Four Do-It-Yourself Ways To Assess Your Health
Let’s consider criteria besides body fat and muscle mass
Every year, consumers spend billions of dollars to lose weight and build muscle. Lean and toned is the pedestrian definition of physical health, and that definition has not changed much in the past 100 years. But does muscle tone and lack of body fat really mean that you’re in good physical condition? Maybe. But let’s consider some other biomarkers that you can use to get a better picture of your overall physical health.
The one common biomarker that I won’t be considering is the body mass index (BMI). BMI, invented around 1840, is a formula that uses your weight and height to determine if you are underweight, overweight, or obese¹. There are plenty of well-known problems with the BMI most notably that BMI does not discriminate between muscle and fat. Hence BMI does not always accurately measure body composition since a muscular person low in body fat can be classified as overweight using the BMI.
In a world where obesity seems to be epidemic, lack of body fat does have meaning, and there are many scientific studies that prove some correlation between lack of body fat and better health outcomes. But, in the quest for a lean and toned body, it’s worth noting that medical science has conflicts with the reverse conclusion: that obesity necessarily means that you are a health risk. There’s even a term for it: metabolically healthy obesity. That means that a person is obese yet they don’t appear to have any health issues. This is an obesity paradox that is not yet fully explained by modern scientific methods.
And yet, there are some other ways to assess the current state of your physical health that don’t require a trip to the doctor nor are likely to lead to the potential body-shaming that comes with relentless attempts to lose weight.
Sleep
Without sleep, you’ll die. The world record for number of days without sleep is 11 days but you only need to go a few days with zero sleep in order to feel nauseous, dizzy, and possibly start to hallucinate. According to the National Sleep Foundation, “Good sleep quality is a well-recognized predictor of physical and mental health, wellness, and overall vitality.”
What constitutes good sleep quality? If you want to delve deeply into the science, the National Sleep Foundation’s December, 2016 report is a decent summary of the state-of-the-art in sleep architecture. However, it’s tricky for someone not in a laboratory environment to measure indicators such as “sleep efficiency” (ratio of total sleep time to time in bed) and “sleep latency” (length of time it takes to transition from wake to sleep). Also, there was not even a consensus among the researchers on the twelve quality-of-sleep indicators listed in the report which makes it hard to give absolute recommendations for most aspects of sleep quality. However, their 2015 recommended sleep durations (see Table 1) is a good starting point.
Outside a sleep laboratory, in order to measure our sleep quality, we have our self-awareness and over-the-counter sleep trackers.
One indication that you’re having issues with sleep is when you have to self-medicate frequently in order to get to sleep. That could mean drinking alcohol, ingesting cannabis, or taking sleeping pills in order to go under. While substances like these will certainly make you sleep, it’s probably not the quality of sleep you want in order to be productive in the long term. For example, with cannabis, you may be missing out on the deeper levels of sleep that will make you feel good in the morning. Ultimately, if you’re frequently self-medicating in order to get to sleep, you may want to consider what factors in your life might be causing you to self-medicate.
There are quite a few wearable, and under-the-matress, sleep trackers on the market such as Beddit, Whoop, Emfit, Masimo, Fitbit, and Oura. These devices attempt to measure your heart rate and body movement while you sleep and then summarize your quality of sleep based on those measurements. While they can help you understand your sleep patterns, they may not be so good at actually measuring your sleep.
Sleep is deceptively easy to measure (“I slept 7 hours last night!”) but difficult to analyze (“Was it REM or non-REM sleep?”). We can look at it from the other direction though. If you wake up feeling rested and go through your day without serious sleepiness, then your sleep is successful.³
Poop
Poop has seen a renaissance of sorts in the past couple of decades and medical science has a pretty good understanding of the traits of healthy poop. Barely 20 years old, the Bristol Stool Scale is an easy way to eyeball your own poop and determine whether there’s an issue. On the Bristol Stool Scale (see Table 2), you want poop of type 3 or 4. Easy, right?
How long should it take you to poop? A fairly recent study found that mammals, on average, take about 12 seconds to poop. That’s a useful average if you’re worried that a predator will smell your fresh poop and seek you out, but it shouldn’t take you very long in any case.
