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Articles
A collection of writing by Daniel Clough.
Defining optimal metabolic health (Part II)
Recently, I laid out some key markers of metabolic health for myself. Since then, Iāve been doing further research and talking to a few people about it.
This mostly strengthened my confidence with the five markers of metabolic health I chose. The only change was an extra marker ā body fat / visceral fat. I had originally been thinking about BMI or waist circumference as a key marker ā but there are obvious flaws in these. Measuring body fat / visceral fat seems much better.
Having high levels of visceral fat (fat found inside your abdominal cavity and that wraps around your internal organs) and body fat definitely puts you at a higher risk of chronic disease. So, Iām adding them to my key markers of metabolic health.
There were a bunch of markers which didnāt quite make the ānorth starā list, which I’m gong to keep an eye on. These are RHR (resting heart rate), HRV (Heart rate variability), Vitamin D (25 OH) and LDL (bad cholesterol). With the exception of LDL, my measurements are all in a good range for these.
I havenāt quite decided how I feel about LDL. Some people say in the absence of metabolic dysfunction, itās not a particularly important marker. Others disagree and suggest a high LDL will cause problems. Iām going to continue to look into this.
So, in summary, here are the key markers of metabolic health for myself ā along with my own measurements.
A quick caveat. Iāve ignored the normal ranges that are typically advised. Instead, based on my research, I have set what I feel are good and optimal levels for metabolic health.
Body fat / Visceral fat
I donāt have a benchmark or measurement for myself yet. Iām going to get a DEXA scan, which is the most accurate way to measure these. It’s also fairly cheap and non-intrusive.
That said, being able to see your abs is a pretty good benchmark. So, for now, thatās my goal.
Blood Pressure
- Less than 120/80 mm
Right now, I sit a bit too high. My latest readings averaged out at 130 / 66. Itās not disastrous at all, but ideally I want to see that first number much closer to 120.
HbA1C
- Good: < 32.5 mmol/mol
- Optimal: < 21 mmol/mol
I came in at 30.7 mmol/mol. Iām in the good range, so fairly happy with that. Now the goal is to push it below 30 and to get closer to 21.
C-reactive protein (CRP)
- Good: < 1 mg/l
- Optimal: < 0.5 mg/l
My reading is 0.71 mg/l. Again, pretty good and in the good range. The goal is to push lower than the optimal < 0.5 mg/l.
Triglycerides
- Good: < 1 mmol/ml
- Optimal: < 0.85 mmol/ml
My reading is 0.96 mmol/ml. Same story ā sitting in the good range, and now need to work at pushing into the optimal range.
HDL cholesterol
- Optimal: > 1.93 mmol/ml
Iām well in the optimal range with a reading of 2.34 mmol/ml here.
What are my immediate focuses for improving my metabolic health markers?
This is a pretty obvious answer for me. The biggest room for improvement (by far) is my diet. Iāve always had a difficult relationship with food and am prone to binge eating. Outside of binge eating, I do time-restricted fasting and eat a mostly paleo diet ā high in protein, high in fat and low / moderate in carbs.
The improvement I need to make is to cut out the binge eating. Iām not trying to be 100% paleo. I am fine with the odd treat, and loosening up at weekends. But, right now it feels 50/50 (bad eating / paleo) and I want it to be much closer to 80/20. I need to reduce refined carbohydrates and sugar.
On top of that, I want to get into a habit of stricter time-restricted fasting. Right now, I’m fairly consistent with 8 hours (eating) / 16 hours (fasting). I skip breakfast and eat lunch at about 1PM. My last meal is usually around 8 or 9 PM. But, I drink tea with milk in the mornings, which is technically breaking the fast. Whilst Iām still getting the benefits of consuming fewer calories that tend to come with time-restricted fasting ā I’m not getting the fasting benefits. Iād also like to experiment with fasting for 24 hours.
So, my focuses are:
- 80/20 paleo, keeping treats to carefully chosen times and avoiding binge eating.
