We had the opportunity to interview Greg Potter, Ph.D., a researcher of lifestyle factors in health throughout life, at Biohacking Conference Moscow, which was hosted at the Congress Centre Technopolis Moscow on September 19th.
In a provocative 2017 publication, Serge Faguet claimed to have spent $200,000 on becoming healthier and happier through biohacking; since then, there has been a growing interest in self-tuning.
While some methods remain experimental and risky, others have reliable evidence behind them and can indeed be used by the public to extend healthspan. However, even the most advanced biohackers, including Dr. Potter, admit that building an evidence-based system to maintain health in middle age is complicated and requires significant intellectual effort.
Your scientific research covers multiple topics, from biometrics, diet and fasting to healthy sleep patterns and various forms of physical activity. Science is quite often counterintuitive, meaning that we can expect one thing yet find something about it different. What findings concerning lifestyle and health have been the most surprising for you so far?
I think it depends on the particular lifestyle factor that you’re looking at; I can give a couple of examples that I found very counterintuitive. Concerning sleep, for example: a number of people who struggle to sleep well and have certain forms of insomnia, and sometimes restricting their sleep actually dramatically improves their sleep quality. Over time, that improves how they sleep. That would be one example.
If you think about health in general, and I know that you are especially interested in longevity, there are various different ways you can look at predictors of longevity. Obviously, lots of people are interested in various pharmaceuticals and so on. If you look at the different predictors of longevity, in an untargeted analysis of those predictors, one of the strongest determinants was the person’s self-reported health. So, if you just ask somebody, very simply, “How healthy do you feel at the moment?” that will give you a lot of insight into how likely they are to live a long life.
The representatives of our community often face difficulties when trying to develop healthy lifestyles for their families and to convince friends, say, to stop smoking or to start eating healthily. People often slide back to their own lifestyles, because their local environments don’t support them in retaining healthy ones. What mindset should a person develop to be more resilient and more successful in adopting a healthy lifestyle?
This is a very big question, and I’ll touch on a couple of things. One of the things is that you mentioned the roles of our environments on shaping our health decisions. In recent years, there’s been a lot more attention given to the importance of things like environmental design and how we can optimize our environments to help make healthy choices more straightforward. That’s something that’s worth people learning more about, and there are various resources out there that people can go to; for example, there’s a book, “Atomic Habits”, which was published by James Clear recently, which many people find to be a very practical guide on how to change their environments to make it easier for them to engage in healthy decisions. That’d be one thing.
Regarding mindsets and habit formation, I think people should pick habits that don’t take long to do and that they can do. If anything, they should try to pick things that seem too easy. Because, if people pick more difficult habits, unless they’re very motivated individuals, they are unlikely to sustain those in the long term. So, rather than trying to make dramatic lifestyle changes, in general, I recommend people make small changes. Then, when they’ve ingrained a particular habit, they can then stack an additional healthy lifestyle habit on top of that. If they do so, in that sequential way, they can also better identify how their habits are affecting their health.
The final thing that I’ll mention is regarding mindset. I think that there are certain forms of mental training that will increase people’s awareness of their mindset. For example, meditation is a form of metacognitive training, or training the ability to think about thinking. Before meditation, many people aren’t aware of how chaotic their thoughts are, the fact that our thoughts just arise in our minds without us having conscious control of them. When people go through mindfulness practice, then they become more aware of the nature of their minds, and what they learn to do is watch thoughts arise in the mind. Then, rather than immediately reacting to those thoughts and acting on those things, they can insert a pause. By inserting that pause, they can shift their stance in a way that gives them the ability to make better decisions, so I think mindfulness training is a really useful practice for people to do.
Using biohacking as an advanced form of a healthy lifestyle is a new trend that first started to actively develop after a few quite intriguing publications, one of which is by entrepreneur Serge Faguet, who claims to have spent $200,000 on biohacking and apparently became calmer, kinder, extroverted, healthier and happier. There are many people who want to follow these examples, but who don’t know where to begin. In your view, what is the wrong way to become a biohacker, and what is the right way?
