What if you could tell before you were entering into a crash or flare that you were about to enter one? What if you had time to rest, take a treatment, employ calming techniques or whatever works for you before you unknowingly put yourself into a crash state? What if you were able to nip chronic fatigue syndrome or fibromyalgia in the bud before it got going?
That time may be coming. Proponents believe that wearables may end up being one of the great health advances of our times.
Precision
One of the great advantages of wearables is their precision. No longer are you tied to inaccurate population norms. Your baseline is no longer the average of thousands of people of mixed gender, age, race and health status. Your baseline is now your body.
That's important. We saw that for some people ferritin levels in the normal range are not normal at all for them - they’re low. Alzheimer's is thought to be unimprovable, but one UCLA Alzheimer's study improved cognitive functioning by optimizing test results using diet, exercise, supplements, behavioral changes and in some cases drugs. (Apple has developed health applications for its Apple Watch. (Fascimile by Justin - Wikimedia).
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[/fright]Nor are people using wearables as dependent on twice or thrice yearly testing to determine what's happening in your body. Furthermore, wearables are an inexpensive (relative to other health costs) way of delivering real data.
With over 70 million devices sold over the past couple of years, wearables are a hot item. How hot perhaps no one suspected until Pebble's 2012 Kickstarter campaign to raise $100,000 for their initial smartwatch model ended a month later with the company raising a cool $10,266,844. (By December 2014 Pebble had sold its millionth smartwatch. In 2015 it raised another $20,000,000. After the Apple Watch cut into its sales, however, Pebble went bankrupt. Fitbit then snatched up Pebble's intellectual property rights; it's a competitive market).
Catching Diseases Early
We know that physiological changes probably begin occurring before you have any symptoms or at least any significant ones. Early life stresses, for instance, apparently institute physiological changes that take decades to come to fruition (in an illness). The immune changes that result in chronic regional pain syndrome (CRPS) appear to be set in motion by a flu-like event occurring just before an injury; it takes the combination of both to get that difficult illness started. Similarly, something unusual clearly happens after an infection in the bodies of many people with ME/CFS. We do know that the severity of an infection - measured mostly by symptoms - plays a key role. Doctors don't do cytokine panels and certainly don't trust symptom severity as a marker, but what if basic changes occur that could be picked up?
The wearables right now don't have the capacity to detect the more subtle changes occurring in those illnesses but they can detect shifts in heart rate, oxygen consumption, etc. Could those be enough to clue us in that an illness, perhaps even a potentially devastating illness, could be on the way? A recent Stanford study suggested that just might be the case.
The Study
PLoS Biol. 2017 Jan 12;15(1):e2001402. doi: 10.1371/journal.pbio.2001402. eCollection 2017.
Digital Health: Tracking Physiomes and Activity Using Wearable Biosensors Reveals Useful Health-Related Information. Li X1, Dunn J1,2, Salins D1, Zhou G1, Zhou W1, Schüssler-Fiorenza Rose SM3,4, Perelman D5, Colbert E3, Runge R1, Rego S3, Sonecha R1, Datta S1, McLaughlin T5, Snyder MP1.
The Stanford researchers evaluated over 400 (400!) wearable devices (over 500 are available) and selected seven that have been validated in previous studies. One person wore all seven devices while the other 42 people in the study used the Basis I or Basis Peak Smartwatch. To date Stanford researchers have used the seven wearables to chart activity levels and steps taken, calories burned, heart rate, inflammation, insulin levels, skin temperature, sleep, oxygen consumption, radiation exposure and weight. The devices tested were:
The researchers applied algorithms that tracked elevated heart rates and skin temperature to attempt to predict illness onset. One person also took their oral temperature regularly and a psychomotor vigilance test that tests fatigue levels. Eighteen people participated in one part of the study that tracked the effects of airplane travel.
Frequent tests of c-reactive protein levels and/or glucose levels were taken in some participants to assess the ability of the wearable to pick up signs of inflammation and insulin resistance.
