How to measure your health with Dr Vishal Shah

Greg: Yesterday was pancake day. I saw you post on LinkedIn.

Charlie: I did. I did have pancakes. Managed to ask work. Well, I just emailed and said, please, can we have pancakes? I think it would be a lovely way to start the day. But what's your topping of choice on pancakes? Because this caused some controversy in the office.

Greg: Historically, squeezed lemon and white sugar, and it's still hard to go wrong with that. Fantastic for tooth enamel as well, bonus. But I also quite like variety. I am a fan of Nutella. That does remind me of being on holiday in France as a kid.

Charlie: Oh, okay. Well, someone at work said beef stew.

Greg: Oh, weird.

Charlie: Thank you. It is weird, isn't it? I was like, beef stew? And then he tried to find these forums and everything where people were voting that beef stew is normal, apparently. Because his theory was, it's just Yorkshire pudding mix, isn't it?

Greg: I'm not sure about this guy.

Charlie: I know. I've had to put him on a disciplinary. I've reported him to HR.

Greg: This is The Method, a podcast from Thriva about what health looks like in the real world. I'm Dr Greg Potter. I'm a scientist and health and performance consultant.

Charlie: And I am Charlie Edmondson. Whilst I love sports, I'm definitely not a science expert. I've got a regular job and I'm here to remind Greg of what life's actually like when you're not a nerd.

Greg: How dare you call me a nerd. On this show, we'll work out some sustainable changes to your routine that will actually make a difference to your health. And to do that, we've got a simple three-step method. First, we bring in an expert to unpack the science behind one key health question. Second, we provide some tips and habits you can try right now. And then finally, we put the practice to the test.

Charlie: Each week we're going to hear from those who have tried and tested our recommendations to help turn a so-called ideal lifestyle into something that actually works for you.

Greg: So today we're speaking about pancakes. Are we? Is that...

Charlie: No. Vishal's come in to speak about pancakes.

Greg: Fantastic. How to assess your pancakes, how to baseline your pancakes.

Charlie: No. Why and how to assess your health is today's topic.

Greg: Have you ever tried to establish a baseline for your health and your performance, bearing in mind that you're an athlete? You are young and fit and healthy.

Charlie: Please. I don't really know, to be honest. I obviously wear a Garmin, Strava. I don't get obsessed with the data, if I'm honest. I used to drive a lot of people mad, especially when I was racing. Triathletes are obsessed with data.

Greg: Data.

Charlie: And I am not a data girl. Least surprising news probably of the day. I just... and I know that sounds really bad. I'm trying to run a PB. But I'm not going to do anything with that information. When I wore a Whoop for a while, it just kept telling me to go to bed at 3pm. Who can do that? It was like, you're really tired. I was like, I know.

Greg: I'm not sure that's very good advice for me.

Charlie: Yeah, it just kept saying, you're really tired today. You should go to sleep. And I was like, mm-hmm. I'm also at work.

Greg: They've refined their algorithm since then.

Charlie: Yeah, I hope so.

Greg: Well, I suppose the follow-up question is you broke both of your femurs. Do you think that had you done some testing prior to that and made some changes that could have supported the strength of said femurs, you could have dodged those injuries or reduced their severity?

Charlie: I think the key thing is I didn't know.

Greg: Because you didn't test.

Charlie: No, but I didn't wake up one day and think, I should really test my leg strength, bone strength today. No one does that. Okay, maybe scientists do that. Normal people don't wake up and think, I should really go and test my bones today.

Greg: No, but I think more people now are thinking in those terms than once upon a time. And I think there is a reasonable way to go about that and it can yield some helpful information. Our conversation today with Vishal should build nicely on the chat that we had with Andrea, because with her we spoke a bit about how to measure various capacities like physical strength. So today we can get deeper into that subject and why it's important, how to go about it, and how to do so in a way that makes sense for an individual. Maybe someone isn't that keen on spending loads of time and money on measurements, but would like to gain some insights, establish a baseline, and then over time their approach can evolve. And I think Vishal is incredibly well positioned to discuss that subject. I know you and I, for example, both did some blood testing recently through Thriva, and our results were generally very good.

But I found it interesting that my vitamin D status was yes, in the normal range, but well below what I would consider to be optimal. And that is despite the fact that I spend a lot more time in the sun than most people. So to me that's interesting, insightful information that I can then act on to nudge my levels back to where I'd like them to be, and then possibly gain some health benefits off the back of that.

Charlie: Mine were normal as well though. Well...

Greg: But yours, I think, were about the same as mine almost to the number.

Charlie: It's all the sun we've got in Manchester.

Greg: Yeah. Liquid sunshine.