I think it’s difficult because many people who are coming into the biohacking community without a background in science lack the ability to discern good information from bad information. A problem in the community is that some people are very gung-ho, so they will try unproven methods on themselves with the goal of improving longevity or whatever. In some instances, I think we’ll find out that these are actually unsafe.
For that reason, I would always look at safety first. A smart way to go about this is to look at the credentials of people who are involved in this community and find somebody whose voice resonates with you. Base your decision on those two things: choose someone who have a background that helps them discern good information from bad information and somebody who seems to be a voice of reason. Then, learning from that person, choosing things that you think are likely to be safe, and then trying one thing at a time and tracking relevant health outcomes is a smart way to go about it. I would view that as being the right way to go.
The opposite of that would be the wrong way to go. That would be trying these unproven methods, which are potentially dangerous; perhaps they’re invasive, for example, or they use novel therapies, or on further rational thought, they just don’t make any sense. There’s no biological plausibility. That would be the wrong way to go about biohacking.
What would you say about the role of diagnostics in doing biohacking in a good way or in a bad way?
There are things that it’s worth everybody tracking periodically, over time. Those are the things that we know are strongly predictive of overall health and longevity, and those things should be tailored to the individual. Most people suffer from some sort of chronic health condition, and most people aren’t in good metabolic health. Frankly, there’s been some recent work in US adults that has shown that more than 80% of people have suboptimal metabolic health, for example, and I know that many of the people listening to this will be very interested in their health, so they’re not representative of the general population.
The point is that perhaps there’s something that you struggle with with your own health, so I would track something that’s related to that. I’d probably track both the outcome and some lifestyle behaviors that affect that too. Maybe, for example, you struggle with your sleep. One of the things that you could track related to that would be your caffeine intake, for example. That would be one thing: track something that is relevant to your personal goals and that you struggle with.
Also, I would periodically track the health-related quality of life. There are some very simple questionnaires out there that are useful. One of them is the WHO 5. Another is the Short-Form 12 questionnaire. I think those are worth tracking over time. There are certain lifestyle behaviors that I think people should all track, periodically; one would be sleep. You can track that using subjective questionnaires. There’s one available here that people might find useful.
You can also track your sleep using wearable devices, whether it’s a smart ring or a wrist-worn device, whatever it might be, and I would track sleep periodically for two weeks at a time, perhaps three times a year, something like that. Then, I would also periodically track physical activity. Most people fail to meet government Physical Activity Guidelines; physical activity is, of course, an important determinant of overall health. A simple wrist-worn device that tracks step count is useful for people. People should be doing resistance training for major muscle groups a couple of times a week, so I think tracking physical activity is also wise.
Periodically tracking nutrition, too, is a good idea for many people. Unless you have a very strong interest in health, it’s unlikely that you have a good understanding of the nutrients that you’re consuming each day.
This raises an interesting point, which is that the mere act of tracking behaviors tends to quite potently and positively influence the behavior that’s being tracked. There’s been some behavioral science research in recent years that has looked at all the different techniques that are used by behavioral scientists to positively affect health behaviors. When they’ve systematically looked at those behaviors, the single most potent technique in positively affecting our behaviors is self-monitoring. It’s just tracking behavior. If you want to improve your diet, then you should occasionally track your diet. Makes sense, right? That would be one thing to do.
Finally, I do think that there are certain health outcomes that everybody should track every once in a while; the frequency with which you track these depends on you as a person. If, for example, you’re overweight, and you’re trying to lose weight, then you should probably track your body weight every week, and probably multiple times each week. If you’re prone to high blood pressure, then you should probably regularly test your blood pressure. If you have some abnormalities in your blood test, maybe, for example, you have dyslipidemia or poor blood sugar regulation, you should track those at relatively regular intervals too. Because those involve invasive tests or blood tests, and so on, you don’t want to track those too frequently, because that does come with some risks, but certainly tracking those at least once a year does make sense to me too.
What is the contribution of various aspects of lifestyle to personal health? Are there factors that can give you more years of healthy life and should be promoted as much as possible? Why are these factors the most powerful, in your opinion?
The most powerful factors are all the factors that people already know about. Those are nutrition, physical activity, circadian rhythms, and sleep. Mindset, I would have as something that subsumes everything else, but within that bucket, I would also put stress and stress management. Then, environmental exposures too, and that could be things like exposure to certain compounds in the built environment, which negatively affect health. It could be time spent in nature and can be exposure to micro-organisms in the soil, which affect the immune system, and so on. The other one that I mentioned is relationships. If we think about the predictors of longevity, again, going back to this personal scenario and particular interest. Interestingly, having a rich social life, and, specifically, not being socially isolated is a very strong predictor of lifespan. That would be something that’s underappreciated, and I hope that people emphasize that more in years to come. Otherwise, it really comes down to mastering the fundamental lifestyle behaviors.
Obviously, lots of people are interested in the development of new drugs and so on, and those will certainly affect longevity in many people. I would contend that these drugs or lifestyles most positively influence lifespan in people who suffer from related health problems. If you take somebody who’s already in good health, then trying some of these putative pro-longevity drugs, I’m not sure how strong of an effect it’s likely to have, going by the data that I’ve seen so far on the drugs that we currently have. That’s not to say that in the future, we might not find some really promising compounds. I hope that we do, but for the time being, I think that we can get many of the benefits that these drugs are trying to induce through various lifestyle behaviors. If we think, for example, about mTOR and that signaling pathway, then we know that, based on studies of non-human animals, such as mice, a ketogenic diet will lead to tissue-specific changes and mTOR signaling, which should have pro-longevity effects. If you combine that with resistance training, which is going to selectively increase chemical signaling in skeletal muscles, and therefore help people hold on to lots of muscle mass as they grow older, which is important in avoiding falls, which are a very strong predictor of dying from any cause, then rather than taking a rapalog or rapamycin and trying to affect mTOR that way, you can just occasionally consume a low-carbohydrate diet and lift some weights to get the same effect.
I think it’s always dependent on the individual. For some people, it’s going to be really important to focus on their sleep. For other people, it’s going to be an important focus on nutrition. When I say that, it might be that for a given individual, nutrition is the most important thing. But the problem is that they can’t change their diet behaviors as easily as they can change other behaviors. So, even if their diet’s the most important thing to address first, if they can’t influence their diet that strongly because they just really struggle to change that behavior, then they might benefit more from positively affecting their sleep, because at least they can make some beneficial changes to their lifestyle that way. It depends on the person, but it depends on the potency of the change and the ability to enact that change as well.
Academics are currently investigating the potential of certain products that are based on supplements to extend healthy life and lifespan while prolonging the period of health. What do you think of this approach in general?
I think that it’s worth pursuing, but with that said, I think that at the moment, the approach is not balanced. What I mean by that is that many of the people who are especially interested in extending healthspan are focusing on the development of novel pharmaceuticals. As I mentioned earlier, there are various lifestyle ways of achieving some of the same effects that some of these drugs are trying to target. The point is that most people struggle with their health because they have poor health behaviors, so what we need to do is better understand how we can help those people and improve their health behaviors. In recent years, more people have been speaking about the importance of behavioral science, but the reality is that most of these companies that are trying to extend healthspan only pay lip service to behavioral science. Very few of them have systematically looked at the behavioral science literature. If you think about drugs, for example, then even if you pay people to take drugs, their compliance with taking most drugs is not that high. That’s when they’re being paid.
That’s something that I find absolutely crazy, that even in cancer patients, the compliance is not 100%.
Exactly. So if we want to help people extend their healthspan in a way which is sustainable, then I would love to take a lot of the money that’s currently being funneled into the development of some drugs, and put that into us being better able to help people change their health behaviors because I think that’s what people need to do, first and foremost.
What lifestyle factors have only a marginal effect on health, and are not worth spending time on, despite being promoted by some companies as “must be done”? Basically, what approaches do you find useless?
Yeah, I’m not sure I would ever say that anything is useless, because we’re all so different from each other. With that said, of course, there are commonalities that everybody should focus on. What I will say is that, in certain communities, I think there’s a massive overemphasis put on certain things. One of those would be the supplement industry and taking doubtful supplements with a view towards improving healthful performance or extending lifespan, for example. The reality is that the industry is not that well regulated. Much of the time, what you buy will not contain what it says it does, and, sometimes, it won’t have the appropriate doses of the relevant compounds to have the effect that it claims to have. I think that there’s too much emphasis put on that by some people. In general, if you think about those lifestyle behaviors that I mentioned earlier, for example, physical activity, and sleep and circadian rhythms, then I think historically, people are focused far too much on nutrition. In recent years, I’m happy to say that people are being more cognizant of things like their sleep. I think that’s definitely a positive societal trend. But there’s still an imbalance. There’s too much emphasis put on nutrition still, way too much interest in certain dietary approaches. The ketogenic diet is one of these that’s useful for some people but only a minority of people. That isn’t something that people who are otherwise healthy should necessarily try. People probably don’t put enough emphasis on the importance of our social lives and the pivotal roles that they have on our health.
There’s an increasing amount of scientific data in our own health data, which is called quantified self, an amount of data that is so big that our human brains cannot process it anymore. It makes decision making about a healthy lifestyle rather tricky. Some people even argue that having your full genome data, for instance, is useless. What’s the best way to benefit from having a lot of data about your health?
To slightly circumvent the question, there’s a benefit to be had by combining big data approaches with smaller data approaches. Because there are certainly different things that we can track about our health, it’s now possible to uncover previously unappreciated relationships between certain factors that affect our health and the health outcomes that are related to them. We can use that type of big data approach to identifying the health behaviors and some of the other inputs to our health that are likely to be good starting points for most people, but we’re all different. We need to take that big data approach as a starting point for what constitutes a healthy lifestyle for somebody. Then we need to supplement it with a small data approach, where we go through a series of micro and one-off experiments on ourselves, and then track how we respond to changes to our lifestyles, and there are ways that people can do this systematically.
Right now, frankly, nobody in the biohacking community or quantified self community is speaking about the stuff that I’m aware of, but that approach entails drawing on some other disciplines. I’m not just speaking about behavioral science; there actually are some things like control systems engineering that are very relevant to this. I think that many people are doing this very well at the moment. Basically, use big data approaches to identify starting points for people, then track how you respond to certain changes in your lifestyle over time, understand that you are an individual.
To finally add one thing related to something you mentioned, which was genetics data, and whether those are useful. I think that many of the novel omics-type approaches, whether that’s proteomics, metabolomics, genomics, I don’t think those data are easy to interpret at the moment. I think the reality is that we know a lot about what, for example, blood chemistry data, tell us about people’s health, and we know how to positively or negatively affect those parameters and how changing those parameters will influence somebody’s health trajectory. But I don’t think that we can say the same thing in, for example, metabolomics or proteomics. I think the reality is that regarding genetics data, different genetic variants interact with each other. This is an enormously complex thing to try and unpack. There are very rare mutations in certain genes, which will potently affect certain health outcomes, but they are extremely rare, and most people probably don’t carry those mutations. Getting a 23andMe report and then trying to make dramatic lifestyle changes based on those, I think, might be a bit misguided.
The reality is also that if you look at how people change their behaviors in response to getting these reports done, the data show that getting something like a genetics test tends to very negligibly affect related health behaviors thereafter. This really comes back to optimizing lifestyle, treating yourself as an individual, but then starting with some general heuristics that are likely to positively affect health, which, of course, are things like consuming whole foods, minimizing stress in your life, being physically active outdoors each day, and hanging out with people that you love.
