Crossing the Chasm: A Breakthrough In Functional Medicine

Photo: Crossing the Chasm: A Breakthrough In Functional Medicine

The last 14 months have been 6 ½ day weeks at the desk. I’ve been feeling the need to detach myself from the trenches, evaluate, and plan the next phase of growth.

So last Thursday night, I clocked out. Nothing in the business needed me, I tied up any loose ends and entrusted my team to keep the wheels turning. I made big plans - a 7 day staycation. I had a stack of books I wanted to get through, 4 mountains in Squamish I wanted to climb, and otherwise, workout, cook and write.

But Friday morning I woke up with a horrible cold, and it has lasted for the week.

It’s convenient and inconvenient at the same time. I haven’t had time to be sick this year, so, (aside from my weekend with COVID) I haven't suffered as much as a slow morning.

Often - as soon as we hit the brakes, our immune system does too. It’s more convenient (I suppose) to be sick when you have a clear schedule.

I liken it to my laptop - that little box that pops up reminding me of the “New Software Update: Would you like to install and restart?” No! I don’t have time for that now! I usually hit the “remind me later” button for a solid month and a half. Eventually, (typically late in the evening) I accept the prompt and step away from the screen.

We need to get sick. It is our body's chance to update our antibodies. Twice / year is probably a good practice. So I am currently experiencing a well timed software update.

Looking at the data on my Whoop Band, I should have seen this coming. My Whoop is a wrist worn device that monitors my exercise exertion, sleep quality, resting heart rate and most importantly - my heart rate variability (HRV). HRV is the variance of time between beats of your heart. Contrary to intuition, if your heart is beating 60 beats per minute, it is not beating once per second. The spread between each beat can vary from 0.8 seconds to 1.15 seconds - sometimes more and sometimes less.

The higher the degree of variance, the higher your heart rate variability.

Why does this matter?

The degree of variability is the real time battle between two important functions of your nervous system - the parasympathetic (think meditation - slow) and sympathetic (think fight or flight - fast).

Both functions are highly important. Our parasympathetic nervous system creates an environment for healthy organs to function and repair, digest and absorb food, and grow our hair and fingernails. Our sympathetic nervous system allows us to think fast, run up mountains and react quickly to threats.

In a healthy body the battle between these two is equal. As a consequence, the heart rate variability is high as two well matched competitors battle for dominance. If the variability is low, it means that one system is dominating the other. One system is strong, and one system is compromised.

We need both. We need to be able to think fast, react, and move. We also need to be able to rest and recover. Physically resting is not enough. If our parasympathetic nervous system (slow) is not healthy, we wake up tired, our mind races when we rest, and our anxiety runs in overdrive.

Sound familiar?

An unbalanced nervous system is not an illness. It is a symptom - think of it as smoke. It’s not the fire, but it is evidence that there is a fire burning.

HRV Sounds the Alarm

Living longer, healthier lives is reliant on two core pillars: Prevention and Early Detection of Disease.

Heart rate variability (and therefore nervous system health) is significant at detecting illness early. We tend to go to a doctor when there is a fire, but rarely for smoke. Symptoms like fatigue and anxiety are commonplace in our daily lives, so minor increases rarely get flagged.

Millions of people are now wearing Apple Watches, Fitbits, Oura Rings, Whoop Bands and more, to better understand their bodies. We can track sleep quality, exercise effectiveness, diet considerations and general well being.

Like any cheap or free cloud based technology, our data is collected, pooled with others and leveraged to serve a greater interest of the supplier (we should know this by now).

There are dystopian possibilities here, obviously. But I am on vacation, so I will focus on the positives.

Disease prevention is the goal, but early detection of disease is the next best thing.

At present, preventative health care is incredibly rare. Most insurance companies don’t pay for preventative treatments, and most physicians receive very little training on the topic. As an example: in the US, very few insurance companies will cover the $300 cost of a coronary artery calcium test - which can detect coronary artery disease at its earliest stages. But, almost all insurance companies will cover the tens of thousands of dollars required for a coronary artery angioplasty and stenting required a few years later, for the same patient.

An upside to volunteering our health data is that case studies can now be run at scale, determining trends between nervous system function and disease. During the pandemic, researchers were able to take full advantage of the proliferation of smart devices, isolating a unique application - COVID19 detection.

One study published to Nature Biomedical Engineering, developed a two-tier warning system based on extreme elevations in resting heart rate, identifying an 81% occurrence of COVID19 detection prior to any symptoms developing, with 12.5% of cases detected nine days in advance of symptoms.

The COVID19 case study is interesting, but the excitement comes from recognizing that this is the catalyst for a new medical technology to receive the attention and funding for further growth.

Why am I excited about this?

We often make the mistake of looking at a technology and thinking in a linear progression. Most of us are familiar with Moore’s Law - the concept that technological improvements tend to double on an bi-annual basis (exponential). Even knowing this, it is hard for our minds to forecast.