- Keep to a stricter 8/16 ā with a 24 hour fast roughly once a week (evening meal one day, though to evening meal the next day).
If I can only nail the first one, it should have a nice positive impact on my key markers of metabolic health when I next measure them (early March 2022).
90 days sober
Iām 90 days sober today. Itās a good time to reflect in general.
On the whole, life is significantly better. I feel much better about myself. My mood is better and I have less anxiety. Iāve lost 8lbs. Iām sleeping better. My RHR (resting heart rate) is lower and my HRV (heart rate variability) is higher. Iām almost always in the green with my Whoop scores. Iām training more consistently and frequently than I can ever remember (4-6 times a week) and without injury. All of my health habits are also more consistent ā eating, supplements, water, caffeine intake etc.
I know that sounds a lot ā almost unbelievable. Iāve written before about how I thought alcohol was the root cause behind my struggle with other things. Too much alcohol on one or two evenings can have a devastating domino effect on other parts of my life. My sleep suffers. My mood is affected. I get anxious. I eat more bad foods. I workout less. I stray from proven habits and routines.
Itās also bigger than each of those individual negative impacts. I lose positive momentum. And then it takes a lot of time and effort to regroup and get back on track. And when I do get back on track, like a vicious circle, it just takes one or two days of a little too much alcohol to disrupt it again.
Is it all good news? Mostly. That said, I still get some low level cravings for a nice glass of red. Iām also still trying to figure out how to feel comfortable in situations with a drinking atmosphere. Thatās about it though and the positive benefits vastly outweigh those minor issues.
So, where do I go from here?
Iām going to stop counting days for a start. And then Iām just going to keep an open mind and do what feels right. That might mean never drinking again. It might mean finding a way to drink infrequently and with limits, if I feel I can successful with that. But, right now ā it means continuing not to drink for the foreseeable.
Tracking your net worth
Iāve been keeping track of my net worth for about five years now. Itās been so useful and I just canāt imagine not doing it now. Itās helped inform many decisions around my finances.
Money isnāt everything. But, you need a baseline to ensure a certain amount of stability in life ā a roof over your head, food, clothes etc. Without that, life is very stressful.
Ideally, you also have enough to enjoy life too. This is where a lot of people get into trouble and end up living above their means. Iām not talking about that. Iām talking about taking a trip, having a nice meal at a restaurant or being able to buy things that add value to your life.
And lastly, you want to be moving to a position where you are financially free and have a lot of freedom for how you spend your time. This is what we call retirement, but I hate that word. It assumes you work for most of your life and then you stop so you can take walks and do gardening. What itās really about is being able to have the freedom to spend your time how you want ā and if thatās continued to work because you love it ā great. If itās to stop and travel the world ā great. And if itās a mix of both ā great!
Tracking your net worth shines a light on exactly where you are. You canāt hide from the numbers. It also makes it clear if youāre going backwards, treading water or moving forwards. Thatās invaluable, because it helps to make better financial decisions.
When I first started tracking my net worth, I made it far too complicated and checked it too frequently. Over time, Iāve simplified it and made better decisions on how I classify certain things. I now update it on roughly a quarterly basis.
I wonāt go into lots of detail here, but Iām always happy to have a chat about my approach with anyone.
I use a google sheets spreadsheet to track my net worth. Itās not fancy and fits on one tab.
I have the following sections that I track:
CASH
- Emergency fund
- General savings
INVESTMENTS
- Vanguard ā FTSE U.K. All Share Index Unit Trust – Accumulation
- Vanguard ā U.S. Equity Index Fund – Accumulation
- Cryptocurrency ā Coinbase
- Cryptocurrency ā Binance
PROPERTY
- House equity (approx.)
ASSETS (anything we have that is of significant value that can be liquidated)
- Watch
- Car
OWED TO US (anything thatās owed to us)
- Hardly ever contains anything!
WE OWE (anything we owe)
- Credit card
Itās worth noting that I also break out the percentages of each investment, so I can understand my allocation at any one time. If you’re interested in the details of that, see here.
