Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#16: To measure or not to measure: who better to study than yourself?
In this episode, we explore wearables and self-monitoring tools like step counters, sleep trackers, and continuous glucose monitors (CGMs). We'll dive into the science behind these devices and share how they can help you gain insights into your health, track progress, and personalize your wellness journey. We discuss the value of self-monitoring, backed by scientific studies, and how these tools can help motivate behavior change.
Key Topics:
- Step counters (smart watches, FitBit)
Studies have shown that this feedback helps increase amount walked, but only if you continue to use them. - Home Blood Pressure Monitoring
Using a home blood pressure monitor, I learned that my blood pressure is higher in the morning, helping me adjust my medication timing. A review of 52 studies found that home monitoring improves blood pressure management. However, it may only be effective if used consistently. - Sleep Trackers and Better Sleep
Sleep trackers like the Oura Ring can help you monitor and improve sleep habits. Studies have shown that using devices like Fitbits, paired with sleep education, can improve sleep quality. Personally, I’ve found that tracking sleep has revealed important insights into how alcohol and consistent sleep schedules affect my sleep length/quality. - Continuous Glucose Monitors (CGMs)
CGMs are not just for diabetics—many people use them to personalize diet and exercise. Studies show that CGMs improve glucose control when meal plans are personalized based on individual glucose responses. For example, I learned that pizza doesn’t spike my blood sugar much, but popcorn does.
N-of-1 Trials and Personalized Health
Wearables enable N-of-1 trials—personal experiments to find what works best for you. Whether it's testing the effects of sleep habits, exercise, or dietary changes, self-monitoring helps tailor interventions to your body’s needs, offering a personalized approach to health.
Hi, I'm Dr Bobby Dub ois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome everyone to Episode 16, to Measure or Not to Measure. Who better to study than yourself? We're going to talk about wearables or things that you can do to test on yourself. It might be a step counter, like Fitbit. It could be a home blood pressure monitor. It could be a sleep tracker, perhaps a continuous glucose monitor or maybe a DEXA whole body analysis. I want to share with you my own experience with these wearables and, of course, talk about studies that support that they actually help people. As always, I will have links in my show notes to help you find those studies, if you wish. Well, as we talked about in episode 12 with a similar title, to Test or Not to Test, I'm not real big on doing screening tests when you have no symptoms. Now, of course, I like screening tests for things like mammography and colonoscopy and pap smears, but it's the total body MRI scans and these hundreds of blood tests, and the issue as we talked about was false positives. But first my story. I love measuring. That's just the nature of who I am and I'm a scientist. And, as the title is, who's better to study than yourself? I've also found that these type of wearables have really helped me. Now let me give you a few examples and then, of course, we'll dive into the studies. I have high blood pressure, and so I have a home blood pressure monitoring device a simple thing. And what I found is that my blood pressure, and so I have a home blood pressure monitoring device a simple thing. And what I found is that my blood pressure is high in the morning and it's actually quite normal in the afternoon. So this understanding has actually changed how I take my medications and it's brought me a more level of blood pressure, which is what I want. Well, I also have sleep monitoring. I wear an Oura ring, but any of them work, and I've found over and over again it has really helped my sleep. I now understand the relationship between alcohol and what it does to my sleep, how long I sleep, how well I sleep, and I also learned that going to bed at the same time each night for me is critically important. I also periodically wear a continuous glucose monitor and what I've learned is well, surprisingly, pizza is okay for me it doesn't really bump my blood sugar too much but bananas or popcorn boy, that makes a difference. So I learned a lot from that. And finally, I've done DEXA whole body analyses and I'll explain a bit later what these all do. But I learned that I have a muscle imbalance. I have different amount of muscle in my left leg versus my right leg, and it's changed how I train. So it's been very, very helpful for me.