The COVID19 study is interesting - but what excites me is what will happen next.

Follow the money.

Consumer spending on wearable tech devices is forecasted to double in only 4 years, from $46 Billion in 2019 to $93 Billion in 2022, according to Gartner.

This growth has largely been fueled by recreationalists - rarely are devices prescribed for medical applications. But with the combination of increasing recreational adoption and newly minted medical credibility, the wearable tech sector is about to change.

The most popular wearable devices like smart watches are in their infancy, which means the user experience is still in trial and error. New processor technologies are rapidly increasing functionality and speed, while improvements in solid state batteries are increasing battery life and shortening charge times.

For the recreationist, user experience is king: Convenience has to outweigh inconvenience.

I’ve never worn a watch because I don't enjoy accessories on my wrist. The convenience of the information it provided was outweighed by the inconvenience of a wrist accessory. The Apple Watch did not convince me otherwise. The convenience of adding my communication platforms to my wrist was still outweighed by the inconvenience of the hardware. But now, with biometric tracking, a log of historic health data that I can use to gauge the effectiveness of sleep habits and exercise regimes, the convenience outweighs the inconvenience, and I have been converted.

This is the typical process of tech adoption:

I’m not early to the party, and I am not late. Smart watches may already seem common, but in the broader scope of wearable technology, we are just crossing “The Chasm”.

But smart watches aren’t the most exciting part. Smart Patches are.

Smart patches will trump smart watches as a less invasive health sensor capable of measuring the basics - heart rate, core temperature etc, but adding increased visibility into important biomarkers like blood sugar levels. Smart patches can also administer medications like insulin for diabetic patients when necessary. We can thank smoking for an early iteration of the nicotine patch.

Don’t have diabetes? Not a smoker?

Doesn’t matter. Use cases get ever more exciting for a recreational health enthusiast like me.

Let me give you an example.

I take a variety of supplements each morning, afternoon and night, to assist a variety of health goals. But whether the goal is reducing inflammation or optimizing mitochondrial health, the activity is the same - orally administered supplements - pills and powders.

While the convenience of swallowing a pill is high, the efficacy is horrible. Even the basics like multivitamins can be massively optimized if administered intravenously. The next time you feel a cold coming on, visit one of the many IV Boutiques that have sprung up in major cities. The difference in absorption is real. You will feel it.

While IV Therapy, subcutaneous or intramuscular injections are far superior - we get back to the convenience versus inconvenience issue. I want to optimize my health, but I’m probably not going to self administer daily injections… yet.

Repairing Some Wear and Tear

But as we age, the demand for complex supplementation increases. Ageing is a slowing of production - Every year after 25, the key ingredients our body produces during our youth start coming off the assembly line with less frequency:

Insulin absorbs excess glucose, protecting our liver and key organs. Without it, blood sugar accumulates and we develop diabetes.

Melatonin is produced in the brain, regulates our internal clock and is a powerful antioxidant. Cancer therapies often include excessively high doses of melatonin supplementation. Sleeping like a baby is not just a fun analogy. Our sleep quality decreases as we age.

Estrogen and testosterone are known as the sex hormones - as they decrease in our thirties and forties we can suffer depression, low libido, weight gain, a decreased sense of adventure and risk tolerance, loss of muscle and decreased bone density.

Cortisol is the stress hormone, an abundance can cause anxiety, but a deficit is equally compromising, removing our ability to react to emotional stimuli.

Retaining balanced hormones is the closest strategy we have to a fountain of youth. Exogenous (synthetic) hormone replacement exists, but our bodies response is highly unpredictable, especially over prolonged use. The key is figuring out how to restart our endogenous (in-house) production.

One answer is peptide therapy. Simplified, peptides are amino acid chains that contain “instructions” to retrain our cells to perform their natural functions (produce the hormones they used to). Two years ago I attended the International Peptide Society Conference in Las Vegas - three days of lectures from the world’s foremost thought leaders in peptide research. Over 7000 Doctors attended from all over the world to learn how to implement peptide therapies in their clinics.

The use cases are endless, from restarting growth hormone production to fixing gut health complications, but all applications had a similar challenge - administration to patients. Pills are convenient but ineffective. Injections are best practice but keep most clients away. So how do we effectively get these into the hands of consumers?

Our skin is like one giant mouth, providing key access and egress points for many of our body's vital systems. Smart patches attached to specific locations of our dermal layer allow general and localized, time released administration of compounds, and could become the conduit for one of the most exciting breakthroughs in functional medicine.

I am aggressively looking for investment opportunities in peptide delivery systems - and am most curious right now about dermal applications - smart patches.

I am all about resetting my biological clock as vigorously as I can. I want to live to 150 years old, but only if I can keep charging hard into my 130’s.

In the next edition I will get into smart lenses, ear mounted devices and why the Augmented Reality of Everything is in our near future.

It's Friday, go do some pushups.