© 2018 | Intake

BRIAN BENDER, PHD

The Complete Guide to Personalized Nutrition

BETTER DATA, BETTER RESULTS

How to Optimize

Your Nutrition

Table of Contents1. The Current State of Nutrition 3

2. Why Personalize? 9

3. You Are What You Eat 15

4. Blood, Sweat, & Tears 19

5. Fitting Into Your Genes 24

6. Your Personal Cost to Living 31

7. Flushing Data Down the Drain 47

8. Get Your Sh*t Together 51

9. A Nutritionist in your Pocket 55

10. Diet-Tracking 58

11. Better Data, Better Results 67

12. References 69

2

CHAPTER

1The Current State of Nutrition

3

Global Nutritional HealthRates of obesity are rising in every country on Earth.1 Much of the developed

world has taken food for granted. Calories are now relatively easy to come by.

And with it, a host of preventable chronic diseases including cardiovascular

disease, type 2 diabetes, chronic kidney disease, many cancers, and an array of

musculoskeletal disorders.

Furthermore, micronutrient deficiencies continue to be widespread. Globally, 2

billion people suffer from low micronutrient intake of one or more essential

vitamins and minerals.2 Many of these are present in developing nations and

are due to more systemic problems surrounding social, economic, and political

issues. But low micronutrient intake is prevalent even in America, and certain

groups are at a high risk for micronutrient deficiencies.

5 Groups at Risk for Micronutrient Deficiencies

1. Vegetarians & Vegans: Vitamin B12 only exists in fortified and animal-derived products.

2. Prenatal: Fetal development adds specific requirements like extra folate, iodine, and calcium.

3. The Elderly: Altered metabolism and reduced diet-quality put the elderly at risk of several deficiencies.

4. Post-Op Patients: Certain surgeries, particularly in the abdominal region, can impair absorption of key nutrients.

5. Obese: Obese individuals often have higher rates of deficiencies in many vitamins and minerals, demonstrating malnutrition can happen even during overconsumption.

Deficiencies are a

major problem, but

overconsumption of

certain nutrients is a

major contributor to

the chronic diseases

that stem from

malnutrition. For

example, too much

sodium and sugar can

lead to hypertension

and obesity. The good

news? The vast

majority of these

diseases are

preventable.

4

In fact, according to the World Health Organization,3

“…the major causes of chronic diseases are known, and if these risk factors were

eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would

be prevented; over 40% of cancer would be prevented.”

And more research continues to demonstrate the same lifestyle factors

(healthy diet, regular exercise, etc.) contribute to robust neurological health as

we age. According to Dean Sherzai, MD, PhD, a director of the Alzheimer’s

Prevention Program at Loma Linda Medical Center,

“Ninety percent of us can avoid getting Alzheimer’s.”

In order to get the world’s diet back on track, and to enable each and every

one of us to reach peak health and performance, 3 processes could help.

1. Identify the diet and nutritional needs that uniquely fit your body and

your mind,

2. Track and maintain these diets over the course of a lifetime, and

3. Monitor your health outcomes and adjust where needed.

Fortunately, new science is refining our understanding and new products and

services are being developed to make the process of collecting personal

nutrition data easier and more effective at achieving optimal health.

So what exactly is personalized nutrition? How can it help me? What products

and services can I use from home to personalize my diet?5

What is Personalized Nutrition?

Personalized nutrition applies this logic to nutrition.

Emotions and preferences are heavily wrapped up in our diets, and culture is a

big part of the discussion. It may be a losing battle to ask Okinawans to give up

rice or Sardinians to give up wine. And despite their different diets, these “Blue

Zones” both have large populations that tend to live past 100 with relatively low

rates of chronic diseases.

But we also can possess different biochemical reactions to food as well.

Allergies are a clear example. Roughly 3 million Americans have coeliac disease

and cannot eat gluten, peanut allergies have more than tripled in U.S. children

over the last few decades, and you can even develop an allergic reaction to

meat through the spread of a virus from a tick bite.

At its core, personalized nutrition is a

diet designed to fit the physical, mental,

and environmental needs of an

individual.

Nutritional needs are much like people.

We’re similar in many ways, but we also

have differences in the way our bodies

have developed and the lives we each

live.

We have different preferences, different

cultures, and different biochemical

reactions to food.

6

But it goes far beyond these obvious constraints.

Differences in genetics can alter predispositions for certain health outcomes;

one person may possess genetic qualities that predispose them to gaining

weight4 more easily, while another may possess inefficient vitamin B12

metabolism.5

And although these studies are too early to make definitive predictions, some

research has shown that individuals possess certain genes that have better

health outcomes on a high-carb, low-fat diet,5 while other genes suggest

better outcomes on a low-carb, high-fat diet.6 And other genes have shown

links to high blood pressure, appetite, and many other aspects of diet-related

health outcomes.7

Nature and Nurture

The lives we lead also greatly impacts our biochemistry and metabolism, each

affected by changes in things like stress,8 sleep,9 family eating dynamics,10 and

diet itself. Differences in lifestyles and environmental conditions can alter

epigenetic modifications to your genes and shift gut microbiota composition.

And these effects are likely not the same in everybody. A recent study in Cell

showed a widely varying glycemic response between individuals to the same

meals.11 In addition to clinical differences, like the amount of sleep they got

the night before, their gut bacteria composition played a substantial role in

their body’s response to food. And while your gut bacteria affects which foods

you should eat, your food in turn affects your gut microbiome diversity.

Epigentics may play a role too. Epigenetics refers to modifications in gene

expression. This means, certain lifestyle and environmental conditions may

change which of your genes are promoted or inhibited.

7

Research is accumulating on the role epigenetics may play on nutritional

health outcomes, particularly for environmental conditions in early-life.12 And

although this was only a rat-study, an interesting finding showed obese rats

produced epigenetic changes that resulted in decreased leptin, the hormone

that makes you feel full. Epigenetics will be an interesting area of research to

watch.13

When it comes to weight loss, many diets of varying macronutrient

composition have been tried. A recent review14 and meta-analysis15 showed

they can all work to help lower weight. The biggest determinant was whether

study participants could stick to the diet.

Personalized nutrition recognizes that certain diets are individually better suited

for certain people. This accounts for variability in

personal preferences, dietary constraints, lifestyle, and

biological variations including genetic, epigenetic, and gut

microbiota composition.

But these studies in gut microbiome and gene expression are beginning to

shed light on the reality that the magnitude of these effects can vary quite

dramatically in different people.

Long-standing dietary advice from major health organizations still hold true.

Listen to the expert opinions on major macro and micronutrient

recommendations. Their advice will rarely lead one astray.

But often, achieving their targets and your own personal goals can be easier

said than done. Personalizing and optimizing your diet using nutrition data to

fit your unique biology and environmental conditions can help optimize and

accelerate your progress to help you meet your goals.

There are some broad commonalities.

Protein may increase satiety and thus,

make it easier for more people to

consume fewer calories because they

feel more full for longer. And

carbohydrates, in general, tend to

produce a higher glycemic response after

meals.

8

CHAPTER

2Why Personalize?

9

Increasing Healthspan & Peak PerformanceLet’s start from the beginning. The first law of thermodynamics says:

Energy can neither be created nor destroyed.

There’s no getting around that one. But – it can be transformed.

Enter, food.

Nutrition is our body’s fuel. We can’t live without it. But there’s a difference

between living with optimal health, and just living. For example, The Michael

Phelps Diet was 8,000 – 12,000 calories a day. He needed OLYMPIC-scale

energy. He doesn’t just train like the normal weekend warrior. He needs to

maintain peak energy throughout training as well as on race day.