Dr. Bobby Dubois:So the take-home messages for today's episodes are that wearables, or things you can do outside of your doctor and your doctor visits can help you get a baseline of what's going on. They can motivate change, which is ultimately what we want to do to live long and well, and it can demonstrate progress or lack of progress, in which case we might have to do something about that. As you know, I am in love with end ofof-one studies and testing things in yourself and figure out what works for you, the ultimate in personalized medicine. These wearables, these home assessments, can allow you to do these end-of-one studies in very powerful ways. In very powerful ways. Well, a little bit of sort of test theory or how to think about them. So, when you go to a doctor or you use one of these wearables, why do you do them and what might they tell us? Well, it could be to screen for an illness. You get a mammogram or a PSA test. Screen for an illness. You get a mammogram or a PSA test. It may look for cancer. Well, it could be to diagnose a disease. You're having some discomfort in your chest. The doctor chooses to do an exercise study of some type and help define whether you in fact have coronary artery disease or you don't.
Dr. Bobby Dubois:Third reason to do a test is to obtain a baseline and see where you go from there. It might be your baseline weight. It might be your baseline sleep patterns. Fourth, it could be to monitor how an intervention is helping or not helping. It could be your blood pressure. Now you have a new medication and you monitor to see if it's gotten to where you want it to be. How are you making progress? And this can monitor that. And finally, a reason to do a test is to motivate change that.
Dr. Bobby Dubois:By doing a sleep assessment at home with your Oura Ring or Fitbit or your Apple Watch, you get feedback. You get feedback on well, I didn't sleep so well last night, wonder what caused it. Or I might try eating earlier before bedtime and see if it makes a difference. So let's now shift from kind of personal examples what I find exciting and helpful for me to what the evidence is, to perhaps convince you that some of this might be a good idea. All right, so we're going to go through a number of these. The first is step trackers. Again, it could be your phone that's sitting in your pocket. It could be a smart watch I have an Apple watch or it could be a Fitbit.
Dr. Bobby Dubois:Any of these things will measure the number of steps that you take. I think it's fun to know. I live on a ranch and take care of things, so I tend to get a fair number of steps. But you know, it's fun to see and it motivates me and other people to take more steps. Well, as we've talked about in prior episodes, steps are good. You know, on average nowadays people get about 4,000 steps or so. Now we used to get a whole lot more 8,000 steps and in the blue zones people get 10,000 or more. And more steps is good.
Dr. Bobby Dubois:Studies show that people who have more walking time and more steps have lower risk of heart disease. Also, from a calorie standpoint, for every thousand steps you take additional, you might burn another hundred calories. So very, very helpful to perhaps know this. But what about the evidence? Does it make a difference? So there was a study of studies, a meta-analysis, that looked at 37 randomized controlled trials. Now, these were modest size studies, but there were a whole bunch of them, and all of these studies used a Fitbit. There were a whole bunch of them and all of these studies used a Fitbit. That's just what they did in those studies. What they found is the people who received the Fitbit, wore the Fitbit, increased their step count by almost a thousand per day and they also lost more weight. They lost about three pounds more. Well, another study done differently found that it increased steps by double that over 2,000. And people's blood pressure fell by almost four points systolic and their BMI decreased by about 0.4. This suggests that having a step tracker and looking at those data might help us to walk more, burn more calories and reduce our risk of heart disease.
Dr. Bobby Dubois:These are all really good things, but, as always, I want to be fair and balanced. There are limitations to studies like this. Oftentimes the people who wear a step tracker, a Fitbit, whatever, are perhaps the least likely to need them. So people who are health enthusiasts tend to use this stuff. It's the people who aren't that we're trying to motivate, so a lot of the data may be around people who are otherwise going to be healthy anyways. The other thing is that a step tracker isn't going to work if you don't continue to use them. Maybe you don't continue to wear it for one reason or another or you don't really look at the data anymore. So these are important limitations, but I think, on balance, for many people it helps them to improve their step count with all the good stuff that comes related to that Okay, home measuring device.
Dr. Bobby Dubois:Number two blood pressure monitoring. Now, they're not very expensive. You can go to the CVS or Walgreens or even your local market and they're probably about $100. And it's been shown based on 52 studies these were observational studies, so not perfect studies that for people who had high blood pressure, it helped them to better manage that problem and I gave you my own experience that it helped me to fine-tune my medication, since my blood pressure problems are more in the morning than in the afternoon and I'm not really unique about that the way it goes Well. One of the problems is that they may show improvements for a period of time. In one study they looked at, they found that blood pressure went down nicely in the people who used the home blood pressure monitoring at six months, but by 12 months it didn't really help, probably because people stopped paying attention to it. So monitoring the progress of your high blood pressure is an important part of a home monitor for that.
