documented this discrepancy in many ways. For example, we tend to eat until
our plate is empty, right? Well, Dr. Wansink and his lab created a bowl of soup
that was literally bottomless. Connected to a secret mechanism that allowed
the bowl to be continuously refilled unbeknownst to the participant, they
consumed, on average, 73% more soup.
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This is a large reason why food journals work. By gaining a better awareness of
the foods you eat throughout the day, and the quantities of foods you eat
throughout the day, many can benefit from the process to moving
consumption into the realm of mindful eating.
This can also help build intuitive eating habits, where we gain a better
understanding of what we should eat, when we should eat, and how much we
should eat.
Changing Habits is Difficult
Not only does the enlightenment that comes from identifying your nutritional
intake help you orient your consumptive behavioral patterns, but the
frequency and longevity of tracking correlates to increased and sustained
health outcomes. So if you track intake more frequently, you lose more weight.
And if you track your meals for longer, you sustain weight loss and healthier
consumption patterns for a longer time.
A study in behavior research identified the primary drivers for understanding
how do food journals work.55 They found,
Even moviegoers, when provided
with 14-day old, stale popcorn, at
38% more when it was served in
larger containers despite a
universal agreement that the
taste was awful. These studies,
and others, have led him to aptly
name this behavior Mindless
Eating.
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• 96.7% of respondents agreed that diet/nutrition apps increase their
motivation to eat a healthy diet.
• 86.2% of respondents agreed that diet/nutrition apps increased their
ability to eat a healthy diet.
• 91.7% of respondents agreed that diet/nutrition apps increased their
confidence in adhering to a healthy diet.
• 94.4% of respondents increased the use in goal-setting.
• And most importantly, 95.4% increased their intake of healthy foods and
95.5% increased their consistency in eating healthy foods.
So, Do Food Journals Work?
Yes, food journals do work. They can help you collect personal nutrition data,
better understand your consumptive patterns and dietary trends, build
motivation and confidence, and help drive better dietary patterns and overall
nutritional health.
But…
Like dieting, they fail if they are only used as a short-term measure. A dietary
reprieve is rarely the solution. A new, positive lifestyle that is sustainable is
more effective.
But there are many difficulties surrounding persistent food journal use.
Drastically reducing the effort to track and understand your own dietary intake
patterns is a good start.
Try Intake! And eliminate the tedious, time-consuming problems with apps with an accurate device you can use from home!
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In the pipeline
Smartplate has built a product designed to track the calories, macronutrients,
and micronutrients of the foods you prepare and eat. Using a plate designed to
sit on a scale, along with AI-based image recognition, you can place individual
food items on sections of the plate in order to get an idea of the nutritional
content of your meals. And SmartyPans has built a frying pan that is designed
to measure calorie content in real time. The user-friendliness of these tools,
and their accuracy, is yet to be seen. But they could certainly be worth trying!
Intake’s new diet-tracking device aims to greatly reduce the difficulty
associated with identifying macro and micronutrient consumption. Without
needing to log each, individual meal, Intake’s device will quantify your recent
caloric, protein, fat, carb, and sugar intake. Soon, we aim to expand into
vitamin and mineral tracking as well. You won’t have to worry about forgetting
or logging a meal again!
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CHAPTER
11Better Data, Better Results
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So there you have it. These techniques for personalizing your nutrition from
home all tend to fall into one or more of a few camps:
• How does your body uniquely deal with different dietary and nutritional
constituents
• How do you identify and monitor your dietary health and ongoing intake
• How do you adjust your food according to this nutrition data
Genetic and microbiome testing offer the promise of explaining how your body
might uniquely react to different macro and micronutrient constituents, but it
is still in its infancy in many regards.
Monitoring your dietary and nutritional health comes in many varieties. Breath
analysis can help identify basal metabolism, blood testing can identify a
smattering of dietary intake and other markers of metabolic health, and sweat
can provide an instantaneous measure of hydration levels.
At the final stages of digestion, stool and urine analyses provide opportunities
to investigate, among other more clinical conditions, blood glucose and dietary
intake, respectively.
Clever software is starting to provide curated recommendations, and
nutritionists can help you plan and maintain meal plans to meet your goals,
but you have to create your goals.
Whether it’s running an ultramarathon, bench-pressing 300 pounds, or simply
a long and healthy life, your diet will play a major role.
Try investigating different methods for personalizing your diet, and see which
one works best for you. 68
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