Charlie: It's cracking the flags. It's not, obviously it's winter. I think it'd also be interesting to know what actually is the right baseline. Like you were just talking about being in an optimal range. The range is massive.

Greg: Hmm.

Charlie: In some of the results. So actually you could be one end of the spectrum to the other and still be classed as optimal.

Greg: Yeah, and you can also be outside of the normal ranges and be healthy. And so you have to understand something about what's normal for you, and then you can understand how things are changing over time. So baselining can be helpful and that is what we're going to get to today. I believe that Vishal is in the waiting room. Charlie, tell us who Vishal is.

Charlie: Vishal is Dr Vishal Shah from Thriva who is Chief Medical Officer. So it'd be very interesting to get his take and his insights on this, considering he lives and breathes it every day. This is what he does for a job.

Charlie: So excited to have you on, Vish. This is going to be a great chat.

Vish: Thank you.

Charlie: I was wondering if we could just kick off with you sharing a little bit about your background and what you actually do day to day at Thriva.

Vish: Fantastic. Yeah. So nice to meet everyone. I'm Vishal, I'm a GP by background, and at Thriva I'm the Chief Medical Officer. I joined Thriva nine years ago because the whole mission and approach to health made a lot of sense to me. As a GP you typically only get 10 minutes with someone, and that's not a great deal of time to really explore their lives, their lifestyle. And a lot of the time you are dealing with problems after they've developed. I wanted to work in a place where I'm able to help people earlier and at scale. And so Thriva is a place where I'm able to do that.

Day to day I oversee all the clinical aspects of the business. So that's things like helping decide the tests that we offer, providing guidance to our GPs so that they provide the right guidance to our users. I also still work with patients at Thriva directly with consultations, and that's something that I really enjoy doing as well. And then outside of Thriva, I have some other roles as well. I'm a trustee at the National Migraine Centre, so that's a fantastic charity that provides specialist care. And outside of work, I'm a husband and a dad of two very cheeky girls, so that also keeps me very busy.

Charlie: Lovely.

Greg: It sounds like you are perfectly placed for today's subject, Vishal. We recently had a conversation with Andrea Maier, a scientist, and in that we spoke about the fact that healthspan doesn't necessarily track lifespan in many parts of the world. People are living longer, but they aren't necessarily healthier for longer.

Vish: Mm-hmm.

Greg: And so that led us to question whether the term healthspan is the right term to be using. And if you want to define healthspan, then we first need to define health itself. So how would you personally go about doing that?

Vish: Yeah. I do think healthspan is the right term, but if you ask people, not everyone wants to live longer. I think it's worth reflecting on why that might be. For a lot of people, getting older, living longer, to them that means that they lose their independence, their faculties. They're not able to do the things that they love and enjoy. So it's not that people don't want more years in their life, it's that they want more good years. And that's exactly what healthspan is to me.

If we look at healthspan, that's traditionally measured as the number of years that you live free from a chronic condition. But I don't think that properly captures it, because health isn't something that's binary. It's not that you are either well or sick. It can exist on a spectrum and your health can also change over time.

I think most of us have an intuitive sense of what it means to be healthy. For me, I think it's having enough energy to do the things that you want to do. It's being able to move well and move pain-free. So it has that physical aspect to it, but there's also an emotional side to it as well. Feeling resilient, being able to cope with the day-to-day stresses of life, being able to think clearly, being able to focus.

And outside of the physical and mental aspects of health, there's also your relationships, having a strong sense of connection with people around you, a sense of connection with your environment. And then it can also include wider things like having a sense of purpose, and also things like spiritual health too.

Just because you've got a chronic condition, that doesn't mean that you're not in good health, because you may be managing it very well day to day. And you can also be technically disease-free but feel awful. You might be stressed out and burnt out. So it's not fair to say that you are healthy in that state either. For me, health is this holistic concept and healthspan is both how healthy you are and for how long.

Charlie: And a lot of the time people do tend to break up mental and physical health as if they're two separate things. Just curious from your take on it, do you see them as separate when you're working with people at Thriva, or do you see them as more interlinked?

Vish: Yeah, that's a good question. I think it can be helpful to split health into categories like physical health and mental health. When we do that, that does imply that they're two separate things that happen to be connected, because that's sometimes an easier way to think about it. But the body doesn't operate that way. It's one single integrated network and it operates at multiple levels, down from the very small, from your molecules to the cells. And that influences your organs, it influences your individual behaviour, the people around you, and your environment.

All of these systems are working together, and when they're working together well then we can say that good health emerges out of that. And when the systems are out of sync, that's when you see problems starting to arise.