Dr. Bobby Dubois:Second, you can see if you're salt sensitive, as I've talked about in the nutrition episode. Perhaps 25% of adults in the US are salt sensitive, meaning when they have a lot of salt their blood pressure may go up. Of course, what that means is a whole bunch of people aren't salt sensitive. Now salt sensitivity is more commonly found. Perhaps 50-60% of people are salt sensitive. If you have hypertension but you're not going to know which category you fit in, you might have a doctor who says to you well, your blood pressure isn't perfect, we're not quite ready to start medication.
Dr. Bobby Dubois:Maybe you should try a low-salt diet. Well, the key question is am I salt-sensitive? Well, in this case, dr Bobby is not salt-sensitive. I can have all the salt I want. It's not going to make my blood pressure any better or, frankly, any worse. That could be very helpful for you to see how do you do it. Well, you do some baseline blood pressure testing, maybe once a day for a week. Then have a normal diet for a while and see what your blood pressure is. Then try a low salt diet. Wait a couple of weeks or a month and see if it's gotten better, your blood pressure has gotten lower. If it doesn't make a difference, then enjoy the salt, because it's a wonderful part of bringing out the flavor in foods, and I'm also a chef and I love to use salt as appropriate to bring out the flavors, to bring out the flavors More about that in a future episode because taste is a wonderful thing and they're not just salt that brings out flavor Vinegar acid, lemon juice, other things do too. So maybe we'll talk about that if folks are interested.
Dr. Bobby Dubois:The third reason to have a home blood pressure monitor is a periodic screening device. It's very, very common that as we age, our blood pressure is going to inch up and at some point it needs to be tested, and it's been called the silent killer because you don't have any symptoms of high blood pressure. So if you don't have high blood pressure maybe you know you test it once a year or so. Then you don't have to buy a device. You can go into the CVS and they typically have the public one that you can use. All right, number three, one that gets a lot of attention, as it should sleep monitors, and again, there's many of them. It can be your smartwatch, it can be a Fitbit, it can be an Oura Ring. To me, this is well.
Dr. Bobby Dubois:As I've talked about, sleep is the unsung hero. It is so critically important to get good sleep because it correlates with mortality, it correlates with cognitive decline, all sorts of things. It's also an amazing area that you can test for yourself the N of 1 trials to see what works for you. For yourself, the N of 1 trials to see what works for you. In episode 3, which was on sleep, I talked about 12 ways you can improve your sleep Six things to stop doing and six things to start doing. What a perfect way to do it. You could test each of these and see if it makes some benefit.
Dr. Bobby Dubois:Well, what about the studies? Because obviously it's not just good enough to talk about this? Well, they had a study where they were looking at in this case, it was college students, about 50 of them, and they wore a Fitbit. Now, what's a little complicating is that it wasn't just the Fitbit. They also gave them some sleep education, things to do or not do, like caffeine too late in the day or alcohol before bed, or any of these other kinds of things. So it was what was called a pre-post design. So they didn't randomize people, they didn't say you 25 get a Fitbit, you 25 don't. It was what's called a pre-post. So they take everybody, do a baseline, and then they do the intervention, which is the Fitbit and the sleep education, and then they wait a while and they do the intervention, which is the Fitbit and the sleep education, and then they wait a while and they see what happens, which is sort of the classic for us if we're doing it in ourselves the end of one design. What they found, though, is that the percentage of people who had good sleep went from 28% which is not a very big number that had good sleep to 46%, and it was also associated with falling to sleep quicker, staying asleep longer and the next day feeling a bit better. What we don't know and again I want you to understand the limitations of all these studies was how much was the intervention or the improvements in sleep due to the Fitbit itself. As I mentioned, they also were given education and they didn't separate them out. Some people got the Fitbit, some people got education, some people got Fitbit plus education. They didn't do that study, so I think it's promising that it improves sleep.