Conversely, it’s easy to live on a poor diet for quite some time; all the while

building a lifetime’s worth of poor dietary habits that lead to many of the

chronic diseases facing us today.

Calories are directly defined as a unit of energy. Energy is locked up in the

chemical bonds within food molecules.

A good way to think of the energy you consume is by the ratio of your

macronutrients – fats, proteins, and carbohydrates. They all contain energy

your body can use, but in different ways. We’ll dive deeper into that later.

During digestion, these molecules get oxidized. Essentially, vitamins, minerals,

and other enzymes break these chemical bonds apart, releasing energy. That

energy is generally repackaged into ATP – the body’s energy currency.

10

Unused energy typically gets stored for later, generally in the form of fat.

So, I’ll just track my calories, right?

Calories are important, yes. Those who track and reduce caloric intake

routinely lose weight and improve cardiovascular health.

And yes, if you ingest more calories than you burn, over time, you will gain

weight.

But the energy balance equation of calories in and calories out is riddled with

personalization that complicates the math. Some examples:

• Resting Metabolism: Just sitting on the couch, we all burn

calories at a different rate.

• Gut Microbiota: Different diets and environmental conditions

change your gut bacteria composition. For example, some

people can extract more calories from fiber than others.

• Genetics: Each person’s DNA is unique to them (except for

twins!). And just like hair color, they can change the way your

body reacts to food.

• Macronutrient Composition: Your body reacts to them

differently. For example, were your calories from protein or

sugar?

• Micronutrient Composition: Your age, gender, genetics, and

lifestyle affect which vitamins and minerals you may be in need

of.

This guide will dive deeper into where this personalization comes from, and

how to go about collecting nutrition data to personalize your diet.

11

You Can’t Improve What you Don’t Measure

Optimization occurs along a particular dimension, so you must decide along

which dimension you are looking to optimize.

Body-builders may be going for bulk, long-distance runners may need to

ensure long-term fuel and adequate mineral ratios, and chess champions

require their brain to be firing on all cylinders.

You may be looking to simply find a consistent diet you love that allows you to

optimize long-term health and general wellbeing. Or perhaps you are looking

to lose weight efficiently, adhere to a dietary regime like veganism. or are

experimenting with something new like a ketogenic diet.

Whatever your goal may be, they all start with the same step.

To optimize your diet, you must routinely and reliably monitor

your dietary intake patterns.

Optimization requires experimentation and refinement

over time. And you can’t improve what you don’t

measure.

Therefore, optimizers must first start with reliable

nutrition data to provide a baseline for understanding

how their body reacts and make evidenced-based

decisions to adjust and track.

12

You might feel like you have a fairly routine and repetitive diet (I have a protein

shake and two eggs every morning!). But few of us eat the same meals, in the

same quantities, every day. And we certainly don’t have the same amount of

physical activity, stress, or sleep everyday.

So when you are trying to remember your meals and compare content

between your best performing day and your worst, ask yourself: “What was my

macronutrient breakdown? Did the percentage of my calories coming from

protein change? What about magnesium? Or potassium?”

Odds are, you won’t even have the same performance if you did isolate a top-

performing diet. There are many factors that will influence peak performance,

like sleep and stress.

But this is a numbers game. If you continue tracking and monitoring

performance based on dietary intake, patterns will begin to emerge.

You first need to know how to quantify and categorize your dietary intake

patterns. Only then can you intelligently adjust, monitor, and optimize based

on your performance.

There are several different aspects of your nutritional health and eating habits

that can be tracked to personalize your nutrition. Some are immediately

available, while others are in the works. And some require only a one-time

test, while others are ongoing.

As new science continues to improve our understanding of nutritional health,

new products and services continue to crop up.

13

This list is designed to be a comprehensive guide to at-home nutrition

personalization services available, as well as several that are coming soon and

are in the pipeline.

A couple of notes before we get started:

• Intake is not affiliated with the products or brands in this list, and

mentioning these products is not necessarily an endorsement. We simply

want to present some products and services that are available.

• Nutrition science is notoriously convoluted. We attempt to provide a mix

of the scientific consensus and emerging, yet promising, science. In areas

where nutrition data science is less well-defined, we do our best to

explain our current understanding, the potential it may bring to

personalized nutrition, and our approach we recommend to new

products and services that aim to use this data.

14

CHAPTER

3You Are What You Eat

15

What Counts as Fat?Body Mass Index (BMI) is a common measurement used across the diet world.

Simply put, your BMI is related to your weight to height ratio. So, the more you

weigh for your given height, the higher the ratio.

This is a useful, quick measurement for determining if someone is

underweight, in a healthy range, overweight, or obese. There are several free,

online BMI calculators you can use.

However, this doesn’t quite capture the whole story.

As you can imagine, muscle plays a much different role on your health and the

way your body metabolizes food than fat.

And taking it one step further, not even all fat should be treated the same way.

Studies show that visceral fat is worse for disease risk factors like

cardiovascular disease and diabetes than subcutaneous fat or brown fat.16

This distribution of fat within the body can produce some counterintuitive

health outcomes. For example, roughly 10% of obese individuals show no signs

cardiometabolic risk factors;17 conversely, 10% of normal weight individuals (18

< BMI < 25) possess a body fat distribution similar to that of obese

individuals.18 These so-called TOFIs (Thin on the outside, fat on the inside) are

at high risk for developing metabolic diseases like diabetes because the

location of fat is important.

In fact, this distribution of body fat may be the cause of the so-called

“overweight paradox,” where some studies have shown a similar risk of

cardiovascular disease-related morbidity and mortality to that of normal

weight individuals in the elderly.19

16

So how do you know what your body fat composition is?

Bioimpedance spectroscopy can be used as an in-home method of

decomposing body-fat percentage. A quick Google or Amazon search will bring

up quite of few of these devices from different brands, usually sold as a scale

or handheld device.

These work by sending a small electrical

current (too small to notice) of varying

frequencies through your body and

measuring the voltage. Different body tissues

(i.e. fat, muscle, bone, etc.) change the

voltage by different amounts. Using some

clever algorithms, these device then

determine the breakdown of your body

composition.

Are they accurate? Not so much. Precise?

Somewhat. But they are getting better.

Like most biochemical testing procedures, it

is recommended to practice consistency

between measurements. Try performing the

test at the same time every morning

(exercise affects the test results) and after

using the restroom (hydration levels affect

this test too).

The technology is improving, but studies in

obese patients and in children continue to

show statistically significant errors when

compared to gold standard measurement

techniques like dual x-ray absorptiometry.20

17

They can be useful for group analysis, but individually the accuracy is not quite

good enough. This goes for body fat distribution measurements, as some

devices purport, as well.

Is bioimpedance still useful?

Despite some error, they can be somewhat useful for qualitative analysis.

Providing a rough estimate, and monitoring change over time, may provide

useful ballpark figures for trends.

Your body fat percentage, fat mass, and fat-free mass are important for health

implications, as well as understanding how your body is metabolizing energy

(we will go into more detail on this later).

Being overweight or obese increases your risk of several chronic diseases,

including type 2 diabetes, cardiovascular disease, and some cancers. However,

body composition does impact the magnitude of that risk, and it can put

normal weight individuals into high risk categories.

In the pipeline

Improvements to bioimpedance analysis hardware and algorithms may

continue to refine the sensing techniques for determining body fat

composition and fat distribution. Until then, home-based tracking is relegated

to waist-to-hip ratios and inaccurate bioimpedance scales.

While medical labs and nutrition facilities often have equipment to help you

determine these numbers, home-tests for body fat distribution are still in the

works. 18

CHAPTER

4Blood, Sweat, & Tears

19

There is a small but growing group of healthy individuals who wear continuous

blood glucose monitors to quantify their body’s response to food. These small

patches have tiny needles that detect blood glucose and transmit the readings

to your smartphone.

After a meal, metabolism begins harvesting energy from the food you ate. This

results in a rise in the amount of glucose circulating in your blood (blood

glucose). This is called the glycemic response.

Some food groups cause a sharp

spike in blood glucose. Sugar is a

prime example.

Other foods, often high in fiber,

cause a much smaller and gradual

rise in blood glucose.

Any rise in blood glucose levels cause a rise in the release of a hormone called

insulin. Too much glucose in your blood will cause you some serious problems.

One of insulin’s jobs is to regulate glucose levels by decreasing its

concentration in circulation.

It is interesting to track the behavior of your blood glucose response to foods

for a few reasons. First, is to spot and monitor pre-diabetes so as to manage

and possibly reverse the disease early.

Chronic hyperglycemia (high blood glucose levels) is a sign of pre-diabetes and

diabetes. Chronic hyperglycemia is also associated with many of the ill-effects

of diabetes, including injury to the heart, nervous tissue, retinas, and kidneys.

Monitoring blood glucose levels can help spot and diagnose pre-diabetes with

enough time to potentially halt and reverse the disease, as well as for

maintenance of symptoms for sufferers of the disease.

20

Second, it can also be useful to track your blood glucose response to foods to

better understand the unique way your body responds to food. A recent article

in Cell showed that the glycemic response can vary significantly between

individuals, despite eating the same types and quantities of foods.11 This may

eventually help you gain insight into the health of your gut microbiome (which

we will discuss more later) and better personalize your diet.

Micros Have a Macro Impact

Another major component of your diet that can be partially interrogated via

blood testing is your micronutrient levels.

Micronutrients consist of vitamins and minerals. They are essential for life,

being used in numerous biochemical pathways as catalysts and coenzymes.

Deficiencies in any one of these can cause both acute problems (when the

deficiency is severe), and chronic (when persistent undernutrition occurs).

Unfortunately, micronutrient intake in modern diets is routinely too low.

So while your body can handle short term deficiencies, long-term deficiencies

should be avoided. Invasive blood testing is one option for determining recent

micronutrient intake levels.

SpectraCell is one of the leading blood-testing service providers for

micronutrient testing services. A few others, like WellnessFX and LifeExtension,

also perform these tests.

However, an at-home product that draws and analyzes blood requires FDA

approval and isn’t yet on the market; although a few seem to be in the works

(in the pipeline, below).

21

The next best thing comes from ZRT Labs, which provides at-home kits that are

mailed back to a central lab for analysis. ZRT provides dried blood spot tests

with a finger-pricking tool to draw blood and mail away. One prime example is

to look for vitamin D deficiencies.

Additionally, ZRT has saliva kits. Although looking for different biomarkers,

these tests primarily look for hormones that reveal information such as thyroid

function.

Other companies like Meridian Valley Labs also provide home blood kits that

test for hormones, but they also assess food allergies which can be extremely

useful for identifying the source of major food reactions.

In the pipeline

A few companies working on at-home blood testing devices for nutrition-

specific biomarkers include Vitameter and KalibrateV. These aren’t yet on the

market, and it’s not yet sure if they’ll make it. But be on the lookout for these

and others. They will surely start to crop up soon.

The Kenzen patch is a new product used to monitor hydration levels and

electrolyte imbalances. This may be useful during training, where making sure

hydration stays at the top of mind. Ultra-endurance athletes may find this

particular appealing. Kenzen also suggests their product can be used to assess

electrolyte imbalances.

X labs (Google) made a bit a press when they were working on a contact lens

containing microelectronics designed to measured glucose from tears. But as

the CEO of Novartis, a partner on the project, says, “It’s a high risk project.”

Many researchers claim the correlation of glucose in tears is not as robust as

blood, and therefore will never provide clinically useful information for diabetic

patients. We’ll have to wait and see about this one. It will likely be years before

a product like this demonstrates any breakthroughs.

22

Saliva is an enticing biological medium because it is non-invasive and easily

acquired. And while some markers of diet and nutrition can be discovered in

saliva, its reach is limited.21

One interesting area might be related to teeth health. Diet has a profound

impact on tooth and jaw development. Foods like sugar and starch are known

to cause cavities and other problems with teeth. But saliva may provide insight

into the current health of your teeth and the amount of resident bacteria.

But since your DNA is the same in every cell of your body, saliva does provide

an easy access point for genetic testing. We’ll dive into that, next!

23

CHAPTER

5Fitting Into Your Genes

24

DNA testing is an exciting, emerging field brought on by the dramatic

reduction in DNA sequencing costs. The Human Genome Project took 15 years

and $2.7 billion to sequence the first human genome in the year 2000. Now,

we are close to a $100 genome sequencer that will only take a an hour! And it

will only continue to fall in the future.

Sequencing your DNA has myriad medical uses, especially with new gene-

editing techniques like CRISPR. There are other interesting uses too, like

tracking your ancestral line using services like 23andMe and Ancestry.com. But

for now, we’ll focus on how they relate to your diet and nutritional health.

Your DNA is unique to you. It is present in all of your cells, and it contains the

information needed to make you you. It directs everything from how to build

your hip bone when you were in the womb, to how your body is going to treat

gluten once it enters your digestive system.

Genes are sequences of DNA that decide how your body is going to produce

different proteins. These proteins then go off to do all of the different things

they do to make life happen.

Sometimes mutations occurs. If a mutation within a gene occurs, that may

change the ability of that gene to produce its corresponding protein. And since

these proteins go off to make life happen, you have a chance of experiencing

life differently if those same proteins are produced in different ways or

different amounts.

Often genes work together through a cascade of biological processes to get

work done. In these cases, genetic mutations must be thought of as changing

probabilities.

25

And example is the BRCA1 gene. Mutations in these genes are associated with

an increased risk of developing breast cancer. But they demonstrate how they

should be dealt with when thinking about probabilities.

Having a mutation in the BRCA1 gene, for example, does not change your risk

of developing breast cancer from 0% to 100%. But, it can still be significant. A

typical American woman has a 12 percent chance of developing breast cancer

in her lifetime. But a woman with a BRCA1 mutation has a 55 to 65 percent

chance of developing breast cancer.22

Not insignificant, by any means. But also not certain.

These are population-wide statistics, and other contributing factors are

required for the disease to actually develop. Many are unknown, often

requiring some combination of environmental factors, lifestyle choices,

triggers, and pure chance.

The same logic applies to most dietary intake needs.

For example, the FTO gene correlates to a propensity for obesity, and the

CYP1A2 gene correlates with your ability to metabolize caffeine. But it’s

important to keep in mind, that it’s believed that well over 40 genes correlate

to obesity; and the genetic loci discovered to have associations with obesity

are only shown to account for about 2-3% of obesity risk.23 So analysis and

recommendations based on the presence or absence of genetic markers

should be viewed cautiously, and sometimes modestly.

But, predispositions can help you personalize your diet in very real ways. Many

issues like obesity or cardiovascular disease are issues that accumulate through

small differences incurred over a lifetime. And 3% can add up over time.26

Knowing your predispositions, then, does not dictate your fate. This is usually

some combination of genetics, your environment, some trigger, and chance.

Some genes, on the other hand, have what is called high penetrance. Unlike

the predispositions mentioned above, mutations in these genes do have close

to a 0-to-1 effect.

The LCT gene, for example, produces an enzyme called lactase. Some

mutations to the LCT gene are known to produce lactose persistence in

practically everyone with that mutation, while other mutations can render

your chances of being able to tolerate lactose at 86 to 98 percent.24 This gene,

in other words, has high penetrance towards lactose intolerance.

Lactose intolerance often develops as we age out of the weaning process. This is an interesting example of a relatively modern form of human evolution based on a cultural shift to an agrarian lifestyle with livestock milk and shorter weaning periods.

But your hair cells and liver cells behave quite differently. This is because they

are expressed differently. Some genes are turned on, while others are turned

off. One cell uses part of your DNA, while another cell uses a different part.

This change in expression can indeed change based on lifestyle and

environmental factors. Even more odd, is that these changes to DNA

expression sometimes can be passed down through generations. This is the

field of epigenetics.

Your DNA doesn’t change (with the

exception of mutations). But, the way

your DNA is expressed can change.

Your DNA carries information about how

to build proteins, and it is the exact

same DNA in every cell of your body.

That means, your hair cell, your muscle

cell, and your liver cell all have the same

DNA.

27

Genetics refers to the sequences of DNA that are heritable (they pass from one

generation to the next). But epigenetic changes may be heritable too. The

mechanism for epigenetic inheritance is still not well understood, but it may

provide some interesting insights into how diet and exercise can change gene

expression.

For example, a recent study published in Cell Metabolism showed that the

epigenetic profile of sperm in obese and lean men were markedly different,

particularly among genes known to be associated with obesity like FTO.25

What does this mean? Poor weight management decisions don’t just affect

your own health. You may be setting your children up for uphill battle.

One classic epidemiological example of this is the “Hunger Winter.” Children

born during the Dutch famine of 1945 resulted in higher rates of diabetes and

obesity later in life; and potentially even resulted in similar trends in their

children.

The good news about epigenetics, is that the changes to DNA expression do

appear to be reversible. So, if you stop smoking,26 begin exercising and change

your diet,27 epigenetic modifications may shift to a more favorable profile.

Your Personal Meal Plan

Your genetic (and potentially in the future, epigenetic) profile can help you

produce a unique, personalized food plan that caters to you. Learning about

certain predispositions may also help you justify certain lifestyle choices.

We should all eat nutritious foods. But if you discovered you are predisposed

to developing insulin resistance from over-consumption of starches,28 you just

might be more inclined to adjust your eating habits to help ward off diabetes. 28

How do I use this nutrition data to personalize my diet?

One inherent downside to genetic testing, is that the ongoing tracking and

monitoring of diet and behavior isn’t possible. Your DNA doesn’t change.

DNAFit, Nutrigenomix, Anabolic Genes, Orig3n, and Fitness Genes are

examples of popular solutions for using your DNA to help guide your diet and

exercise regimes. With a quick saliva swab, your DNA gets sequences and

particular genes known to be associated with particular dietary concerns like

lactose intolerance and carbohydrate sensitivity are identified.

Others, like Habit, use a combination of DNA testing and a series of blood tests

in order to provide personalized meal plans.

Information about these genes present in your DNA help you determine the

likelihood of expressing each particular trait.

How would you use this?

Think of these results like a personal guide. These results can help steer your

dietary needs in a direction that may prove to be a better fit for you body and

help you optimize your health and performance.

Are there any home epigentic testing services?

Not yet. The closest is likely Episona’s home sperm testing kit for measuring

male fertility.

But diet is likely a factor that shapes your epigenome. However, it may be

some time before enough science has been collected to use epigenetic

profiling for personalized nutrition.

29

In the pipeline

Genetics is uncovering relationships our genes have with diet and nutrition,

but so far their effects tend to be rather small with low penetrance. Take any

guidance with caution.

But this is a rapidly changing field of research with new science sure to come

in droves. Take new studies with a grain of salt, and wait for convergence

among the experts before you try any major changes.

And be on the lookout for the first epigenetic testing services. They may crop

up soon. But the advice on skepticism goes doubly for epigenetic tests. The

field is sure to bring more understanding to personalized nutrition data, but it

is extremely nascent. Give this one another decade.

30

CHAPTER

6Your Personal Cost to Living

31

What is Metabolism?According to Mitchell (1962),29 your basal metabolic rate (BMR) is simply,

“the minimal rate of energy expenditure compatible with life.”

When you run, jump, swim, and talk, energy is used. This isn’t too hard to

conceptualize. But sometimes we forget about the other work going on behind

the scenes. The work to keep you alive.

Beating hearts. Breathing Lungs. Thinking Brains.

Your body is constantly using energy simply to keep organs functioning and to

keep you alive. This minimum amount of energy required to keep those

internal organs functioning is your BMR.

In fact, roughly 70% of your caloric intake is used for this basal cost of living.

According to an FAO review,30 your total metabolic breakdown roughly follows:

• Liver 27%

• Brain 19%

• Heart 7%

• Kidneys 10%

• Skeletal Muscle 18%

• Other Organs 19%

And because 10% of caloric intake is used for thermogenesis (keeping our

bodies warm), only around 20% of our calories are used for the physical

activities we pursue throughout the day.32

Is my BMR

unique?

There is a decent amount of

variation among the

population with respect to

BMR. So what’s causing this

variance?

This is an area of ongoing

research, but there are

some studies that suggest

where this variance comes

from. Largely, it comes from

your body composition.

A 2005 study in the

American Journal of Clinical

Nutrition investigated

potential sources for this

variance.31 Here’s a

snapshot of their findings:

• 63% of BMR variance

came from fat free

mass

• 6% came from fat mass

• 2% came from age

• 2% came from intra-

subject variability and

analytical error

• 26% was unknown

33

What characteristics were not associated with BMR variance?

• Height

• Sex

• Bone Mineral Content

The researchers also investigated the effect of three hormones on this

variance, and found no significant variance associated with leptin or

triiodothyrionine; but thyroxine seemed to account for roughly 25% of the

unknown variance in men, but not women.

This leaves us with two major takeaways:

1. Your body composition is the major player in your basal metabolic rate;

however

2. Roughly a quarter of the variance is due to “other,” unaccounted factors.

Another 2009 study estimated that body composition accounts for roughly

80% of BMR.32 What’s causing the 20-25% of variance?

There are a few hypotheses. One, as noted in each study, is that the different

tissue components of fat free mass are not accounted for. Studies show that

resting energy expenditure can vary quite significantly between organs, tissues

within organs, and organs between individuals.33 The size of organs vary, and

the composition of organs can vary.

Other variations may compound as well. The brain uses slightly different

amounts of energy during neural activity like visual stimulations,34 and

temperature, stress, and sleep are all known to alter BMR.35

And certainly, genetic variations may play a role as well. As we inevitably

uncover more information about the genes involved with regulating different

organ, tissue, hormonal, and cellular metabolic pathways, we will likely

discover more insight into subtleties of BMR variance.

34

What is Your Respiratory Quotient?

The respiratory quotient is a number unique to your lifestyle and body

composition that shows up primarily in the world of fitness and nutritional

health. Used to gain a better insight into the inner workings of your

metabolism, this number can help you gain insight into how your body is

processing your diet and harvesting energy.

In addition to your BMR, most of us move around throughout the day, adding

extra caloric expenditure into the mix.

You need to get this energy from somewhere.

Usually, this energy comes from food. When you haven’t eaten in awhile, your

body uses stores of energy from stored glycogen and body fat.

Your body oxidizes these various substrates to harvest energy for your cells to

reproduce, muscles to grow, brains to think, and so on.

Your respiratory quotient is the direct measure of carbon dioxide production

against oxygen utilization. What this information provides is a measure of

where your body is primarily getting its fuel from.

In other words, which substrate is being oxidized more for your body’s energy

needs: carbohydrates or fats?

35

How do you Measure your BMR and Respiratory

Quotient?

Many fitness centers and wellness clinics will perform respiratory quotient

tests, because unfortunately this is not something you can easily do at home. It

requires a bit of equipment and a trained professional.

You typically need to fast for some amount of time. For my test, I fasted for at

least 12 hours before the test. This is because recent intake of any foods can

significantly alter the results.

It’s also important not to do much physical activity beforehand. This, too, can

impact the test results.

The test itself is rather simple. You sit still. While you sit, recline, or lay, you

wear a mask that covers your mouth and nose. You’ve likely seen these kinds

of masks on people performing a VO2 max test. The mask connects to a hose,

which is connected to a computer and a machine. You also wear a heart rate

monitor.

And that’s it! You sit and breathe for around 20

minutes, because it is useful to have some time

to get relaxed (usually only around 5 minutes of

continuously clean data is needed).

This test is also the same conditions required to

assess your basal metabolic rate (or, resting

metabolic rate). So, make sure both numbers

are calculated and you can kill two birds with

one stone!

36

What Do the Results Look Like?

Your respiratory quotient is a decimal between 0.7 and 1.0. A normal range is

typically around 0.8 – 0.85.

The results may also be broken down by macronutrients to represent how

much of each substrate your body is deriving its energy from. Here is a pie

chart of my recent test results showing the breakdown.

What Do the Results Mean?

A respiratory quotient of 1.0 essentially means that all of your energy is

derived from teh metabolism of carbohydrates.

The reason for this number takes one back to college chemistry. Remember,

the respiratory quotient is the ratio of oxygen consumption to carbon dioxide

expulsion. Glucose metabolism breaks down in a 1-to-1 equivalent of oxygen

to carbon dioxide. The equation below shows that 6 oxygen molecules are

used to produce 6 carbon dioxide molecules.

C6H12O6 + 6O2 → 6CO2 + 6H2O

37

A respiratory quotient of 0.7 is the opposite, meaning that all of your energy is

derived from the metabolism of fat. While different fatty acids have different

ratios, palmitic acid gives an example of producing a respiratory quotient 16

CO2 / 23 O2 = 0.696.

Complete protein metabolism has a respiratory quotient of around 0.81.

Similar to fat, this is an average because protein as a term embodies all of your

amino acids. The body doesn’t contain large stores of protein for energy

metabolism. However, some protein is metabolized internally. And the rate of

protein turnover does not differ significantly between undernourished and

well-nourished individuals.

These numbers for each macronutrient constitute energy being derived solely

from these categories. But because we almost never exist in this state, the

number falls somewhere between them and exists as a combination of these

macronutrient substrates.

Body Composition

Some studies how investigated the relationship between various aspects of

body composition, like body weight, fat mass, and fat-free mass to the

respiratory quotient and found significant correlations to all.36 Generally, the

higher the body weight, fat mass, or fat-free mass, the lower the respiratory

quotient; lower body weight and fat mass led to higher respiratory quotients.

The logic here follows that fat oxidation is directly related to the amount of

free circulating free fat acids in your body. The less you have, the less your

body can metabolize and derive energy from them. Thus, carbohydrates and

glycogen stores occupy a greater percentage of your energy source. 38

Dietary Patterns

The food quotient is a number that is similar to the respiratory quotient. It is

designed to represent the macronutrient breakdown of your diet. Some

researchers have hypothesized that the food quotient should equal the

respiratory quotient for those with stable weight and in energy balance.

Correlations have been found, but this relationship is not always clear.

One stark example comes from Jewish physicians investigating metabolism in

the Warsaw ghetto of the 70s. Chronically undernourished individuals had

respiratory quotients over 0.95. Later, other researchers also showed that

individuals at stable weight but that are chronically energy deficient have

higher respiratory quotients, typically over 0.90 (whole well-nourished

individuals were closer to 0.83).

However, in all cases, increasing carbohydrate consumption has a percentage

of one’s diet increased the respiratory quotient. So, a high respiratory quotient

also reflects recent dietary patterns alongside body composition.

Body Mass Change

One study investigated the relationship of the respiratory quotient to the food

quotient, to determine whether the respiratory quotient correlates well to

measures of recent dietary patterns.37 They did not find a good correlation

during their 10-week study.

Rather, they found a strong correlation between the respiratory quotient and a

recent change in body mass. Having lost body mass in the past 5-7 days was

correlated with a lower respiratory quotient (closer to 0.8 and below), while

increasing body mass was associated with a higher respiratory quotient (closer

to 0.9).

39

Another study showed similar results in obese women.38 This, in part, explains

why it is difficult to keep off fat after weight loss. As your body loses weight,

your degree of fat oxidation decreases and thus your propensity to store the

fat you ingest rises.

Genetics

However, some of your respiratory quotient may be genetic. Your body’s

tendency to oxidize fat has been shown to follow familial lines to some

degree.39 And other studies have identified particular genes that are

associated with high and low fat-oxidation. Thus, some variability is to be

expected, despite similar body compositions and dietary patterns.

How Do I Use My Respiratory Quotient?

Your respiratory quotient gives you insight into your dietary patterns, your

body composition, and your metabolism. Currently, one of the best ways to

use this information is to help inform future personalized dietary patterns that

may be more beneficial for your dietary goals.

Identify Potential Sources of Weight Management Issues

Most well-nourished individuals will exhibit similar respiratory quotients and

basal metabolic rates. This is, usually, a good thing.

But sometimes individuals may be outside of the norm. This is useful to

identify and may indicate either skewed dietary patterns, rapidly changing

body composition, or potentially chronic undernutrition.40

Adjust Dietary Patterns to Meet Your Goals

For example, studies have shown that low fat oxidation (high respiratory

quotient) is associated with future weight gain.40 The theory being that those

who metabolize carbohydrates better than fat will naturally store more fat over

time, leading to weight gain.

And another review article corroborates this research, connecting genetics and

recent body composition changes to your respiratory quotient as a measure of

past and predictor of future weight maintenance.41

Particularly in obese individuals, their metabolic “flexibility” (ability to switch

metabolic oxidation easily from carbohydrate to fat) is diminished and makes

losing weight and keeping it off more difficult. This may imply certain diets or

fat oxidation stimulants may be beneficial for these individuals.

Trend Analysis

Due to the inherent variability among individuals and their respiratory

quotient, it is sometimes difficult to identify the precise mechanisms behind

skewed, but not extreme, values. What can useful, is monitoring your own

value over time.

By tracking your respiratory quotient against possible changes in weight and

diet, you may be able to verify healthy and stable metabolic activity, or

potentially identify issues that are a cause for concern or help better

understand the results you are seeing with weight management.

41

A few handheld indirect calorimeters are available for home use. These

operate similarly as a breathalyzer. After breathing into the device, out pops a

rate of calorie burn.

One is the MedGem by Microlife. While simple and relatively inexpensive, the

MedGem only tracks O2. By not also tracking CO2, it misses the complete

picture.

As mentioned above, the respiratory quotient varies person to person based

variables like body mass, age, gender, and others. The MedGem approximates

the R.Q. as 0.85 for everyone. This can result in a decent amount of error.

However, it still provides a decent snapshot of your BMR and can help you

refine your diet based on your metabolism.

Another option for a home-use indirect calorimeter is offered by Breezing.

Although more expensive, the Breezing monitor does take both O2 and CO2

measurements using disposable biosensors and has been shown to be

equivalent to clinical lab-scale tests.

Can I Change my BMR?

First, your BMR will give you a guide as to your minimum caloric needs. The

average is typically around 1,500 kcal per day.

This can, and does, shift. Albeit, minimally.

Prolonged undernutrition will typically lower your BMR. This is one of the

factors for why dieters often gain weight back once the diet is over, and why

other dieters seem to “plateau” while trying to lose weight.

42

Your body does this in an attempt to self-regulate energy balance.42 Imagine

yourself as a hunter-gatherer several thousand years ago. When food was hard

to come by, it was useful for your body to slow down metabolism so you didn’t

starve as quickly. Your caloric intake decreased, so you body’s energy demands

decreased along with it.

Similarly, when your fat stores are increased during prolonged

overconsumption, your BMR will increase by a small amount.

And the majority of your BMR is dictated by your fat free mass. Hitting the gym

and gaining muscle mass, therefore, will increase your BMR.

Moving requires energy. That means, the more you move, the more calories

you burn.

But there are some subtleties here worth noting.

Moving might not impact calorie burn as much as you think; and

Physical activity changes other diet and nutrition-related physiology “under

the hood.”

Here’s an example to put things in perspective. Although this depends on

many factors, such as weight, an average person burns about 100 calories for

every mile they jog.

Let’s think about that. If you run 10 miles a week, you will burn an extra 1,000

calories. On a 2,000 calorie per day diet, that’s only about 7% of your weekly

calorie budget.

Then, you must contend with hunger. Exercise releases cortisol. Among other

things, this hormone tends to stimulate appetite.

Is exercise worth it, then? Absolutely.

43

In addition to burned calories, exercise still works wonders for things like

cardiovascular health, mental health, stress reduction, bone health, lean-

muscle development, and so on. And as we’ve discussed, lean muscle

development will increase your BMR.

Calories for Calories

Diet induced thermogenesis occurs after you eat food.43 Any food.

Your body requires the use of calories – aka energy – in order to digest and use

calories. You read that right. It may sound odd, but digestion is work for the

body. So some calories are still required in order to digest food.

Macronutrients require different amounts of calories in order to be digested.

Proteins increase thermogenesis the most (30% of calories burned), followed

by carbohydrates (5-10%), and then fats (0-3%). A typical, balanced diet

usually renders thermogenesis at around 10% of your total calories burned

throughout the day.

The Obvious One – Moving Requires Energy

The final part of the equation here is how many calories you burn per day from

your daily activities.

Do you move around a lot? Do you exercise?

Or do you sit in your car, take the elevator to your office, sit for 10 hours, head

home to the couch, watch tv, and fall asleep?

In addition to your BMR (on average around 1,500 kcal/day), you may burn

anywhere from 500 if you’re an office worker or another 5,000 if you’re

training for a marathon.

44

To bring the discussion full circle, we’ll use your goals and a simple equation to

help give you a guide to how many calories you should eat every day.

Losing weight?

When you take in less energy than you expend, you will burn adipose tissue

(fat, plus about 10% water per cell) for energy and lose weight. It won’t be

much, but like saving for retirement, this will accumulate over time.

But keep in mind, how much you expend will change. As we’ve seen, your BMR

will change as you consistently eat fewer calories than you expend and as your

body composition changes. So maintaining consistency will require your food

intake levels to change over time as well.

Gaining weight? A similar approach exists. But again, adding muscle weight or

fat weight will affect your BMR in different ways.

Maintaining weight? Simply do your best to maintain energy balance. Like

we’ve seen, your body has some incredible homeostatic mechanisms in place

designed to help regulate your body during brief fluctuations. It’s a consistent

over- or undernutrition that will slowly accumulate over time. But don’t worry.

The process can always run in reverse!

45

In the pipeline

Breath can be used for identifying your BMR, but can it be used for other diet-

related tracking purposes?

A limiting factor of all biological medium is the library of physiological

biomarkers available. For example, if your breath doesn’t contain any

molecules that relate to how much vitamin B12 you’ve recently consumed, no

new technology will be able to “track” it.

But new research continues to expand what nutrition data is possible to track

using breathe.

In the meantime, advances in breath analysis may be limited to better BMR-

testing devices.

46

CHAPTER

7Flushing Data Down the Drain

47

The first thought that comes time when you hear “urine test” is likely the

home pregnancy test.

These tests typically use a technology known as a lateral flow assay. Here,

capillary forces pull urine up a paper strip. You can try this experiment at

home. Take some paper, carefully dip it in water, and watch the moisture creep

upwards.

Urine is non-invasive and is an end product of the digestion process. This

means it is directly affected by your diet.

Urine is also a very complex mixture,

containing a slew of small organic and

inorganic molecules that come from

upstream metabolic processes.

In lateral flow assays, molecular probes are

places on the strip that find one of these

particular molecules of interest in urine,

and bind to it. They only bind to that a

single molecule, and do something special

when they do find their binding pair.

They change color.

The color change indicates the presence of the molecule, and there you go.

There are other urine tests, like pH test strips, or strips that look for ketone

bodies. These work using a similar principle.

Hydration levels can be measured via urine pH. Many vendors sell disposable

pH strips that can be easily used by dipping into a pure urine sample. After

waiting around 15 seconds, the strip changes color and can be compared

against a color guide to provide an estimate of pH.

48

Ketone test strips are available from a variety of vendors and operate similarly

to pH strips. After dipping them into a pure urine sample and waiting around

15 seconds, the strip changes color. Comparing the color to the color guide on

the box allows you to identify the concentration in your urine.

Home-urine collection is another option.

One example could be of interest to vegans. Vitamin B12 is only found

naturally in animal products. However, in today’s world, we not have several

kinds of foods that are fortified with various vitamins and minerals, including

vitamin B12.

Your body can store excess vitamin B12, so if you aren’t eating enough, your

body can handle the drop in intake for a while. But eventually, if not

replenished, you will become deficient. This can come with a host of problems

from anemia to birth defects.

The Norman Clinical Laboratory provides urine testing for methylmalonic acid

(MMA). In B12-deficient individuals, MMA is elevated. Therefore, within a few

days of mailing in your urine sample, you will have a decent understanding of

whether your vitamin B12 levels are where they should be. And ZRT Labs

provides at-home, dried urine sample kits for testing an array of different

hormones like estrogen and cortisol.

But much more possibilities lie ahead, because urine is a complex fluid with a

slew of metabolic end-products. Many macronutrient, micronutrient, and food

groups possess statistically significant correlations that trend with recent

dietary intake patterns. Others can help identify whether your body is

metabolizing the nutrients you are eating and whether your body is currently

in a nourished state. 49

In the pipeline

Intake is developing next-generation urine analysis technologies designed to

instantly and quantitatively measure biomarkers of dietary intake. In a few

seconds, you will have an entire day’s worth of data regarding calorie, fat,

protein, carbs, and sugar intake. Furthermore, Intake is also working on

quantifying key vitamins and minerals!

Sign up here for updates and pre-order promotions!

50

CHAPTER

8Get Your Sh*t Together

51

If you had an interest in this book, there’s a good chance you’ve already heard

of, or know a lot about, the gut microbiome.

It’s a pretty hot area of research these days. More universities and medical

facilities are opening research centers devoted to the gut microbiome, and

we’re already seeing clinical procedures like fecal microbial transplants (FTM)

at major hospital centers.44

Sure, it may sound like an odd procedure, to say the least. But a New England

Journal of Medicine randomized control trial found that FTM treatment cured

94% patients of C. difficile infections.

Where might you get this infection? Often, after antibiotics use.

Clearly, antibiotics are immensely beneficial to society, having saved millions of

lives throughout the years. The issue here, is when too much gut bacteria gets

cleared away and C. difficile grows and spreads in this wake.

Your gut microbiome is a complex and active ecosystem. There are over 100

trillion bacteria cells in your gut of over 2,000 varieties. In fact, there’s more

bacterial cells living inside you right now than your own cells!

Don’t think about that one for too long…

Gut flora numbers and distributions are controlled by a number of factors,

including your genetics, your environment, your stress, and your diet.

Different diets produce different microbiota. For example, shifting from a

vegetarian diet to one with meat changes the gut bacteria diversity within only

two days.45 52

Stress? Believe it or not, that gut feeling you have may be more real than you

thought.

The gut-brain connection has been undergoing some serious research lately.

And the findings are fascinating. In short, the gut microbiota affects your brain

– from mood to function. Some research is even starting to connect maternal

nutrition to the rise in developmental neurological disorders, like autism

spectrum disorders, from a change to gut microbiota in early childhood.46

But a diet personalized based on your gut microbiota has potentially important

ramifications for things like obesity and diabetes. A recent report in Cell

showed that a person’s glycemic response (their spike in blood sugar levels

after a meal) can vary significantly between individuals – even after the same

meal.11 They developed an algorithm that took certain clinical and microbiota

data into account that successfully modulated their glycemic response on an

individual level.

This type of personalization is very exciting, as glycemic response and insulin

sensitivity are important metrics for diagnosing and monitoring diabetes. And

other research on gut microbiota in mice show similar effects towards the

development of obesity.47

Day Two allows you send in a stool sample, by mail, for analysis of your gut

microbiome. They specifically look for a HbA1c, which correlates to average

blood sugar levels over the past few weeks.

In combination with dietary intake tracking, this may provide a window into a

personal diet that accounts for glycemic response. However, being an average,

it needs to be compared to your average dietary intake. This may be tough to

parse out what to change.53

uBiome offers an at-home testing kit designed to sequence your gut

microbiome DNA profile. Like DNA and epigenome testing, the science here is

early and in all respects has a higher value for research than practicality at the

moment. But you can still find interesting correlations than you may find useful

for understanding changes wrought by dietary change.

Viome is another new company looking to analyze your gut bacteria using

artificial intelligence to personalize your diet.

In the pipeline

While consumer companies like Day Two and uBiome provide some

microbiome diversity analysis, the science is too new for extensive diagnosis

and treatment regimes to be developed with significant confidence. But we

will surely to see a lot of future activity in the microbiome arena.

54

CHAPTER

9A Nutritionist in Your Pocket

55

Nutritionists and registered dietitians have studied and trained specifically to

help you meet your dietary goals. They will often begin the relationship with

an assessment of your dietary intake. Typically, a food journal is used.

And as we’ve seen, technological improvements along a variety of biological

mediums are increasing the accuracy, the breadth, and the ease of use for

much of this data collection and ongoing monitoring.

But collecting the data is only part of the journey.

Using nutrition data to make informed decisions about how best to adjust your

diet, make smart food choices, and monitor performance are all important

steps towards optimizing your nutrition and meeting your goals.

Several nutritionists and wellness clinics provide online counseling services to

help personalize meal plans and supplement regimes.

But will artificial intelligence democratize personalized nutrition for the

masses?

Artificial intelligence, or AI, is one of the most watched technological advances

these days. (Here’s a great intro video for those really interested in diving in.)

Some argue that as many as 47 percent of jobs could be automated away.

But the devil’s in the details.

Typically, analysts and futurists suggest routine, predictable work will be

automated much faster than service jobs that require a human, personal

connection.

The nutritionist’s role then, may splinter. Or at least, shift. As they say, AI won’t

likely automate “jobs,” but it will automate “tasks.”

56

With the rise in better data collection and analysis of nutritional health

metrics, a diagnosis and personalized treatment plan may achieve automation

relatively soon. This could democratize nutrition advice for the masses, and

help put a nutritionist in every pocket.

But nutritionists will remain for quite some time. Particularly for the emotional

support they provide.

Diet is full of emotion. What we eat is tied to culture, image, self-worth,

health, and disease. AI might be able to help optimize your diet better than a

human; hell, it might even be able to predict which eating habits you are more

likely to stick to and recipes you will enjoy.

But nutritionist can connect on a human level. And its similarity to psychology

and human support means it likely isn’t going anywhere soon – in fact, their

numbers may grow in the short term.

In the pipeline

Artificial Intelligence? This might not be as far off into the future as it might

sound. Expect to see rudimentary services emerge soon that combine the

emerging influx of personal health data like genetic, microbiome, metabolic,

sleep patterns, and dietary intake patterns to be integrated and analyzed into

personalized nutrition recommendations.

It might be quite some time (if ever) before AI provides the emotional coaching

that only an expert nutritionist provides, but it will almost certainly become a

useful assistant!

57

CHAPTER

10Diet-Tracking

58

Sometimes tracking one’s diet as very direct consequences on immediate

health. Allergies are a prime example. Nima has built an at-home food allergy

testing device to measure gluten content, and they plan on expanding into

more allergy testing soon.

Other tracking systems are useful for meeting weight loss goals or optimal

athletic performance.

Fitness trackers have been a step in the right direction. Understanding your

caloric expenditure is very useful. And many in the fitness world are early

adopters for other tools like heart rate monitors. But while heart rate

measurements are getting much better, calorie expenditure is still very

inaccurate.48

And what about the other side of the equation – nutritional intake?

Nearly three decades of academic, peer-reviewed literature have

demonstrated, time and again, that tracking your dietary intake can

substantially help you lose weight and meet your nutrition goals.49

There’s just one problem. Nobody does it.

At least, not continuously. And if you’ve ever tried one, you probably know the

reasons. As one researcher commented, “Data entry is a fine job…if you get

paid to do it.” They’re painfully tedious, time-consuming, inaccurate, and

difficult to maintain. One study found that less than 3% of people who

downloaded a free diet-tracking app continued to use it after one week.50

Why Do Food Journals Work Poorly in the

Real World?

Studies have investigated the reasons why food journal users decide to use,

and not use, routine diet-tracking.51 Here are the major reasons. If you’ve tried

one before, chances are you also fit into one or more of these categories.

59

It’s Too Tedious

The general complaint of tedium usually tops the list for complaints around

food journaling and food diaries.

We eat a lot! Generally, we eat at least three meals a day, and snack along the

way. Lest we forget what we consumed, we need to login to our apps, search

for an find the food, quantify how much we ate of it, for each ingredient.

We need to do this for everything we eat everyday? And if we forget, then the

whole day’s data becomes much less useful? It’s no wonder this is the primary

cause for quitting food journals.

Time-Consuming

Going hand-in-hand with tedium, is the time-cost. Food journal apps have

dramatically reduced the time associated with written journals for

documenting and calculating various food intake metrics, but it still requires

quite a bit of time after every meal, every day, to maintain this habit. It’s also

one of the top-cited reasons for quitting.

Which Food? And How Much of it?

Food journaling requires you to look up nutrition content of ingredients from

databases stored within the app or somewhere else online. These tools have

certainly gotten better over time.

But sometimes, it is difficult to know which food you have based on the

database entry for those kinds of foods. An incorrect selection can hurt the

accuracy of your documentation. Plus, not even identical foods are created

equal.

Then, you must document the quantity of each food you ate. When you are

eating processed foods with a nutrition label, this is much easier to estimate.

60

But when you prepare your own meals, or eat prepared meals, it becomes

very difficult to know how much food you prepared and ate. One cup? Three-

quarters of a cup? This difficult often leads to trouble with food journalers.

And what are meals from restaurants, a friend’s house, or your coworkers

made of?

Food journaling requires you to log all of your meals. That includes meals

eaten out at restaurants and meal prepared by friends and family. But how do

you know the contents of these meals?

