Confession time… I’m a complete and utter geek. I LOVE technology. By LOVE, I mean I really love it, in that super silly way where you are convinced you positively need the latest Apple device – absolutely every latest Apple device. Of course I don’t indulge my addictions (for which, read ‘I would if I financially could”) but when an opportunity comes up to try a new tech thing out, I literally can’t say no…
So it is with the Apple Watch. Not new, I know, but new to me. And God, I love it. I can’t even explain how much I love it, or why – except that I am someone who doesn’t just ‘accessorise’ with technology, I actively integrate it. It has, distinctly, worked its way into the technical infrastructure with which I run my life and business, enhancing the way I operate all of my technology.
One of its best selling points, however, is an area where I am instinctively wary: ‘activity tracking’. I’ve tried FitBits in the past but the beauty of the Apple Watch is that it’s all hooked up and syncs automatically with almost every other piece of tech I own, sliding seamlessly into my daily life and showing alerts everywhere I look
Fitness Tracking Devices
As a healthcare professional working in practice, I know the value of fitness tracking devices. For various reasons, and from opposite ends of the same spectrum, I sometimes request that my clients track their calories in an app for a few days. For others I might recommend tracking steps for a while to ensure that they are making incremental progress towards their goals, whatever they are.
Why do I do this? I do this because data is powerful. Objective, external figures in black and white are often compelling influencers of behaviour. Often attributed to Peter Drucker (a management ‘expert), the phrase “What gets measured, gets managed” has now slipped into regular use, perhaps thanks to the work of Tim Ferriss, of 4-Hour Work Week fame (examples of his praise of this ethos are linked here and here and, of course, in his book, linked here). In the world of ‘optimisation’ and ‘productivity’, in order to make improvements we must first measure the status quo. The very act of bringing attention to something (by measuring it) naturally changes our relationship to it.
Upping the ante on how tracking can provoke behavioural change involves adding peer pressure (potentially more powerful than monetary ‘incentives’ – see link to study here). Our tracking apps can be synced with our social media profiles and distributed to the devices of loved ones. “Sharing” data, whether through opening up your activity stats to a group of competing friends, uploading your dietary intake to Facebook or even simply knowing that your practitioner is going to be checking up on your data during your next consultation, creates a competitive, motivational ‘community’ spirit which has been shown to directly influence the behaviour of participants.
Tim Ferriss is again useful on this topic – describing how ‘accountability’ can be built into self-improvement using peers, and for an in-depth analysis of what influences behavioural change, and why tracking apps, measurement of data and added social accountability features are so successful in this area, I highly recommend Nudge by Sunstain and Thaler and also a great review of far more techniques for creating behavioural change than covered in Nudge listed on The Digital Intelligence website linked here.
Fitness Tracking In Practice
Fitness tracking in my practice is another data point for analysis. Much like diagnostic testing, app and device data can supplement my picture of any client’s lifestyle and health condition.
I use fitness apps in practice for some of my clients by having them put all of their food intake into MyFitnessPal to illuminate just how little they are actually eating – often the first step on a long road to relaxing a restrictive relationship with food.
For others, tracking workouts and calories burned (however imprecisely depending on the tech used) is a beautiful way to demonstrate how much or how little their lifestyle matches their energy intake.
And for my Type A, highly driven, adrenalised over-achiever clients, the ability to witness on a test result how poor their heart rate variability (HRV) is (signalling a lack of nervous system recovery) or even how poor their cortisol output is (by running diagnostic testing) is precisely the motivation they need to take a big step back from their highly frenetic approach to life. Tallying DUTCH data with HRV plus a workout-tracking data point can allow us to guide behaviour to a better, more self-nurturing place.
When Testing Turns Toxic
However, I am always walking a fine line in my practice. The truth about measurement, testing and the analysis of lots of data is that it is incredibly useful whilst at the same time being potentially dangerous, triggering and damaging.
I may recommend that some of my clients use a bit of data-gathering to influence change, there are others for whom this would be precisely the wrong tool, which is precisely what the rest of this article will explore.
Testing is a beautiful thing, particularly in medicine. Diagnostics are vital to an accurate assessment of health status and for the selection of the correct treatment for their situation.
This said, Functional Medicine practitioners have been accused (including by me) of taking diagnostics too far. Because the internet age provides information direct to patients themselves, it is common for a clinician to be asked for a raft of testing before even having had an initial consultation. Some practitioners choose to acquiesce to their patients wishes, basically because running tests can prove quite lucrative for relatively little work output on behalf of the clinician. Other professionals are more of the mind that cautious, staged testing should be rolled out, starting with the essentials and only assessing that which changes the clinical recommendations.
I am firmly in the latter camp. One reason for this is that healthcare is expensive and tests are not cheap (almost all of which have to be privately financed in the UK). But the second reason, less discussed but to my mind more pertinent, is that pretty much every test I could run on almost any patient will find something. Something wrong, off balance, out of kilter, slightly strange. Rarely, if ever, is everything completely and utterly normal.