Dr. Bobby Dubois:Well, here's another study, and I really think this is a cool study. They took people that were wearing a Fitbit, who also had medical records that were electronic, so they could link their sleeping and the problems they're having, or how well they're sleeping, to their medical records and the medical illnesses that might develop, and this was almost 7,000 people. On average, they were about 50 years old and they followed these people for four years and what they found is the people that had irregular sleep. So some days it was better, some days it was worse. It correlated strongly with subsequent development of obesity, high blood pressure and depression and, as we've talked about on the weight loss episode and the sleep episode. Lack of sleep or difficulties with sleep are very much associated with these problems. So a very cool design. I really liked it. What they also found is that people who didn't get much REM sleep, which is the sort of dream phase, and those that didn't get much deep sleep, those people had a higher risk of atrial fibrillation.
Dr. Bobby Dubois:Atrial fibrillation is a rhythm disorder in your heart. You have the top part of the heart, the atrium, the bottom part of the heart, the ventricle. This is the top part and in people with atrial fibrillation they don't have a steady heartbeat. The atrium is just doing its thing and it's really not pumping the way it should. And one of the problems of atrial fibrillation is that when you have that part of the heart that isn't pumping, you can get blood stuck in there that turns to blood clots and those blood clots can then go into your body, hurt your lungs, hurt your brain. So atrial fibrillation, especially when it stops and starts and stops and starts, is a real problem. What they found was, again, people whose REM and deep sleep weren't good had a higher risk of this heart abnormality.
Dr. Bobby Dubois:Now I do want to share that these sleep trackers aren't perfect. They may underestimate disruptions in sleep. They may overestimate total sleep hours. My brothers told me ah, it doesn't seem to help at all. I just gave up using this stuff. Now, if you were to do a sleep study and you were to do one of these Fitbit or Oura rings, yes, you may get some distinctions, some differences, but what I do believe is it's a wonderful way to measure change. Maybe it's not giving you the exact number of hours of sleep or the exact number of hours in each stage of sleep, but I'm pretty convinced that it will show changes. So if you decide that you're going to now not drink alcohol for a week and see what it does, maybe the exact numbers aren't perfect, but it will show the changes, which is really what this is all about. We're not about exact numbers, we're really about the changes. So that's sleep trackers. I really, really, really think they're worth trying for everybody, because we can all improve our sleep. And boy is it important. And for those of you who are not older, sleep often gets more problematic as you get older. So if you can fine tune things when you're younger, even better as you get older. So if you can fine-tune things when you're younger, even better.
Dr. Bobby Dubois:Number four continuous glucose monitors. These are those little things that are on people's arms that typically are for folks who have diabetes, and typically it requires a doctor to order them. But increasingly you're finding other people non-diabetics who are trying them out for a period of time. Now it's a continuous glucose monitor, meaning it's giving you a real-time readout on your phone of what your blood sugar is. You know, is it normal? Is it high? You just had some food. Does it go up? How much does it go up? How long does it take before it get back to normal?
Dr. Bobby Dubois:For a diabetic, it's critically important because they need to fine-tune, if they're on insulin, their insulin levels or modify their pills that relate to it. Now, I did mention it usually requires a doctor and your own doctor to prescribe it, but there are some telehealth options where people are getting these without going to their doctor. On the other hand, if you ask your doctor, he or she may say they would be happy to prescribe it. Insurance may not pay for it, but they're not that expensive. They're probably $30 or $40 for each one. Each one lasts about two weeks. You could try it for a month if you're interested.
Dr. Bobby Dubois:I think it's wonderful because it helps you to fine-tune your diet. All the time, when you look at diet recommendations, they're saying everybody should do this. Well, you need to personalize. You need to see for yourself what drives your blood sugar up or down or whatever. For yourself, what drives your blood sugar up or down or whatever.
Dr. Bobby Dubois:So here's a study. They basically took a group of people, and there were about 800 people, and they personalized their meal plans. Okay for you, you're going to have a little more apples and oatmeal. For you, we're going to give you this other, different menu. So they personalized the meal plan based upon what the continuous glucose monitor showed about that person and what they found is they had better glucose control.
