Data driven health decisions

I just had a personal experience with how timely, personal measurements can drive better health and lifestyle decisions.

Unfortunately, it wasn’t related to any of the times that I’ve been genotyped, nor was it in the context of care by any physician. In fact, I had to cross state lines in order to get it done.

More on that later.

The punch line, for the curious, is that I have elevated levels of mercury in my system, and I should probably eat a bit lower on the food chain when I order sushi.

Genomics fanboy

I’ve been a genomics fanboy for years. I enrolled in 23 and me when it first came out. I did the exome add-on that they offered briefly in 2012. I signed up with the Personal Genome Project around that time, and one of the exomes you can download from their site is mine. I drove an hour and spat in a tube for the Coriell Personalized Medicine Collaborative.

Coriell has been the most satisfying for me personally, since they occasionally email a PDF of a manuscript that is based on analysis using data derived from my (and many other’s) saliva. For me, at least, getting to read science papers and think, “I helped!” is much more motivating than cryptocurrency based micropayments.

While it’s all been fun and interesting, I haven’t learned very much that was terribly actionable. Without putting too fine a point on it, I have basically re-verified that I don’t have any of the major genomic disorders that would have already shown up by middle age. My standard line describing what I learned is I’m most likely male, almost certainly of northern European descent, likely brown hair, likely brown eyes, etc.

A question of focus

One way this shows up for me is that I don’t really know where to focus my health and lifestyle efforts. Sight unseen, one might tell a person like me that I should work out a little more, mix it up with cardeo and weight bearing exercise, eat a mostly vegetarian diet, don’t smoke, drink in moderation if at all, maintain a regular sleep schedule, use sunblock, floss, don’t sit too long at work, meditate, never read re-tweets, practice test driven development, etc, etc, etc.

None of it appeals and more or less because I know that all this advice is generic. I.e: It doesn’t really apply to me. I’m pretty healthy, so who cares, right?

On the opposite side, I’ve written before about my frustrations in convincing my physicians to screen me for colorectal cancer. I have a family history on both sides, genetic markers, and a medical history that all point in the same direction: Elevated risk. The current state of clinical practice is that men don’t need screening before age 50. I’ve been getting screened since my late 20’s, and I persist in thinking that it’s a really good idea. This is one of those cancers that is easily treatable with early detection and lethal without it.

So there we have it: Advice is either so generic that I ignore it, or else when I do have actionable information it’s a challenge to convince my physician to act on it.

Personalized bloodwork

Enter Arivale. They are a relatively recent addition in the direct to consumer health and lifestyle offerings that are cropping up this year. I heard about them through professional connections (thanks Dave!), and I’ve been excitedly waiting for them to offer services in Massachusetts.

The Arivale process involves a battery of bloodwork, genetic testing, and a gut microbiome (which is a novel experience if you haven’t provided a laboratory with a stool sample before). They combine this with coaching from people trained in nutrition, genetic counseling, and behavioral modification.

Because of the niceties of paying for lab work, I had to leave Massachusetts in order to reach a lab who could actually accept my money to draw the blood. Bright and early on a morning in the middle of February, I made a pre-breakfast, pre-coffee commute into New Hampshire to be stuck with needles.

Let me pause and say that again: Our health care system is so screwed up that I had to cross state lines to get bog-standard bloodwork done, entirely because I was paying out of pocket for it.

I also filled out a battery of health and family history questionnaires, as well as some about personality and lifestyle.

Show me the data

A couple of weeks later, I got an email and logged into a slick web dashboard. I went ahead and did the integration with my Fitbit account. I disabled GPS location sharing but enabled the rest. Let’s hear it for granular access control. Because Fitbit connects to my wireless scale, my Arivale coach was suddenly able to access five years of weight data on top of the four years of info on my pulse, sleep, and walking habits that my Fitbit devices have accumulated.

Let me pause and say that again: I logged into a slick web dashboard and integrated years worth of data about myself in the context of a new battery of lab tests. At no point did I have to write down my previous physician’s FAX number on a piece of paper.

It felt normal and ordinary, because I’m used to these integrations everywhere except health care. I do this sort of thing with my bank, my utilities, my news feed, and all sorts of other places.

That is a different rant, but come on!

Ahem.

Retrograde

Anyway, I logged in and saw (among other things), this:

It honestly gave me pause. I’m pretty robustly healthy. I don’t expect to see any of my biological metrics “in the red,” but there it was.

So I did a quick Google search, top hit, I feel lucky:

A bit of refinement:

Which led me to look at my last few Grubhub orders.

Yeah, every time I order, I bolt on that mackerel. That’s for me. That’s my treat. It’s worth noting that February 15 was the night before I made that hungry, grouchy drive. I know that mercury accumulates in tissue and lingers there over time, your milage may vary, but it’s a pretty clear signal in my book.

And it showed up in my lab work.

Fallout

So there you have it. All of a sudden, I’ve picked something actionable to do for my health – out of the incredible variety of good advice at my fingertips. Because, well: