“Ask your healthcare provider to help you monitor — and measure — areas of health that you want to improve upon and reduce risk.”
— Nanette Santoro, MD
Can A Tao be Biomarked?
Tao is defined as a way or a path. A biomarker is essentially something in the body that can be reproducibly measured to give an indication of a clinical marker. For example, cholesterol levels are a biomarker that gives an indication of heart health.
At the Translational Science Symposium on Midlife Wellbeing held in advance of the 2021 Annual Meeting of the North American Menopause Society, Dr. Nannette Santoro, Chair and Professor of Obstetrics and Gynecology at the University of Colorado, School of Medicine, followed Dr. Holly Wyatt’s inspirational talk, The Tao of Wellness, with a talk titled “Can a Tao be Biomarked?” Dr. Santoro shared with healthcare providers what measurements predict the risk of future illness, and how they might be modified. Dr. Santoro also offered ideas to help women think about how to be proactive in measuring and tracking their wellness on their own and with their healthcare providers.
Why measure and manage biomarkers?
Peter Drucker was a famous Austrian American management consultant, educator, and author, whose writings contributed to the philosophical and practical foundations of the modern business corporation. He is known for several quotes, but two are worth noting because of how they relate to midlife health. “What gets measured gets managed” and “the best way to predict the future is to create it”. By measuring biomarkers — metrics of health — you create awareness and accountability. You’re also empowered with knowledge that allows you to take control and change your future health.
What can be measured?
Many markers of disease are not yet routinely available through primary care providers. But there are some simple tests and measurements that are part of standard primary care in North America.
Screening tests
Glucose levels (test name – HgbA1c)
- What it measures: blood glucose concentrations over the preceding 8–12 weeks. It is an indication of average blood glucose concentration and is used to diagnose pre-diabetes and diabetes.
- When to take note: If your level is above 5.7 you should have a discussion with your provider as this is a marker for pre-diabetes.
Blood pressure (BP)
- What it measures: the pressure of blood pushing against the walls of your arteries which carry blood from your heart to other parts of your body. It’s used to diagnose hypertension.
- When to take note: Here you want the upper number to be 120 or below and the bottom number to be 80 or below. When numbers are above that you are said to have hypertension. Hypertension increases your risk of stroke, heart disease and heart attack.
Cholesterol levels
- What it measures: There are three components of a cholesterol measurement; High-Density Lipoproteins (HDL), Low-Density Lipoproteins (LDL), and Triglycerides. HDL is the “good” cholesterol, a higher number means lower risk for heart disease and LDL is bad so you want that number to be lower for risk reduction.
- When to take note: Your total cholesterol should be below 200.
- Research also shows that larger particle sizes for all of the lipoproteins (both HDL and LDL cholesterol) confer reduced risk of high blood pressure, cardiovascular disease, and metabolic disease but measuring this requires non-routine testing (which may be indicated for some), and lifestyle interventions to modify particle size aren’t known.
Simple physical measurements you can measure and manage
Body mass index (BMI)
- How to measure: This is a measurement that combines weight and height. There are many BMI calculators online. It’s a crude measurement and doesn’t take into account body fat versus muscle. It considers all weight the same. Additionally, this measurement comes with some controversy as different ethnic groups have higher BMI without concurrent increased risk to health.
- When to take note: Despite the above caveats, generally a BMI of less than 25 puts you at lower risk for cardiovascular disease, metabolic disease, and cancer.
Waist circumference/Waist to hip ratio
- How to measure: put a tape measure around your middle, just above your hip bones and belly button, at the narrowest part of your waist. Measure your waist just after you breathe out. Measure your hips at their widest point, usually right around where your thigh bone meets your hip bones. Divide the waist measurement by the hip measurement. A waist-hip ratio of 0.8 or less is desirable, and a waist-hip ratio of 0.9 or above is a sign that lifestyle changes and/or medication is in order.
- When to take note: If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk also goes up with a waist size that is greater than 35 inches for White and Black women. For Asian women, it’s 31.5 inches.
Other measurements that require some technology
Heart Rate Variability (HRV)
- What it measures: HRV measures the time between heartbeats. The more variation in the time between heartbeats, the healthier the heart.
- How to measure: for HRV you need a wearable device like a FitBit, Apple Watch, a heart rate monitor, or an Oura Ring
- When to take note: Everyone’s HRV is different but generally, you want a higher HRV which indicates a higher variability between heartbeats and more resilient stress response.
Grip strength
- What it measures: The strength in your upper arms, wrist, and hand.
- How to measure: there is a special tool called a dynamometer used in health care settings.
- How you can improve your grip strength: Any object that you can squeeze in your hand repeatedly, a balled-up piece of packing paper, a tennis ball. Do several reps until your muscles get tired. An online search will yield more ideas like carrying a bucket of water or wrist curls with weights.
- Link to wellness: grip strength has been shown in research to be a biomarker for aging, linked to mortality, and several chronic diseases. This research article reviews studies on grip strength if you want to learn more.
Also, many devices can help measure your heart rate, HRV, and daily movement. Some even track sleep. These enable you to see the impact of different types of movement and activities levels on heart rate or how introducing a breathing practice might impact your HRV.
Create a Goal and Measure Your Way to It
So back to the Peter Drucker quotes. “What gets measured gets managed.” Consider the measurements mentioned above and based on your personal situation discuss which measurement you’d like to monitor with your health care provider. “The best way to predict the future is to create it.” Create your future by setting goals that will impact your measurements. Dr. Holly Wyatt’s talk encouraged broader, more expansive thinking about wellness. Set goals around movement, breathing practices, nutrition, learning something new, investing in a relationship. All of these can have an impact on what you are measuring.
This information was presented at the Translational Science Symposium “Charting the Path to Health in Midlife and Beyond: The Biology and Practice of Wellness” held in advance of the 2021 Annual Meeting of The North American Menopause Society in Washington, DC. Excerpts from the Translational Science Symposium are presented as part of the Live From #NAMS2021: The Latest Breakthroughs in Women’s Midlife Wellness series published by Women Living Better and Lisa Health with permission from NAMS.
Please visit Lisa Health and Women Living Better to find more information and recommendations from top experts in menopause, midlife health, and healthy aging.