Dr. Bobby Dubois:Now, this was in folks that have diabetes, so you have to take that with a grain of salt. It's also shown that it modifies people's behaviors that have diabetes. They eat better, they exercise more, just by being able to monitor things with their continuous glucose monitor. And, as I just alluded to, exercise also affects our blood sugar. So you might be able to go for a walk and have a candy bar and it might not bother your glucose nearly as much as if you were sitting still at your computer having the same candy bar, but again, this is something you can learn. Now, what we don't know is what if you're not a diabetic, does it really matter what your blood sugar changes? Are not a diabetic, does it really matter what your blood sugar changes are? We don't really know. But many of us are overweight and when we're overweight, we start to get some unstable blood sugars and we start to lean towards what a diabetic has in terms of blood sugar swings blood sugar swings. So for many of us, it might be very helpful.
Dr. Bobby Dubois:I don't have diabetes, but I learned some really important things about myself. So, in addition to the studies, of course, I want to give you my own personal experience. So, for me, I can eat pizza, which I really, really love, and gelato or ice cream, which I also really, really, really love. Interestingly enough, even though there's a lot of carbs in those, it doesn't really bump my blood sugar that much. Why? Because it's a combination of fat as well as the sugar or the carbs. On the other hand, if I have popcorn or orange juice, my blood sugar just skyrockets. Now it generally comes back down pretty quickly, but it's something that I learned. Well, here's something else that I learned which was very, very helpful for me.
Dr. Bobby Dubois:I periodically feel very weak. Now I don't mean like this week I feel weak and the next week I feel strong. It could be during the day. I might have a period of time in the afternoon where I'm just I don't know. I just feel weak as a kitten, and that often goes away in an hour or so. So I'm asking myself okay, I know my blood pressure is a problem and maybe that feeling of weakness is that my blood pressure fell and I'm what's called orthostatic or I'm lightheaded because of that. Well, I can test that.
Dr. Bobby Dubois:So one day I noticed that I was feeling very, very weak and I checked my blood pressure. Blood pressure was fine. I checked my blood sugar and I had eaten something with a fair number of carbs maybe an hour before and my blood sugar had fallen. I also had this experience when I was on the treadmill doing a little workout and all of a sudden I felt like God. The air went out of a balloon. I just all of a sudden felt tired. Well, I looked at the continuous glucose monitor and it had fallen, you know, close to 60 or below 60. I had a little gel of which had some sugar in it. Five minutes, 10 minutes later I felt great. So for me, I've learned that, even though I don't have diabetes, there's some fine tuning. That's very, very helpful, and it's especially helpful if you have high blood pressure and a few other things to try to disentangle. Why am I feeling the way I'm feeling? So continuous glucose monitor.
Dr. Bobby Dubois:Next, dexa whole body composition analyses. So these are tests that you don't do at home, but these are things that you don't go to your doctor necessarily for he can order it or she can order it. But there are also places fitness centers and others that will do a body composition analysis through DEXA. This is the same name as when people get a DEXA bone scan to see if you have osteoporosis or beginnings towards that. They're not that.
Dr. Bobby Dubois:These decks of body composition analysis are not that expensive. I think I paid 70 or $80 for them and you can look them up on the web and find ones. They measure all sorts of things. They do measure your bone density, which mine was fine. That wasn't really what I was focused on. They will measure also your fat composition, and not just in general, but your visceral fat, which maybe we'll talk about another day, but that's the component of fat around your organs. That's truly important. The rest of the fat may make you look fat, but it's the visceral fat that's really really important and this can be measured again in the body composition analysis really important, and this can be measured again in the body composition analysis. Also, I found, as I shared with you earlier, that I had an imbalance of muscles. My left leg had less muscle than my right leg and, lo and behold, I'm more unstable on my left leg than right leg.