If you want a next-level analysis of your poop, you can pay for a stool analysis to find out if there is strange bacteria, parasites, or even blood not visible to the human eye. Poop transplants have shown to be effective for certain gut infections where antibiotics don’t work. All of this ties into your gut flora (microorganisms in your stomach) which is related to a relatively new area of scientific study, probiotics.
Blood Pressure
Blood pressure is one of the four main vital signs. In Western medicine, blood pressure, along with respiratory rate, heart rate, and body temperature are what doctors use as a baseline when evaluating a patient’s health. Respiratory rate is easy to measure, and should be around 12 to 16 breaths per minute. Heart rate and body temperature are also easy to measure using classic methods and a thermometer.
Blood pressure is a generally useful biomarker, and, unlike the other three vital signs, it’s more likely that your blood pressure could be off and you wouldn’t realize it. High blood pressure might be an indicator of various cardiovascular-related issues, and it’s easy to measure. You can purchase a digital blood pressure reader for around $30. If your blood pressure is too high, it’s called hypertension, and if it’s too low, hypotension.
A blood pressure reading has two numbers, for example, 120/80. The first number is the systolic blood pressure which is the most important number as it represents the highest blood pressure attained while your body moves blood around your body. The second number is the diastolic blood pressure which represents the lowest blood pressure your body attains.
While high blood pressure (see Table 3) is clearly of concern, low blood pressure may or may not be an issue. The Mayo Clinic says that a reading below 90/60 is “generally considered low blood pressure.” If you have low blood pressure and are having dizziness, lightheadedness, or fatigue problems, it might be symptomatic of other issues.
Mobility
By mobility, I mean both the elasticity of your muscles⁴ and the range of movement (ROM) of your joints. Mobility is often ignored until it’s compromised, and then it may be a contributor to back, knee, or hip issues. The muscles in your body have a fair amount of elasticity, but that elasticity fades over time if it’s not maintained.
So what can you do to assess your current state of mobility? Most medical studies focus on testing older people and people with medical issues. For the average person, though, you can try some carefully executed postures designed to reveal the extent of your mobility in different areas of your body. I’m a fan of the site Physiopedia which contains some accessible descriptions of somewhat obscure clinical techniques. Below are a few well-known tests.
Hip Flexors: Thomas Test
Hamstrings: Puranen-Orava Test
Lower Back: Schober’s Test
Neck and Upper Spine: Cervical Flexion-Rotation Test
Shoulders: Apley Scratch Test
What’s a “normal” range of motion for joints? The CDC has published the results of their range of motion study which provides a table of “normal” ROM for different male and female age groups. The results are listed in degrees of motion, so, in order to apply the results, you also need to look at the document which describes how they tested for range of motion.
Some people are born with various degrees of hypermobility. For those people, the challenge is to reinforce the muscles around their hypermobile joints. But for the majority of people, the challenge is to retain elasticity in our muscles and the range of motion in our joints.
Is muscle elasticity important? I don’t buy into fitness trends, but the concept of measuring and improving your flexibility is being rapidly commoditized by startups like StretchLab, Racked, and Stretch*d.
Scoring Your Health
If there’s one thing that BMI has shown us, it’s that a single biomarker is not a reliable indicator of good health, and that determining “normal” ranges for biomarkers is a difficult task. It’s also hard to determine causality even when we know that a biomarker lands outside of expected ranges. Still, it seems like there is an opportunity to devise a score, comprised of a composite of various health metrics, that would be more useful than any single criteria (this is left as an exercise for the reader).
There are other useful biomarkers around. Blood counts can give you an idea of how “normal” your blood work looks, and whether you may be suffering from anemia or other maladies. Grip strength, strangely enough, correlates to a number of problems including bone mineral density, cardiovascular health, malnutrition, and overall mobility though I was unable to find a definitive answer to what constitutes “normal” grip strength.
Have your own favorite biomarker? I’d like to hear about it.
¹The word “obese” means that you weigh enough that medical science thinks it’s likely that you have health issues whereas “overweight” simply means that you weigh more than the recommended amount for your age and height.
²You can find numerous scientific studies that correlate excess body fat to mortality and health issues. Here’s an old one. It concludes: “…it is evident that increased amounts of internal adipose [fat storage] tissue in the abdomen puts one at the greatest health risk.”
³But do you use a lot of caffeine to wake up in the morning? That’s another issue.
⁴The word mobility is sometimes used to simply mean the ability to stand up, walk, and otherwise move your body from place to place.
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