I also have a summary section that summarises the total amount and the percentage of cash, investments, property and assets.
CASH ā 1%
INVESTMENTS ā 32%
PROPERTY ā 61%
ASSETS ā 6%
OWED TO US
WE OWE
Iāve put in my real percentages to help show you how this type of visibility helps you make better decisions. Ideally I would like to see less of a weight on property, more weight on investments and a touch more in cash. So, right now weāre looking to build up a bit more in cash and weāre continuing to invest aggressively. That should help shift the weightings over time.
Every quarter I check the accounts and update the numbers to see where things are heading. The exception is property and assets, which I look at yearly. I only make an adjustment to these if I believe things have materially changed. Importantly, I try to be super conservative here, because I never want my net worth to appear higher than it is. Iād rather have a pleasant surprise, than be disappointed.
The only thing I havenāt mentioned is my pension. I track that also, but for some reason I donāt include it in my net worth. I seem to have a bit of a weird relationship with pensions because of the fact that money is locked away and then accessed later in life with some restrictions. That said, I should probably include it in the total net worth number. Iāll think about that.
If you donāt already track your net worth, Iād highly recommend sitting down and mapping it all out. Itās eye opening when you see it for the first time. I think youāll find it an inflection point for taking more ownership of your finances and making some different decisions.
What is leadership?
Thereās no shortage of opinions on what leadership is, and how it differs from management. You can find whole books dedicated to the topic.
I think of leadership as three things:
- Setting and communicating future direction and goals (including the why)
- Attracting and retaining the best talent
- Creating an environment in which people can be successful.
I appreciate thereās alot that sits under those three things. But, ultimately, whatever the level of leadership, it leads back to these three focuses.
For example, if youāre a CEO, it means setting and communicating the overall vision and strategy of the company. You then have to help everyone connect the dots between the near term priorities and the end goal. It also means building a leadership team who will hire the best talent and run the company in a way which gives it the best chance of success.
If youāre managing a small team, it means making the long-term priorities of your team clear and showing how they fit with the company’s overall vision, strategy and goals. You then have to help the team connect the dots between their tasks and the team’s long-term priorities. And lastly, you have to make sure your team has the best talent and is able to get their work done to a high level.
Like I said, thereās a lot of detail that sits under the above three things. But, if you ever feel yourself getting a bit lost in the detail, youād do well to come back to these three things to help guide what you focus on.
Why everyone should invest
There are two reasons why everyone should invest.
The obvious first one is to build wealth for yourself. Albert Einstein once described compound interest as the āeighth wonder of the worldā for a good reason. If you invest Ā£300 a month at an average of 8% growth per year, youāll be have more than Ā£1M after a 40 year period (Ā£1,047,302.35 to be exact).
And hereās the kicker, your contributions would only total Ā£144K. This means over Ā£900K is interest!
The less obvious and second reason is that it teaches you to prioritise and focus on the long-term. And it teaches you in the best way ā incrementally, by making mistakes.
I bought bitcoin in early 2017, but sold it in early 2018 because it started going down. Yeah, that was fucking stupid. I also bought and sold some tech stocks in that same period, for the same reason. Yep, stupid again. I sold on the dip because I let my emotions get the better of me. I was too focused on the short-term.
Iām incredibly unlikely to make the same mistakes again. I can’t even imagine it. I have 30% of my net worth invested at the moment (mostly index funds, but also some growth funds / stocks and cryptocurrency). If it were halved tomorrow through a market crash, I wouldnāt flinch. I truly believe that. I would just see it as turbulence towards my long-term goal. In fact, I would go as far to say that it might well be the best investment opportunity Iāve ever had. I would remain calm and continue to invest as it recovered (which history tells us it always does).
Investing helped me develop that mindset. When things go wrong (not just in investing, but in life and work), Iām now quite good at remaining calm and taking a step back. I look at the bigger picture, which helps give me the right perspective. And from there, you can decide how to move forward ā which might mean doing something different, but also nothing.