Dr. Bobby Dubois:But what about the evidence? I mean, this is really interesting and it might motivate you to do better with your diet and maybe lose a few more pounds if you looked at how much your fat percentage was, and not just your fat percentage, but also how much lean mass, how much muscle you have and also whether there's the visceral fat. Of course there are bathroom scales that will tell you your weight, they'll tell you your fat percentage in some cases, but they won't tell you the fat that's in your organs or around your organs, that visceral fat, and it won't necessarily well, it certainly won't show you your muscle mass, body part by body part. Well, there was a study, study, and what they found was just doing simple weighing. Going on a scale by itself didn't do very much to change people's body composition. Again, that's no surprise. If you don't do anything other than just look at the scale, without changing your diet or exercise, it's likely not to do much. But there's a study and it'll be linked in the show notes In a really small study in women who were overweight or obese, they gave them these scan results. Now they also had cognitive behavioral therapy, so it helped them to deal with triggers why am I eating right now? Am I nervous? This is something related to that, and what they found was that these people, with the feedback of the body composition analysis, actually did see changes.
Dr. Bobby Dubois:So again, you can try it out. It's not that expensive and it may help you. Or it may not help you, but it's something I'm doing and I have found it to be useful. And I have found it to be useful. Okay, number seven wearables that detect heart arrhythmias. So the Apple Watch came out not that long ago with some capabilities that can show whether you have atrial fibrillation that I talked about earlier. These wearables are really good if you have atrial fibrillation all day long, day in, day out. They're not quite as good at predicting when you go in or out of atrial fibrillation, but if you have problems with cardiac arrhythmias, one of these devices might be something to think about.
Dr. Bobby Dubois:And lastly, resting metabolic rate. Now, many people don't know what this is. This is again. You go into one of these places that might do the DEXA whole body analysis these fitness centers and you sit down, you relax and you breathe through a mask. And when you're breathing through the mask, it's seeing how much oxygen you're using and how much CO2 you're producing, which helps define what your resting rate is. In other words, how many calories do you burn? If you just sat still all day long, you get a few more hundred calories. Because you walk around, you get more hundreds of calories if you exercise, but the resting metabolic rate will tell you. Am I somebody that, without doing too much else, burns 1,200 calories a day, or 1,900 calories a day? And it might help you along with what we talked about last time on what do we do and don't know about weight loss to look at your portion sizes and say, oh, my goodness, I had no idea my basic meals are so many more calories than I thought, or maybe they're fine.
Dr. Bobby Dubois:So there was a study. There was about 50 people and they were in their 50s and they were in the obese category. They had a BMI of over 130. And folks got a resting metabolic rate. But they also got a dietary prescription helping them to say, okay, this is the number of calories you burn, so let's keep it within that. And they also had some general counseling about weight loss. Turned out that folks lost weight 4% of their body mass and 20% of the people lost over 5%, which is great. The problem is that whether they had the resting metabolic rate as part of the education or not didn't make a difference. So you may find it's helpful, you may not. I think once in a lifetime, just to sort of assess it is useful. And again, it's not that expensive. All right, we're finishing up now. So final thoughts For me, as a nerd and as a scientist, home measurement is just plain fun.
Dr. Bobby Dubois:For me, and for everybody else though, I think these home measurements provide a baseline. Whether it's your sleep, your weight, your blood pressure, whatever it is, I believe they can motivate change. It's not the final answer to solving our sleep problems or anything else, but I believe it motivates change and when you see changes moving in the right direction, that in fact, is very motivating. It is a great end-of-one opportunity. I talked about sleep, the most valuable in that regard, but as well, you can try things related to your blood pressure or your glucose, like I've done. So I've given you a lot of sort of personal examples in that regard. So if you have some of these devices, share them with me. Send me a note, either through my website or through Instagram. Let me know If you try something. If you try an N of 1 trial, do share it with me, because I want to share it with others, just as a preview of coming attractions.
Dr. Bobby Dubois:I'm not exactly sure where some of these will land in terms of timelines, but people have asked me about seed oils and whether they're bad for you, and I started digging into the data on that. People have asked me about red light therapy, and what do we know? And is it an urban myth and one that I'm having a lot of fun with right now thinking about and looking at the data is sort of around that starve, a cold feed, a fever Does it matter if you have a cold or flu, whether you exercise, don't exercise, lie in bed or not? What do we know about that? So, fun stuff to come and I look forward to sharing it with you. So until next time, I hope you can move on your journey to live long and well, spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom. That's, doctor, as in D-R Bobby. Live long and wellcom.