Beyond the Influencers: A Stoic Guide to Your Biomarkers

The Wild West of Health Optimization

Biomarkers for health are now easily accessible by the general population, whether it be through the prescription/guidance of a physician, an over the counter tool like a continuous glucose monitor (CGM), or through web based platforms to order specialty tests. Their significance, however, is held hostage by whatever social media influencer or bro-science dude you pay attention to. Does cholesterol matter? Which kind? In what context?

The struggle is that the individual can obtain virtually any biomarker they want, but there is no uniform way to interpret those biomarkers, and most importantly, no action plan tied to the biomarkers to either preserve or favorably modify them. Sadly, because of the ubiquity of biomarker availability and the fact their application now goes beyond disease prevention and modification and extends into health optimization, we cannot reliably depend on a general primary care provider to order and interpret the results to every test we think is important for our health.

The good news is that there are options for the "consumer" (previously the patient) to access this critical data to optimize health. The bad news is that there is no standard (like there is in the practice of medicine, for example) for who interprets the results. We are armed with a full arsenal of health data but the ultimate goal is to leverage that data to improve and optimize our health.

If the data are showing issues, who is prescribing the intervention to right the ship? Is it the dude you follow on instagram? Is it your buddy who is really ripped (so he must know what he's talking about)? Are you doing your own homework? Luckily, AI is a tool at everyone's fingertips and it's not that far away from being a solution to this problem. But at this point, the AI is still quite dependent on prompts from the user, so it is prone to some serious flaws. I experienced this firsthand during my exploration of the ketogenic diet and the absolute havoc it wreaked on my lipid profile, but I digress.

With all of that said, the availability of any and every biomarker under the sun is still probably a net positive. We just have to be careful with the interpretation of results and the interventions we decide to, or not to, implement, as this is where the proverbial rubber hits the road.

What Exactly is a Biomarker?

Now, if you have no idea what biomarkers are, let me clear that up now. A biomarker is any measureable indicator in the body that can be leveraged to diagnose, monitor or predict the likliehood of developing a disease. There is a lot to this, and I am going super simple here, but for the average person taking a personal interest in health, this is sufficient. Two high-level categories are:

1. Physical Biomarkers

   1. Blood pressure

   2. Body weight and composition

   3. VO2 Max

   4. Etc.

2. Blood and Fluid Biomarkers

   1. Fasting blood glucose

   2. Lipid profile

   3. Etc.

Another way to categorize biomarkers is by whether they are subjective or objective measures. Subjective measures are defined by the lived experience of the individual, whereas objective measures are quantifiable and can be compared to population norms or used to risk stratify.

Here are a few examples of subjective biomarkers and what an appropriate next step might be:

Subjective Biomarker	Action
Any musculoskeletal pain	Diagnostic workup by a qualified Healthcare Provider (HCP), possibly requiring imaging
Any activity limited by symptoms	Diagnostic workup by a qualified HCP, identify root cause of symptoms
Stress and anxiety	Identify the cause of the disturbance through preferred means (i.e. self exploration, therapy, meditation, etc.)

Of course, these subjective biomarkers will likely have some sort of objective marker closely related to them. This would enable the use of multiple parameters to evaluate progress for a given challenge being faced.

For example, if you are experiencing knee pain, you might visit an orthopedist. The orthopedist would likely do some baseline measurements and tests, such as muscle strength and range of motion. Now you have two baseline metrics: the subjective pain you are experiencing (which healthcare providers often ask you to quantify on a pain scale in an attempt to make it more of an objective measure) and the objective, physical, measurements taken by the HCP.

The key, in this type of scenario, is to recognize that simply improving a number is not really very useful if it does not tangibly improve your lived experience. If your range of motion improves and your strength improves but your pain is not resolved, then there is still a problem. This is where it is important to be your own advocate. Becuase you are putting in the work, you are going to likely see the objective improvements. The HCP might tell you that things are better now, but you know better.

This is not true in all cases and there are undoubtedly examples of subjective experience that won't have a solid objective measure to couple with it, such as anything involving the mind. But there are also critically important objective biomarkers that do not impact our subjective experience in any way shape or form.

The Continuum of Prevention

Just because you look good, feel good and are living life exactly the way you want, that doesn't mean your disease risk is zero. Consider things like blood glucose and cholesterol levels. They could be completely normal or dangerously out of range, and there is no way for anyone to know without an objective assessment. Or, god forbid, the metrics have been out of whack for so long that you experience a heart attack or some other physical manifestation of the disease.

The objective biomarkers help us to determine where we are in the game.

• Primordial Prevention: Prevention of the risk factors from devleoping in the first place, like establishing habits to maintain your normal blood pressure.

• Primary Prevention: Management of the risk factors to prevent the first serious event, like taking a medication to lower your chronically elevated blood pressure.

• Secondary Prevention: Management of a disease following the establishment of disease or an event, like taking medications following a heart attack or after a diagnostic test identifies atherosclerotic plaque in the heart.

• Tertiary Prevention: Management of chronic disease to slow progression, like an invasive procedure such as a bypass to treat cardiovascular disease.

The point is that without some baseline understanding of your objective health, you really have no idea where you are in this continuum of prevention. Are you doing perfectly and trying to stay that way through primordial prevention? Or are you on your way to disease with risk factors already present that need primary prevention. If you have already had events, it is easier to define where you are in terms of your preventions strategy, but your level of aggression might be a bit different than someone who has never had an issue before.

Knowing Your Why

Taken together, our lived experience and the raw data available in our body give us a more complete story about our health status. Additionally, we need to give equal consideration to physical fitness levels, and you can't have one without the other.

The same questions I proposed with respect to fitness apply here, plus one.

1. Why are you trying to be "healthy?"

2. What are you hoping a clean bill of health will enable you to do?

3. What are the things in your life that bring you the most joy and what level of fitness is required to do them? And for how long do you wish to continue doing those things?

4. How much do you enjoy the activities required (i.e. the work) to improve the different components of fitness (i.e. strength training, zone 2 training, HIIT, etc.)? T

5. How willing are you to do the things required to modulate the biomarkers (i.e. exercise, nutritional compromise, medication adherence, etc.).

Before you run to the the lab to get poked and prodded, make sure you know your "why." Biomarkers are critically important to ensure our ability to optimize our health, but more important than the numbers themselves is the plan to preserve or improve them. If you are not on board with doing the work, or the improvement of a certain parameter is lower priority given your North Star philosophy, you will be much better prepared to allocate your time and resources to make sure you are still in line to improve your life, not just your health.

We must never forget that our health is fragile and not entirely within our control. The Stoics consider health, along with wealth and reputation, "indifferents." We do not need health to be a good, virtuous person. However, having it enables us to contribute more meaningfully in our life, but the realization that health is outside of our control is practicing the virtue of wisdom. Working hard to maintain or optimize health allows us the opportunity to practice virtues like temperance and courage.