There's an App for that: Your Health!

During the Fall Challenge, you have been asked to do "Color My Day" to win an entry to a drawing. But, that is only the tip of the iceberg of what the app we use can do. Today, I will show you what a fully completed profile on the app can do to enhance your health program.

The app we use as part of the programs at Rainier Medical allow your physician and health coach to obtain both objective data and subjective feedback about how your health is doing and how your program feels. As you can imagine, we can do a much better job based on better data! Since we want to have the best health program for you, help us help you! We are Team Rainier!


Color My Day

In Color My Day, you are asked to take nine seconds to answer five questions subjectively on how your health self-care has gone for that day. Here are a few examples of what fully completed months can look like and information that can be helpful:



With this pattern, it is apparent that weekends are typically "yellow" while the weekdays are typically "green." Many times people feel that weekends are more challenging to eat in a structured fashion, but once you are past the first 12 weeks, this can be a very successful "5/2" type strategy which is a play on intermittent fasting. It means that five days a week, your calories, carbohydrates, and fat intakes are lower, and 2 days a week they are a little higher, typically about 30% higher. This would mean you had about 22 days a month that are lower calories and 9 days a month that are about usual intake. We know from intermittent fasting studies that a pattern like this can be better tolerated than a standard calorie restriction that is everyday. So, reframe your mindset and focus on the positive: you can see all the "green days" and the consistent pattern.



With this pattern, the beginning of September looks different than the end of September. What this tells me is that something was going on, probably the start of school, and the person adapted and got into a great habit within the first half of the month. I like to think that completing this showed the person that even though there were 5 challenging days in the first half of the month, there were 10 days that were spot on, so they knew they could do it!



I show this month because it shows the power of self-monitoring. Although there are 16 days that are yellow or red, there are 11 days that are green. Would it surprise you to know that this person lost a pound during this month and maintained a 53 pound weight loss? This is month 8 for this person, so that means they have kept off 20% of their weight for 5 months already. I like this example because it shows the power of accountability. In maintenance, yellow and red days will not harm your health as long as you balance them with green days. Pair it with your weight monitoring, and you will find the balance that achieves your current goal, whether it is weight loss of 3-5 pounds per week, 1 pound per week, or weight maintenance. For a video on how to do Color My Day, click here.


Weight Diary


Checking your weight can help you manage your weight and also to understand how your body responds to your program. Remember, weight loss is not alwats linear; some people lose weight in steps. Also, all weight loss stops. At that point, maintaining is a huge win! Weight loss can happen in stages, too. Many times, we miss the forest for the trees, and taking a step back can give great perspective! Here are some examples of how monitoring weight can help.


In this example of a one month weight history, a person may come in and tell me that they feel frustrated because they can not seem to lose any weight, that they feel like their weight keeps going up and down the same five pounds.



But, take a step back and look at the weight history over the last 9 months:





Perspective is everything! Because there is data over the course of the 9 months, I can see that this person effectively lost 20% of their weight, and then when the weight started to trend up at month 6, which is what science tells us can happen due to metabolic adaptation, this person adapted and got back to their goal weight and then has kept it there with a very small range!


Nutrition Log


The nutrition log is important because it tells us what is going "in" to the body. Science has shown over and over again that there is something called "recall bias" which means that humans are very inaccurate in simply recalling events and facts. So, it can be frustrating for a person if they are not getting the results that they want, either with how they feel, athletic performance, hunger, cravings, blood sugar, or weight loss. If this every happens, I will ask a person to do a food diary so we can have data on which to operate. Again, science shows that recall is highly inaccurate!


Here is an example of a person during the very low calorie diet phase:



This shows that the calorie intake is higher on Friday, Saturday and Sunday. I might expect this person to tell me that they feel too busy to consume all five of their medical foods while they are at work but they can do it on the weekends. The calorie intake shows about 3 to 4 medical foods on weekdays and the prescribed 5 on weekends. This may result in a person feeling lower energy or higher hunger during the week or having cravings or seeing more loss of skeletal muscle mass on the body composition. I would ask them to be consistent with their body during this very low calorie phase and their body is more likely to be consistent with them. We may also be able to see that fewer calories is not always better.


Of course, not all calories are the same, so the food log will also break down the calorie intake into macronutrient categories:




The "yellow" portion of the bar is protein, the orange is carbohydrates, the blue is unsaturated fat, and the red is saturated fat. This is the macroutrient profile while on complete medical food replacement on the protein sparing modified fast. When I hover over the bars in real time, it tells me percentages, which are about 60% protein, 20% carbohydrates, and 20% fat. (Do not try to mimic this without medical foods). While you do not need to do anything other than follow the protocol while on the medical foods, it is good to do your food diary at least part of the time during this phase, because it is helpful to compare it to the food diary that can be important during maintenance phase. See here the food diary of a person in maintenance:



The calories in these 2 diaries are the same, but note the differences in the relative contributions in the color of the bars. In this log, the calories are 55% carbohydrate, 15% protein, and 30% fat. This is the pattern on one example of a vegan diet. With this pattern, the person may find that they have an increasing body fat percentage even though their calories are low. This may be due to higher insulin levels and lower skeletal muscle mass. This provides a powerful visual to see why not all calories are the same for every body.


For a video on how to do a food diary on HealthTrac, click here.


Blood Pressure


The blood pressure log can be a very important tool. High blood pressure is called "the silent killer" because it is usually asymptomatic. Blood pressure can go up and down significantly in a rather short period of time for some people. Blood pressure readings in the office can be higher if a person is nervous or has not taken their medicine two hours before. For all of these reasons, it is important to get more information on a person's "total blood pressure burden." I think it is a real game changer to use a blood pressure cuff that I can see. Here is an example of a person who has had high blood pressure for many years:



You can see thst the blood pressure varies by almost 30 points. This person is taking four blood pressure medications and the regimen did not change over this time, but their blood pressure did. By checking it, and working together, they could bring it down with lifestyle measures. If they were not checking, neither of us would have known.


Steps


We know that physical activity and not being sedentary is very good for your health. It is common for activity to go up and down rather drastically based on things like work, family, pets, and injuries. This can affect blood pressure, weight, sleep, mood, and cholesterol. I really find the step counters helpful for context. Human bodies do not function well when they are still! We use to say in residency that it is harder for illness to hit a moving target! Here is an example:



This is a 3 month diary, but you can see that the average is about 8000, which is good, but there are about 20% of the days that are significantly lower and about 10% that are higher. The goal is to keep the average trending up until you hit about 10,000 and to avoid as many that are lower as possible. Here is the same diary, but looking a little closer:



You can see here that during this week, five days were about average, and 2 were much lower. You can expect to feel differently on the low days, so that person could understand and take a closer look.


Connection


Thank you for taking the time to read this. My goal is that more people will understand how much insight and understanding can be gained by investing the time to track your important health parameters. I appreciate very much when people use the Healthtrac app, iHealth scale, iHealth blood pressure cuff, and a Garmin or FitBit which syncs to our app. The scale and blood pressure cuff cost about $45. We can order them for you and try to get it reimbursed by your insurance or you can get the on amazon. They are available in our store under "enrollment/equipment" or click here. Remote patient monitoring, or connecting an individual's health data/vital signs, with their physician, is an exciting area of emerging research.


Take Back Your Vital Signs,


Valerie Sutherland, MD




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