That framing of health can feel quite complex. And so although we do view health as a system, we do break it down with a framework or a map. At Thriva we break down health into different domains. Things like mind, heart, metabolism, your hormones. And each of these domains isn't a separate silo that works independently. All the different domains interact with each other. I think of each domain as a lens through which you can view your health. And within each domain, we then look at a small set of indicators that you can track and measure. That gives you a sense of where you are at, allows you to see what needs attention.

And then on the other side of the framework, we also include things like what you can do to improve your health. We call these the levers, and these are really how you organise your life and your habits and your lifestyle to allow good health to emerge. So these categories are things like rest, your nutrition, what you eat, your movement, how you connect with people, those sorts of things.

Greg: You spoke there about how we are really a network of networks, from cells to organs and organ systems. An implication of that is that if you pull on one of those levers that you mentioned, something that for example relates to physical activity, you might be primarily targeting one network, but then that's going to influence other networks and have quite far-reaching consequences. Can you give an example of how pulling on one of those levers can have lots of positive effects in a given scenario?

Vish: Yeah, sure. The exciting thing about viewing your body as a network is that because it's all connected, one change can ripple across the whole system. If we take something like strength training, you might do that to build muscle. And when you build muscle, that improves your metabolism, you're able to handle blood sugar better, but it also protects your bone density. It might then also improve your mood and confidence. When you do some exercise, it releases things like BDNF, which is a neurotrophic factor, which is implicated in learning and memory.

Charlie: Sorry, Vish. What's a neurotrophic factor?

Vish: Yeah, it's a good question. It's a protein. A neurotrophic factor is a protein that's made by your body that supports your neurons or brain cells. They help the brain cells survive, and then they also strengthen the connections between the different cells. So that's why they're linked to things like memory and learning and mood. It's involved in brain plasticity.

Charlie: Thank you.

Vish: So exercise can actually help your cognition and the way that you think, which is awesome. Other examples? I mean, there are so many. Something like vitamin D. People think of that as a nutrient because you do find it in food, but it's actually a hormone that your body produces. Vitamin D supports your bone health, but it's also something that modulates your immune function and can be implicated in mood and the way that your muscle functions. So you've got one thing that you can change, one improvement, and that's going to have multiple effects across the system.

Charlie: Greg asked me in the intro about establishing a baseline. It's come up a few times with me and Greg and with other guests. I was wondering whether you could explain what we actually mean by establishing a baseline and why it's important.

Vish: Yeah, sure. Your health is going to change over time, and it can be sometimes quite noisy when you try to measure it. If you take a single snapshot of your health, that can be misleading because you might catch yourself on a particularly bad week or a really good week. By tracking different metrics, looking at your health from different angles and tracking over time, that allows you to establish a baseline and reduce some of that measurement noise. What you can do is then understand what's typical for you.

Charlie: We're just essentially saying a baseline is a line in the sand, your starting point.

Vish: Yeah. But it's also understanding what your trajectory is as well. Because health, being this holistic concept, is a bit of a fuzzy thing. And so when you've established that baseline, you know that when you deviate from it, that becomes a more meaningful signal that something might need adjusting. By tracking over time, you can make a change to your lifestyle, you can then track the response, and then you can really learn what's actually working for you as an individual.

Greg: And on the subject of measurement noise, I think that's a really important point because there's noise in some of the measures themselves. Some of the things that you're measuring will vary quite a lot based on various extraneous factors.

Take the example of measuring your body weight. That's going to depend on factors like whether you went to the toilet recently, your hydration status, and so on. But there's also variation that's driven by other behaviours, like physical activity and food intake, and variation that's driven by your body's clockwork. A good example of this would be testing testosterone. If you're a man, there should be a sharp spike in testosterone synthesis in the morning such that your testosterone levels are going to be highest around the time that you wake up in the morning. Therefore, if you were measuring your testosterone twice, three months apart, but you took one of the measurements after waking and another in the evening, then you've added noise into the measurement process. So it's really important to standardise things when you take tests.

Charlie: Yeah. I'm just curious why you're talking there about testosterone levels being higher in the morning. Because I personally wouldn't know. If you get sent for a blood test by a doctor, you tend to go whatever time your appointment is in the day, don't you? They don't tend to say, can you come back at a certain point?

Vish: That's right. It is not something that people would intuitively know and it's not something that a lot of doctors know as well. But it's very important to standardise the testing conditions. Take it at the same time, having fasted, being well hydrated, so that you're trying to eliminate as many of these other factors that can change your levels.

Greg: Just going back to baselining, do you think that someone should establish a baseline regardless of their current age if they haven't done so previously? Because we spoke with Andrea about how many capacities peak in early adulthood, and she said something to the effect of: we're probably physically most able at the age of 25 or so. But the reality is that different capacities peak at different ages in different people. For example, if you're doing strength training in the long term, a lot of people are at their strongest in their forties or even their fifties, whereas some other capacities, like certain cognitive functions, do tend to more consistently decline from early adulthood.