Without asking, it is nearly impossible to know. And asking can feel awkward. If

you eat out frequently, this can really impair your food journaling practice.

Not Remembering Everything You Ate

What did you eat for dinner yesterday? For many of us, this seemingly simple

question can draw a blank. Let alone, what did you have for dinner two days

ago.

Without logging every meal, while you are eating it (which most of us will

probably not do), our memory starts to become the harbinger of inaccuracy.

Then, you need to document how much you ate, too. Forgetting these pieces

of information undermine the whole process. And if the day’s data becomes

less useful, it becomes easy to drop the process altogether.

Quitting the Habit

Sometimes you remember to log your meal, but you forgot exactly what you

ate. Other times, you might simply forget to log the meal entirely!

This happens quite frequently for many users. And when your day is only a

patchwork of food logging, the data becomes much less useful. Calorie counts,

macronutrient ratios, micronutrient thresholds…they all remain inaccurate and

can hurt the day’s data as well as any long-term trends you are hoping to

monitor. This unsurprisingly leads to quitting entirely.

61

The Act of Journaling Can Feel Obsessive

Food is a central component to a happy and healthy life. We dine with friends

and family for nourishment of bodies, but also for spending time with loved

ones.

Chronic food journaling, for some, begins to impair their relationship with food

in a negative way. The need to remember your meals in rigorous detail, and

constantly log each item multiple times a day, day-in and day-out, can start to

feel obsessive. Furthermore, it can start to lead to a decline in the quality of

your food-related life (which can directly impact your overall life satisfaction).52

Feeling Guilty about Logging Unhealthy Foods

Just as it can be difficult to admit to a real-life nutritionist you’ve binged on

cake last Saturday, food journaling can invoke a similar guilt. Whether it is

conscious or subtly sub-conscious, we tend to want to omit (or downsize)

logging of foods we deem to be unhealthy. Again, undermining the accuracy of

your food journal and your own dietary goals.

Lack of Discretion

Many of us don’t feel comfortable logging our food unless we are alone.

Sometimes, we simply may not want others to know we are tracking our diet.

It may spur a conversation about weight or habits we simply don’t want to

bring up and discuss.

But we often eat in the company of others. Friends, family, coworkers. And if

you don’t log your food during, or shortly after, a meal, it is difficult to

remember everything.62

In addition, it can be awkward to ask a friend or coworker about the

ingredients of a home-cooked dish to log the meal properly.

How Do Food Journals Work then?

If there are so many reasons why people quit food journals, do food journals

work at all? How are there so many success stories out there, and how do

peer-reviewed research articles keep showing that they work?

In short, they work when people use them. Many people quit due to the

reasons shown above. Been when food journals do get used, they work. Here’s

why.

We Are Bad at Estimating our Intake

Diet-tracking works, in part, because studies routinely show that we are

woefully inept at estimating our nutritional intake.53 He eat many more

calories than we think we consume by a wide margin. We often estimate

calories based on the size of a dish, and calorie density is completely ignored

from the mental equation.

On a more granular level, we do the same for various nutritional components

as well. For example, we underestimate sugar intake largely because we aren’t

aware of how much sugar is packed into our foods.54

Clever studies from Dr. Brian Wansink of Cornell’s Food and Brand Lab have

documented this discrepancy in many ways. For example, we tend to eat until

our plate is empty, right? Well, Dr. Wansink and his lab created a bowl of soup

that was literally bottomless. Connected to a secret mechanism that allowed

the bowl to be continuously refilled unbeknownst to the participant, they

consumed, on average, 73% more soup.

63

This is a large reason why food journals work. By gaining a better awareness of

the foods you eat throughout the day, and the quantities of foods you eat

throughout the day, many can benefit from the process to moving

consumption into the realm of mindful eating.

This can also help build intuitive eating habits, where we gain a better

understanding of what we should eat, when we should eat, and how much we

should eat.

Changing Habits is Difficult

Not only does the enlightenment that comes from identifying your nutritional

intake help you orient your consumptive behavioral patterns, but the

frequency and longevity of tracking correlates to increased and sustained

health outcomes. So if you track intake more frequently, you lose more weight.

And if you track your meals for longer, you sustain weight loss and healthier

consumption patterns for a longer time.

A study in behavior research identified the primary drivers for understanding

how do food journals work.55 They found,

Even moviegoers, when provided

with 14-day old, stale popcorn, at

38% more when it was served in

larger containers despite a

universal agreement that the

taste was awful. These studies,

and others, have led him to aptly

name this behavior Mindless

Eating.

64

• 96.7% of respondents agreed that diet/nutrition apps increase their

motivation to eat a healthy diet.

• 86.2% of respondents agreed that diet/nutrition apps increased their

ability to eat a healthy diet.

• 91.7% of respondents agreed that diet/nutrition apps increased their

confidence in adhering to a healthy diet.

• 94.4% of respondents increased the use in goal-setting.

• And most importantly, 95.4% increased their intake of healthy foods and

95.5% increased their consistency in eating healthy foods.

So, Do Food Journals Work?

Yes, food journals do work. They can help you collect personal nutrition data,

better understand your consumptive patterns and dietary trends, build

motivation and confidence, and help drive better dietary patterns and overall

nutritional health.

But…

Like dieting, they fail if they are only used as a short-term measure. A dietary

reprieve is rarely the solution. A new, positive lifestyle that is sustainable is

more effective.

But there are many difficulties surrounding persistent food journal use.

Drastically reducing the effort to track and understand your own dietary intake

patterns is a good start.

Try Intake! And eliminate the tedious, time-consuming problems with apps with an accurate device you can use from home!

65

In the pipeline

Smartplate has built a product designed to track the calories, macronutrients,

and micronutrients of the foods you prepare and eat. Using a plate designed to

sit on a scale, along with AI-based image recognition, you can place individual

food items on sections of the plate in order to get an idea of the nutritional

content of your meals. And SmartyPans has built a frying pan that is designed

to measure calorie content in real time. The user-friendliness of these tools,

and their accuracy, is yet to be seen. But they could certainly be worth trying!

Intake’s new diet-tracking device aims to greatly reduce the difficulty

associated with identifying macro and micronutrient consumption. Without

needing to log each, individual meal, Intake’s device will quantify your recent

caloric, protein, fat, carb, and sugar intake. Soon, we aim to expand into

vitamin and mineral tracking as well. You won’t have to worry about forgetting

or logging a meal again!

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CHAPTER

11Better Data, Better Results

67

So there you have it. These techniques for personalizing your nutrition from

home all tend to fall into one or more of a few camps:

• How does your body uniquely deal with different dietary and nutritional

constituents

• How do you identify and monitor your dietary health and ongoing intake

• How do you adjust your food according to this nutrition data

Genetic and microbiome testing offer the promise of explaining how your body

might uniquely react to different macro and micronutrient constituents, but it

is still in its infancy in many regards.

Monitoring your dietary and nutritional health comes in many varieties. Breath

analysis can help identify basal metabolism, blood testing can identify a

smattering of dietary intake and other markers of metabolic health, and sweat

can provide an instantaneous measure of hydration levels.

At the final stages of digestion, stool and urine analyses provide opportunities

to investigate, among other more clinical conditions, blood glucose and dietary

intake, respectively.

Clever software is starting to provide curated recommendations, and

nutritionists can help you plan and maintain meal plans to meet your goals,

but you have to create your goals.

Whether it’s running an ultramarathon, bench-pressing 300 pounds, or simply

a long and healthy life, your diet will play a major role.

Try investigating different methods for personalizing your diet, and see which

one works best for you. 68

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