Is there a factor, such as the development of new applications with deep learning, that can actually make this big data stuff usable for ordinary people?
Regarding the second point I made about the need for a smooth data paradigm, I think that some of these more advanced computational methods will be very insightful in the years to come and can be applicable to some of these animal experiments. I don’t think people are quite at the stage where that’s possible yet. I haven’t seen anything to lead me to think that that’s the case.
I guess that would just require us to unite, in one network, the medical data from classic medical organizations like hospitals and clinics, where people track their health records, with applications that track assorted health data from diagnostic centers that conduct checkups, especially large checkups and regular checkups. Then, we can use something like deep learning to analyze this data and to support the decision making of a medical specialist, who can then give this information back to the patient in an understandable way.
Exactly. Eric Topol, who many of the listeners will be familiar with, wrote a nice paper earlier this year reviewing the convergence of AI and medicine. We can think about all these different -omes. You have your genome, you have your proteome, you have your metabolome, you have your behaviorome, the sum of all your behaviors each day. We need a way of combining all of these together and then using some of these computational approaches to make sense of that. Then there are additional areas that we can know, based on math, exactly what people should be doing right now; theoretically, we can know that, although we live in this unpredictable universe, which is full of entropy. Math will help identify what people need to be doing. We still need to know how to get people to actually do what they need to do to capitalize on those health benefits.
Motivation is a problem.
Yeah, motivation, but also all those environmental factors that influence our decision making. How can we design our built environments to help people better navigate their health decisions?
Could you please tell our readers about your current projects? What is your current mission? How do you understand it and what are you working on right now in your plans?
I am working for a startup, and what we’re really trying to do is automate health coaching. Most people’s health problems are preventable or reversible through simple lifestyle behaviors, but people don’t know exactly what they should be doing. They don’t know what they’re able to do, and they don’t know how to support their ability to change those behaviors. What we want to do is create a tool that helps people navigate all of those decisions and pushes people towards their health goals but also still supports their long-term health. We want to create something that is scalable but also cost-effective, because the reality is that most people that have poor health aren’t as well off as the people who have lots of money and therefore can afford all the best medical care. If I’m thinking about how I can do the most good in the course of my career, then the reality is that helping these people who have less money and poorer health is better aligned with that mission.
What measures to maintain health are you using; what are the pillars of your own lifestyle?
My lifestyle interventions are the ones that I’ve discussed. Regarding measures of health, there are certain things that I track, like my physical activity patterns. I’ll occasionally wear a wrist-worn activity monitor, which will tell me about my snap count. I record the structured exercise that I do, which is normally resistance training four times a week. I sometimes record processed food intake. For example, if it’s the holidays, I’m concerned that I’m going to consume lots of very poor-quality food. Then, simply tracking my unhealthy food intake at that time is likely to make me more aware of it and so, hopefully, to make me less likely to consume lots of that rubbish food. I occasionally get blood tests, maybe every two or three years or so, I regularly check my body weight, although I don’t struggle with my body weight these days at all. I check my sleep maybe four times a year or so for a couple of weeks at a time.
I do also sometimes track life events too, because if, for example, you lose your job, or you move to a new place, then all those things are massive stresses and are really strongly predictive of health outcome, so I would plot those too. One other random thing to mention is that there’s a blog called “Wait, but why”, which I love. The person who writes that blog, years ago, came out with this calendar, which is called “Your life in weeks“. It’s a calendar that plots a 90-year life. And there’s a single cell for each week in a 90-year life. I have one of those calendars. Each week, I plot something that I’ve really enjoyed the previous week. I plot meaningful stuff to me in that way.
Do you, as an advanced biohacker, have a take-home message for our readers?
If you are interested in your health, then don’t develop an unhealthy obsession about your health.