Defining optimal metabolic health (Part I)
Over the last year, Iāve become more interested in my health. It led me on a journey to better define what good health means ā where I came across the term ‘metabolic healthā.
What is metabolic health? This is the best description I found:
Metabolic health is having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications. These factors directly relate to a personās risk for heart disease, diabetes, and stroke.
That opened my eyes to a whole new world. I came across stories of people who look really healthy ā yet their blood panels showed signs of metabolic dysfunction. I guess itās similar to a great looking car that breaks down by the side of the road. Things can look great on the outside, but under the hood there might be a problem brewing.
If you take the description of metabolic health above, only 12% of Americans are metabolically healthy. In many cases, these are people who look fairly normal, go to the gym etc. ā but they have a heightened risk of heart disease, diabetes, and stroke.
I wanted to find out where I stood. So, I took the plunge and ordered a blood test that checked for 45 biomarkers. The good news was that 98% of my results were in the normal range. That was reassuring, but there were two problems. Firstly, 45 measurements is a lot of things ā what are the ones that matter the most? (think 80/20 principle). And secondly, what are optimal levels (not normal) for these. Once Iām clear on these, I can start to figure out what I should focus on to improve my metabolic health.
Iāve started my research. Whatās difficult is there are lots of varying opinions. But, so far Iāve narrowed it down to these five northstar metrics:
Blood Pressure
High blood pressure increases your risk of serious problems such as heart attacks and strokes. This one is straightforward, because everyone seems to agree what optimal is:
- Less than 120/80 mm
HbA1C
The HbA1C test is used to identify the concentration of glucose (sugar) in the blood. It gives an average reading of glucose levels over a duration of 2-3 months. The HbA1C result highlights the risk of developing diabetes.
My research led me to a good (not normal) and optimal benchmark:
Good:
mmol/mol | mg/dl | IFCC |
<32.5 | <100 | <5.1% |
Optimal:
mmol/mol | mg/dl | IFCC |
<21 | <70 | <4.1% |
Note: the reasons for 3 different measurement types is because different parts of the world use different ones (in the UK we use mmol/mol).
C-reactive protein (CRP)
CRP measures the amount of inflammation in your body. High levels are associated with an increased risk of developing cardiovascular disease and stroke. It doesnāt pinpoint the source of inflammation, but a high number here is going to cause problems down the road.
CRP benchmarks seem to be fairly well agreed upon:
- Good: <1 mg/l
- Optimal: < 0.5 mg/l
Triglycerides
Triglycerides are a type of fat (lipid) found in your blood. Itās important for maintaining energy and provides the fuel for muscles to work. High levels of triglycerides increase your risk of heart disease and pancreatitis.
Again, most people seem to agree on the below benchmarks:
Good
mmol/ml | mg/dl |
< 1 | < 90 |
Optimal:
mmol/ml | mg/dl |
< 0.85 | < 75 |
HDL cholesterol
HDL is short for high-density lipoprotein. It works as a scavenger, picking up and carrying away excess cholesterol in your arteries and transporting it to the liver where it can be eliminated. Itās what we call āgood cholesterolā. High levels of HDL will lower your risk of heart disease.
From what I can research, these appear to be pretty solid optimal levels:
Optimal:
mmol/ml | mg/dl |
> 1.93 | > 75 |
Thatās where Iām up to so far.
Next steps:
I have a few other metrics floating around that I need to look into further and decide if they are important enough to be considered a northstar metric for metabolic health (25-OH Vitamin D, Haemoglobin, LDL ā bad cholesterol, total cholesterol, resting heart rate, heart rate variability etc.).
I also want to sanity check the above five with some smart people who understand this stuff better than me. Are these the right North Star metrics? Do the optimal levels feel right? Am I missing something?
Iāll cover my progress in the next post. Iāll also eventually bring it full circle and compare my own results to the optimal benchmarks ā along with what Iāll be focusing on over the coming months.
P.S. I did the biomarker test with Forth. I highly recommend them. I had all 45 biomarker results with doctors notes within 48 hours of sending off the blood samples. Their platform for viewing and understanding your results over time looks super good too. And theyāre really affordable too at Ā£139!
The fear mongering news cycle
The fear mongering news cycle is so obvious, but it works every time.
- The media decide to rally behind something that will trigger fear in us (i.e a there is a risk that a shortage of lorry drivers may cause some petrol shortages)
- The media sensationalise the story with the goal of selling papers or getting clicks (i.e weāre going to run out of petrol and weāll all be screwed)
- A minority of people panic, react and do stupid things (immediately rush to drive to the petrol station to fill up their cars, petrol cans etc.)
- This behaviour actually causes the sensational story that the media were responsible for to come true (so they look like they were right AND they sell even more papers and get more clicks as they continue to cover it)
- Everything goes back to normal and settles down. We forget about it and move on.
- Repeat
Itās depressing that our media and news system is so broken. Itās one sensational story after another with either an agenda or simply the goal of stirring us up to sell more papers and get more clicks.
Life is much better when you ignore the news. You wonāt become ignorant and you won’t miss out on anything that actually makes a difference to your life. Youāll just shut away the noise so you can focus on the things that matter in your life.
Iām not perfect at ignoring the news. I used to be, but the COVID Pandemic pulled me back into a bad habit of checking the news every day. Whilst Iām not part of the group that panics and reacts, Iām still exposing myself to unnecessary noise. So, I’m going to make a big effort from today to let go of my daily checking the news habit.
Building a baseline
Itās much easier to maintain a baseline than it is to build one.
A few examples:
Itās hard to reach your ideal weight. It requires a lot of consistency around activity and diet. But, once you get there, itās fairly easy to maintain it with an 80/20 approach. Youād have to have a prolonged period of inactivity and bad eating to reverse things.
Itās hard to get out of debt. It requires you to live below your means and consistently pay off the debt. But, once you get there, itās easier to stay on top of things. Building some savings often feels easier than getting out of debt.
Itās hard to build up to running a 5K. But, once you get there, you could take a few weeks off and still get one done. Sure, itād be harder, but it would take months of no running to find yourself in a position where you can’t run a 5K.
Why is that?
Well, need to establish new habits and behaviours to reach a baseline with something. It’s hard to establish them in the first place. But, once you do, it’s easier to keep them going. They become part of your new normal.
Momentum is a part of it too. Itās hard to build momentum. But, once you have momentum, you have to be pretty negligent to lose it.
And then you have the mindset factor. When youāre building towards something, it can often feel impossible to reach. But, when you get there, you have a different relationship with it. Itās no longer such an impossibility ā itās the new normal. Case in point, the 4 min mile.
This is all useful because it helps motivate you to do the hard work that it requires to build a baseline. Remember, it wonāt always be that hard.
You already know what to do
I recently had a blood test that checked for 45 biomarkers. The results were mostly in the recommended normal range ā and certainly the ones that matter the most were in a good place.
I don’t want to be normal though. I want to know what my northstar biomarkers are and then what levels for optimal health.
Iāve started my research on that. As with everything, itās complicated to wade through everyone’s opinions and find reliable sources. I started to get overwhelmed and a bit lost in it ā slightly slipping into perfectionism.
And then it hit me. Sure, this is important work and Iāll nail it eventually. When I do, Iāll have the certainty about on exactly where I am and what I need to focus on. But, what am I really trying to achieve here? Itās to understand what actions I can take to improve my metabolic health the most. And in reality, I already know that.
What makes the biggest difference to being in the best metabolic health? Diet. And where do I have the most room for improvement with my health habits? Yep, diet. I donāt need to finish my work on the biomarkers to know that improvements to my diet is the most meaningful thing I can do to improve my metabolic health.
If you find yourself getting overwhelmed by something, try and take a step back. Theres a good chance youāre getting in your own way. And thereās an even better chance you already know what to do.
So, thatās my big focus next week. More paleo and stricter intermittent fasting.