Results
We suggest that wearable devices may be a sensitive measure for detecting certain inflammatory responses, and that in some circumstances, these may even be better than participant-reported observations. The authors
Airplane flights are a major stressor for many people with ME/CFS and/or FM. The data collected suggested that reduced oxygen availability may be the reason why. As the planes hit higher altitudes blood oxygen levels dropped, sometimes to very low levels. Oxygen levels tended to rebound but intervals of very low oxygen (14.8%) were still seen. Statistical tests indicated that the reduced oxygen availability was correlated with self-reported fatigue levels in healthy people.
Inflammation is recognized as a contributor to many diseases including probably ME/CFS and fibromyalgia. Could the wearable detect signs of inflammation? The lab tests indicated that increases in heart rate and skin temperature were, in fact, associated with increased levels of inflammation (c-reactive protein). Because CRP is associated with all sorts of inflammatory issues from infection to autoimmune diseases to cancer, it's a very broad measure. The study suggested, though, that in general increased resting heart rates (not caused by exercise) are associated with inflammation - as perhaps many people with ME/CFS have suggested.
The most intriguing part of the study came when the devices proved to an effective early warning of incipient Lyme disease. One participant experienced symptoms but no bull's eye rash several weeks after visiting an area with Lyme disease. His reduced oxygen levels and elevated heart rate at the beginning of his long plane flight home were expected, but when they failed to normalize during the flight and when his heart rate remained elevated even after returning home, he suspected something else was up. Shortly after that he developed a cold. Tests later indicated that he'd been infected with the Lyme bacteria. The wearables indicated his body was reacting well before he developed symptoms.
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[/fright]An increased heart rate was the first sign of illness onset in every participant in the study who came down with a cold. Of course, some people with chronic fatigue syndrome (ME/CFS) use early morning resting heart rates to assess whether they should rest. Dr. Klimas uses increased resting heart rates upon awakening in her patients to determine if an ME/CFS/FM patient has done too much exercise or activity the day before.
Interestingly the only supplement or drug that seemed to influence inflammation were fish oil supplements. See more here.
Insulin resistance is another issue that may pop up in ME/CFS and fibromyalgia at some point given the difficulty exercising and studies showing high triglyceride levels. (Higher triglyceride levels, lower levels of high-density lipoproteins, and higher blood pressure are associated with insulin resistance). Plus the possible problems with glucose utilization suggested by recent metabolomics studies, sound, at least to this layman's ears, similar to the decreased uptake of sugar by muscle and fat cells found in insulin resistance.
Insulin resistance doesn't just increase one's risk of diabetes; in some people it contributes to cardiovascular disease, inflammation or other conditions, and it is common. A recent study suggested that poor diet and sedentariness contribute to insulin resistance in as much as 35 percent of the population of the United States.
Rather astonishingly, the researchers were also able to produce an algorithm that predicted which participants were insulin-resistant based on their number of daily steps, daytime heart rate and the difference between their daytime and nighttime heart rates. No less than sixty percent of the participants were insulin-resistant.
Given the possible mitochondrial problems in ME/CFS it's intriguing that a recent Stanford study found that a gene linked to insulin resistance also affects the mitochondria. Altering this gene in mice caused them to have difficulty exercising. Poorly functioning mitochondria appear, then, to be associated with insulin resistance (reduced glucose uptake).
While this study was probably the most comprehensive study to date of the effectiveness of wearables, it did not track heart rate variability. Other variables such as galvanic skin response, food intake and continuous glucose were tracked, however, and will be addressed in another publication.
Stanford and Precision Health
Stanford's MyHeartCounts smartphone app demonstrated that massive amounts of data can be collected using these apps. Almost 50,000 people enrolled in a study examining activity patterns within six months and 23andME's genomic data is being integrated into the study to provide genetic insights. An IPhone app is being used to study the effectiveness of drugs to increase activity in people with peripheral artery disease. In July Stanford will host the Big Data in Biomedicine Conference which is designed to "transform lives through precision health".
Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia
Tracking hundreds or even thousands of ME/CFS or FM patients to determine what is tweaking them (airplanes, activity, poor sleep, medications, environments) is certainly within reach. If increased heart rates are indicative of the beginning of an inflammatory event, might an anti-inflammatory drug or avoiding inflammation inducing foods be helpful? Do higher carbohydrate diets increase resting heart rates?
The chronic fatigue syndrome (ME/CFS) community is getting into the game. The Open Medicine Foundation has plans to collect data from many ME/CFS patients’ wearables.
The Bateman-Horne Institute is currently testing out the Oura ring that measures activity and sleep. Both Dr. Kogelnik of the OMF and the Solve ME//CFS Initiative are presenting at the World Precision Data Conference this month in Silicon Valley.
Wearables able to measure heart rate and/or heart rate variability and other measurements are already being used to inform about diet, exercise and treatment decisions on a personal level in some patients.
ME/CFS/FM studies could, by combining lab tests with wearable data, pick up disease and patient specific issues. Calorie, glucose, fat, and carbohydrate counters could delineate a subset of patients for whom carbohydrates cause inflammation. Galvanic skin response, heart rate and heart rate variability measurements could delineate patients with autonomic nervous system problems and conceivably link them to activity, sleep issues, diet, etc. EEG wearables could add brain wave changes into the equation.
That's just the tip of the iceberg. Other sensors, most of which are probably not on the market, have been developed to assess gait, sweat metabolite analysis, pH and calcium concentrations, lactate levels, blood flows and blood volume, one's heath status using tears, saliva sweat and others. Contact lenses have been developed that detect infections by measuring cytokine levels and textiles can measure cardiac functioning.
Could the shift from an acute pain state to a chronic pain state in FM be detected using brain wave monitors? Could savvy parents clap a wearable on a teenager suffering from a cold that would indicate that this time they REALLY, REALLY needed to rest? A creative use of wearables might be able to tell us much.
That time may be coming. Proponents believe that wearables may end up being one of the great health advances of our times.
Precision
One of the great advantages of wearables is their precision. No longer are you tied to inaccurate population norms. Your baseline is no longer the average of thousands of people of mixed gender, age, race and health status. Your baseline is now your body.
That's important. We saw that for some people ferritin levels in the normal range are not normal at all for them - they’re low. Alzheimer's is thought to be unimprovable, but one UCLA Alzheimer's study improved cognitive functioning by optimizing test results using diet, exercise, supplements, behavioral changes and in some cases drugs. (Apple has developed health applications for its Apple Watch. (Fascimile by Justin - Wikimedia).
[fright]
With over 70 million devices sold over the past couple of years, wearables are a hot item. How hot perhaps no one suspected until Pebble's 2012 Kickstarter campaign to raise $100,000 for their initial smartwatch model ended a month later with the company raising a cool $10,266,844. (By December 2014 Pebble had sold its millionth smartwatch. In 2015 it raised another $20,000,000. After the Apple Watch cut into its sales, however, Pebble went bankrupt. Fitbit then snatched up Pebble's intellectual property rights; it's a competitive market).
Catching Diseases Early
We know that physiological changes probably begin occurring before you have any symptoms or at least any significant ones. Early life stresses, for instance, apparently institute physiological changes that take decades to come to fruition (in an illness). The immune changes that result in chronic regional pain syndrome (CRPS) appear to be set in motion by a flu-like event occurring just before an injury; it takes the combination of both to get that difficult illness started. Similarly, something unusual clearly happens after an infection in the bodies of many people with ME/CFS. We do know that the severity of an infection - measured mostly by symptoms - plays a key role. Doctors don't do cytokine panels and certainly don't trust symptom severity as a marker, but what if basic changes occur that could be picked up?