Human beings are not stagnant, steady-state islands and as such are in a constant state of flux. Running a test on someone must be done in the context of their life, their activities, their diet and their other conditions. Every test, therefore, must be interpreted bearing all of these other factors in mind because small things have disproportionate impact when it comes to lifting the lid on physical functions, biochemical balance and hormonal/immune system regulation.
Reactive treatment for every slightly errant test marker is a dangerous way to practice medicine, Functional or otherwise. Patients’ conditions must be seen in the light of the broader manifestation of their constellation of symptoms and issues.
After digging into the tests for mammography and breast cancer screening Chris Kresser recently wrote an exceptional article (linked). Here he demonstrates that mammography (i.e testing) over-diagnosed breast cancer by 52% – with over-diagnosis leading to over-treatment. This is a serious problem, not just with breast cancer but in many cancer screening methods (review paper linked). Over-treatment is dangerous because no treatment is completely without side effects. In the case of cancer, treatment can be incredibly toxic, not to mention a ‘cancer’ diagnosis being a psychological trauma.
What About Being Left To Our Own Devices?
I remember my GP telling me once that if he went out and tested a random sample of people on the busy streets of any UK town, all of them would come back as Vitamin D deficient. He wasn’t making the case for mass market supplementation. Instead, he was making the point that they would (mostly) have been completely ignorant of their deficiency prior to testing AND completely fine. i.e. millions of people are living with diagnosable ‘conditions’ or ‘deficiencies’ of which they are blissfully unaware because they are making no discernible difference to their life or health.
This illustrates an important point. The human body is a remarkable feat of engineering. It is literally capable of miracles, every second of every day. I trust the science which shows cancerous cells are continually created throughout our bodies but we are beautifully able to identify, isolate and destroy these on a routine and regular basis. Think of this like cellular housekeeping.
I also trust the science which shows how we can shift our rhythms, our biology and our nervous systems, simply by calming our brain waves and shifting thought patterns. Meaning our biology is a responsive and mutating thing, adept at adaptation and finding resilience regardless of much adversity.
I also believe that the very nature of tracking and testing distances us from the fact that, for a vast proportion of the time, our bodies are contentedly self-managing, all by themselves.
Homeostasis is a flipping marvel – we are kept within a very narrow band of temperature, have acute and finite control over energy usage throughout our systems, we seamlessly switch between creating ATP (energy), storing glucose, metabolising, digesting, excreting etc. and we harmoniously match patterns with the sun cycles, moon cycles, seasons and more. Each day our body exquisitely cleanses, detoxifies, processes, ages, grows, dies – with an endless repetition of cell death and birth in a stunning symphony of genetics which we call just being a human.
Testing and tracking, adding and subtracting the totals, calculating equations and reducing human functioning to markers and data points seems to me to distract entirely from this orchestral masterpiece of being in form. Our bodies can give life to whole new humans… and yet we can’t trust it to tell us when we’ve done enough steps in a day, stood up for enough hours or what we want to eat (regardless of the macro breakdowns our app will happily calculate)?
Measurement Equals Obligation
This is where the tool to observe becomes a hammer with which to beat ourselves.
Just because something can be measured, we naturally believe we have complete control over the metrics. More than that, we start to believe that we should be manipulating and changing them. We feel that the metrics matter.
At first our ability to alter the numbers on our apps is incredibly empowering. But then we start to believe that we have to work towards shifting those numbers. It isn’t “what gets measured gets managed”. It becomes, “what gets measured MUST be managed”.
For millions, this is a strong motivator. My current Apple Watch is saying I’ve made it an “11 day streak of Move Goals!” You can damn well believe I’m going to try to make that 12… even though I don’t know quite how or why my Move Goals were selected, except that I didn’t specify numbers, or that I had to do it daily, or even weekly…
It is easy to see how this becomes overwhelming. Our app measurements add more ‘to-do’ items to our ever-increasing haul of tasks because we feel absolutely obligated to continually improve our numbers.
In my experience, tracking doesn’t actually mean ‘keeping track’ of, or merely ‘watching’ ourselves. Instead, the art of tracking sends a subtle challenge inward that we must make choices to ensure we attain our ‘targets’ or ‘goals’. All of these goals are arbitrarily set by computer algorithms based on the most basic of personal information.
Starting to make choices based on the numbers on a screen is precisely the point of using trackers for self-improvement, increasing exercising and dietary care. However, by using these data markers to drive our decision making, we are, in fact, taking a giant step back from what literally underpins the humanness of what it means to be alive… how we are FEELING.
Don’t Trust That, Trust This
There is an accompanying dialogue which further drives this point home. Everywhere I look there is a subtle accusation that we cannot trust our body’s own signals: i.e. we must outsource decisions to data and ‘intellect’ because we cannot possibly sanction the wills, feelings and desires of our physical form.