The wearables right now don't have the capacity to detect the more subtle changes occurring in those illnesses but they can detect shifts in heart rate, oxygen consumption, etc. Could those be enough to clue us in that an illness, perhaps even a potentially devastating illness, could be on the way? A recent Stanford study suggested that just might be the case.
The Study
PLoS Biol. 2017 Jan 12;15(1):e2001402. doi: 10.1371/journal.pbio.2001402. eCollection 2017.
Digital Health: Tracking Physiomes and Activity Using Wearable Biosensors Reveals Useful Health-Related Information. Li X1, Dunn J1,2, Salins D1, Zhou G1, Zhou W1, Schüssler-Fiorenza Rose SM3,4, Perelman D5, Colbert E3, Runge R1, Rego S3, Sonecha R1, Datta S1, McLaughlin T5, Snyder MP1.
The Stanford researchers evaluated over 400 (400!) wearable devices (over 500 are available) and selected seven that have been validated in previous studies. One person wore all seven devices while the other 42 people in the study used the Basis I or Basis Peak Smartwatch. To date Stanford researchers have used the seven wearables to chart activity levels and steps taken, calories burned, heart rate, inflammation, insulin levels, skin temperature, sleep, oxygen consumption, radiation exposure and weight. The devices tested were:
- Scanadu, iHealth-finger, Masimo - worn on the finger, pulse oximeters measure the amount of oxygen in the blood
- The Basis 1 and Basis Peak Smartwatches were used to track heartbeat, motion, perspiration, skin temperature, ambient temperature, activity, and sleep. (All Basis Peak devices were recalled in Dec. 2016 because of an overheating problem and are no longer available)
The researchers applied algorithms that tracked elevated heart rates and skin temperature to attempt to predict illness onset. One person also took their oral temperature regularly and a psychomotor vigilance test that tests fatigue levels. Eighteen people participated in one part of the study that tracked the effects of airplane travel.
Frequent tests of c-reactive protein levels and/or glucose levels were taken in some participants to assess the ability of the wearable to pick up signs of inflammation and insulin resistance.
Results
We suggest that wearable devices may be a sensitive measure for detecting certain inflammatory responses, and that in some circumstances, these may even be better than participant-reported observations. The authors
Airplane flights are a major stressor for many people with ME/CFS and/or FM. The data collected suggested that reduced oxygen availability may be the reason why. As the planes hit higher altitudes blood oxygen levels dropped, sometimes to very low levels. Oxygen levels tended to rebound but intervals of very low oxygen (14.8%) were still seen. Statistical tests indicated that the reduced oxygen availability was correlated with self-reported fatigue levels in healthy people.
Inflammation is recognized as a contributor to many diseases including probably ME/CFS and fibromyalgia. Could the wearable detect signs of inflammation? The lab tests indicated that increases in heart rate and skin temperature were, in fact, associated with increased levels of inflammation (c-reactive protein). Because CRP is associated with all sorts of inflammatory issues from infection to autoimmune diseases to cancer, it's a very broad measure. The study suggested, though, that in general increased resting heart rates (not caused by exercise) are associated with inflammation - as perhaps many people with ME/CFS have suggested.
The most intriguing part of the study came when the devices proved to an effective early warning of incipient Lyme disease. One participant experienced symptoms but no bull's eye rash several weeks after visiting an area with Lyme disease. His reduced oxygen levels and elevated heart rate at the beginning of his long plane flight home were expected, but when they failed to normalize during the flight and when his heart rate remained elevated even after returning home, he suspected something else was up. Shortly after that he developed a cold. Tests later indicated that he'd been infected with the Lyme bacteria. The wearables indicated his body was reacting well before he developed symptoms.
[fright]
Interestingly the only supplement or drug that seemed to influence inflammation were fish oil supplements. See more here.