In the recent books, Stephan Guyenet’s “The Hungry Brain”, Gary Taubes “The Case Against Sugar” and Robb Wolf’s “Wired To Eat” – which I also wrote about here) reinforce the message that our bodies and the signals they send are not to be believed. Somehow our biology has been hijacked by “Big Food”‘s creation of hyper-palatable foodstuffs which confuse and trick our biology into ever-deranged cycles of overeating.
Let me just state that the science of the arguments in the above mentioned books is (largely) unequivocal (though Gary Taubes has received much criticism for his over-simplified ‘insulin hypothesis’ view of weight gain). They all, mostly, agree that our tastebuds have been dominated by sugar/fat/calorie bombs (doughnuts, anyone?) and we are driven by primal urges in a commoditised, Westernised food environment to basically devour the entire sweet shop… Daily.
However, I am also a little bit convinced that every single human on the planet knows that when they’re chowing down on the last of a bumper packet of biscuits that they didn’t eat every single one because they were actually hungry. We are completely aware when eating whether we’re doing it from a place of craving, bingeing, sugar-seeking or simple hunger. It doesn’t mean we stop, granted. But it does mean we know what we’re doing in those moments.
The problem comes when we confront the ‘food-craving’ physical signals by slamming all internal instincts as completely erroneous and only fit to be ignored. This literally devalues every single sensation our bodies then experience.
Basically, if our bodies can’t be trusted to give accurate hunger signals, how on earth can they be trusted to tell us anything else (when to move, when to stand, how many steps we have left ‘to go’, floors to climb, etc. etc.). Tracking apps reinforce this sense that we are all stupid – and that we must rely on the external data to make us effectively able to behave well as a human.
Conversely, there’s the moment when you take off your device to go for a shower. Officially, those 8 steps to the shower, 5 minutes standing up and 8 steps back to the tracker on the counter – NEVER ACTUALLY HAPPENED!!!
You can go for a day-long hike, leaving your precious tech at home… AND YOU NEVER EXERCISED AT ALL. That night, your phone will shriek at you to get in 8000 more steps, even though you’ve been on your feet ALL FLIPPING DAY.
By creating an app to tell us how to behave we are completely outsourcing physiology to technology. We are trusting our devices more than our own bodies. And we are becoming a slave to the metrics, rather than listening to the noises of our internal monitors – of which we have thousands.
You see, we were all born with internally regulated activity trackers and calorie counters. They’re called ‘hunger’ and ‘energy’. They’re not always accurate down to the decimal point. But they’re the only thing that can create a bespoke protocol for you to follow which factors in where your health and vitality is at at every single moment, exquisitely judging how much you’ve got left to give to your day, and whether that next mouthful of pie/cake/chocolate is what you want.
Note – I said WANT, not “need”, “can adapt to” or “have earned”. WANT. A device can’t tell you what you want…
Because food in, energy out, exercise and nutrition – they’re only a small part of what it is to be human. Tracking everything to the ‘nth’ degree is covering the basics of statistical survival. What ever happened to the humanness and the experience of being alive?
Divorce Your Devices – or Risk Being Divorced from Your Body
For me, placing a device between yourself and your life is a tool which can be selectively incorporated under the right circumstances. However, it must be done in the complete cognition that in the moment of employing device management strategies for life you are placing both a filter and a wedge between yourself and your body or experiences. You are becoming divorced from the messages which are whizzing around your being in every second, in preference for viewing your life through the ‘objective’ (i.e. digital) interpretation of your actions. And you are holding your energy at arm’s length – storing your data in your smartphone, rather than listening to the feeling in your feet.
This is the easiest and fastest way to become separate from your self. I believe that separation from yourself is the first step to sickness.
Dissociation is all-too-easy when we are running our lives through the data streams we send to our synchronised cloud identities. I say this as a tech addict, computer lover and iCloud ninja. I also say this as someone who knows how easy it is to make choices based on whether my devices will attest to my activity, rather than whether my body was in the right space, place and level of health to do what I chose to do.
If you are making decisions based on the data, I’d caution you to ask yourself why. Do you not trust yourself and your body to make good, healthy, balanced life decisions? It’s bluebell season at the moment. Go for a walk in the countryside. Don’t pace past the flowers attempting to beat your ‘speed record’. Stop. Smell the flowers. Your Watch can’t do that. It’ll be pushing you to go the extra mile and I’ve yet to see the app which schedules flower smelling time. All of which means:
The best device for judging your human activity is your own, designated, human vehicle. Develop a relationship with it before you outsource all of your decisions to the metal objects blinking in your pocket, on your wrist, on your bedside, on your desktop…
And overall, learn to Trust Yourself. No app made can show you how to do this. Instead, this process starts when you stop looking to the validation of your devices and start to believe that all the signals you need are right inside the fleshy human space that you call home.