Insulin resistance is another issue that may pop up in ME/CFS and fibromyalgia at some point given the difficulty exercising and studies showing high triglyceride levels. (Higher triglyceride levels, lower levels of high-density lipoproteins, and higher blood pressure are associated with insulin resistance). Plus the possible problems with glucose utilization suggested by recent metabolomics studies, sound, at least to this layman's ears, similar to the decreased uptake of sugar by muscle and fat cells found in insulin resistance.
Insulin resistance doesn't just increase one's risk of diabetes; in some people it contributes to cardiovascular disease, inflammation or other conditions, and it is common. A recent study suggested that poor diet and sedentariness contribute to insulin resistance in as much as 35 percent of the population of the United States.
Rather astonishingly, the researchers were also able to produce an algorithm that predicted which participants were insulin-resistant based on their number of daily steps, daytime heart rate and the difference between their daytime and nighttime heart rates. No less than sixty percent of the participants were insulin-resistant.
Given the possible mitochondrial problems in ME/CFS it's intriguing that a recent Stanford study found that a gene linked to insulin resistance also affects the mitochondria. Altering this gene in mice caused them to have difficulty exercising. Poorly functioning mitochondria appear, then, to be associated with insulin resistance (reduced glucose uptake).
While this study was probably the most comprehensive study to date of the effectiveness of wearables, it did not track heart rate variability. Other variables such as galvanic skin response, food intake and continuous glucose were tracked, however, and will be addressed in another publication.
Stanford and Precision Health
Stanford's MyHeartCounts smartphone app demonstrated that massive amounts of data can be collected using these apps. Almost 50,000 people enrolled in a study examining activity patterns within six months and 23andME's genomic data is being integrated into the study to provide genetic insights. An IPhone app is being used to study the effectiveness of drugs to increase activity in people with peripheral artery disease. In July Stanford will host the Big Data in Biomedicine Conference which is designed to "transform lives through precision health".
Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia
Tracking hundreds or even thousands of ME/CFS or FM patients to determine what is tweaking them (airplanes, activity, poor sleep, medications, environments) is certainly within reach. If increased heart rates are indicative of the beginning of an inflammatory event, might an anti-inflammatory drug or avoiding inflammation inducing foods be helpful? Do higher carbohydrate diets increase resting heart rates?
The chronic fatigue syndrome (ME/CFS) community is getting into the game. The Open Medicine Foundation has plans to collect data from many ME/CFS patients’ wearables.
The Bateman-Horne Institute is currently testing out the Oura ring that measures activity and sleep. Both Dr. Kogelnik of the OMF and the Solve ME//CFS Initiative are presenting at the World Precision Data Conference this month in Silicon Valley.
Wearables able to measure heart rate and/or heart rate variability and other measurements are already being used to inform about diet, exercise and treatment decisions on a personal level in some patients.
ME/CFS/FM studies could, by combining lab tests with wearable data, pick up disease and patient specific issues. Calorie, glucose, fat, and carbohydrate counters could delineate a subset of patients for whom carbohydrates cause inflammation. Galvanic skin response, heart rate and heart rate variability measurements could delineate patients with autonomic nervous system problems and conceivably link them to activity, sleep issues, diet, etc. EEG wearables could add brain wave changes into the equation.
That's just the tip of the iceberg. Other sensors, most of which are probably not on the market, have been developed to assess gait, sweat metabolite analysis, pH and calcium concentrations, lactate levels, blood flows and blood volume, one's heath status using tears, saliva sweat and others. Contact lenses have been developed that detect infections by measuring cytokine levels and textiles can measure cardiac functioning.
Could the shift from an acute pain state to a chronic pain state in FM be detected using brain wave monitors? Could savvy parents clap a wearable on a teenager suffering from a cold that would indicate that this time they REALLY, REALLY needed to rest? A creative use of wearables might be able to tell us much.
- Take the online Canadian Tiredness test used in the Stanford study and/or try the "Test Your Tired Self" Australian test measuring your fitness to drive here.
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