Vish: I think it's better to test early if possible, because you have more data and you really understand how your faculties, your abilities have changed over time. I think it's always useful to get a comprehensive view of what your health is, because no matter how old you are, that doesn't mean that you can't make improvements. There's always something that you can do, and it doesn't really matter whether you are at your peak before or whether you've still got some room to grow. It's useful to have that data, whatever your age.

Charlie: So if we move from the science to practical steps that people can take away to feel and function better. If someone was new to testing and they've made the decision, they're going to give it a go, find out what's going on. Do they need to check every area at once, or is it fine to be a little bit more selective? Pick a few to start with.

Vish: I think testing something is better than nothing. The good news is, because there's so much overlap between the different domains that we talked about, you can get a fairly broad coverage of your health with a small number of tests. I think for most people, understanding what your cardiometabolic risk is, understanding your key nutrients, and then having a good sense of how much you're sleeping, how much you're moving, what's your strength, are you able to do some key functional movements, that's going to tell you an awful lot.

What we've tried to do at Thriva is organise all this information into a way that allows you to understand it. We've got something called the Thriva dashboard, which is like a car dashboard. It's pulling in all the key things that you want to be looking at, and we've been selective about what we think it's worth tracking so that it feels comprehensive but not overwhelming.

Greg: And obviously I'm biased, but I do really like the Thriva dashboard because it's not just about blood tests. You can, within the dashboard, pull in for example an estimate of your maximum oxygen uptake from a device like a Garmin or a Fitbit or an Apple Watch. And so it really is a one-stop shop where you can overview your current state of health and do so in a longitudinal way, as you described earlier. Because one of the nice things about these devices is that they give those repeated measures and they do so in the background.

So it's not like you need to go out of your way to assess your resting pulse rate. They're doing that automatically for you. So in that way, they're a nice supplement to some of the other tests that we'll speak about.

Vish: Yeah, a hundred percent. It's nice that a lot of that is frictionless. But again, you can still find out a lot without needing to buy a wearable as well. There are other things that you can learn and you can do simply at home.

Charlie: So on that, I thought it would be quite nice to do a little quick-fire round. The plan is, I'll name a few Thriva healthspan areas, and it would be great if you could give one affordable, easy test that people can access to help track the different areas. But I am going to challenge you to keep your answers short, which, having spoken to Greg quite a lot, for science people is quite difficult. So please put him to shame.

Vish: I think I might be at risk of being a bit long-winded.

Charlie: So the first one is your mind.

Vish: Yep. So this is emotional and cognitive health. I think sleep is fundamental here. You don't necessarily need a tracker to get a sense of what your sleep is doing. Just asking yourself what your sleep quality has been like, you can score that out of a hundred. That gives you a lot of information, taking into account how much you've slept and how refreshed you feel when you wake up. I think that's a really important thing to track weekly or once or twice a month. That would be my cheap thing to do.

Charlie: I love that. Vish, you are so much better at this than you are, Greg.

Greg: Wait, wait. Don't I get to chime in too?

Charlie: Oh, is it sleep? You do love sleep.

Greg: I do like sleep. I agree with Vish that it makes sense given the Thriva framework to think about cognitive function, emotional wellbeing, and sleep. But I would say in terms of affordable tests, shameless plug, I'm on the scientific advisory board for the Food for the Brain Foundation, and they have a freely available cognitive test that's being validated, that people can take if they want to benchmark their current cognitive functions. Things like their ability to pay attention and remember things.

For mental wellbeing, there's another freely available scale called the Warwick-Edinburgh Wellbeing Scale that I think can be helpful when tracking that over time. And then for sleep, in terms of validated questionnaires, I really like one called the SATED Questionnaire. It's an acronym for the different components of it, just because it's about multidimensional sleep health. So sleep duration, sleep timing, sleep regularity, sleep quality, and so on.

Charlie: So the second one, the second healthspan area, is your heart.

Vish: So I would choose ApoB, which stands for apolipoprotein B, which is an advanced lipid marker. It's a simple blood test, fairly accessible, but I think one of the most important risk factors for cardiovascular disease that one should track over time.

Charlie: Could you just explain what lipids are? I've got a memory that if your lipids are high, it's not good. Is it cholesterol, or...

Vish: Yeah, so essentially your liver makes cholesterol. Cholesterol is something that is essential for life, so it's not good or bad. Because cholesterol is a fat, it doesn't just dissolve in the blood. It needs special carriers to transport the cholesterol from the liver where it's made to the different cells in the body that use it. These transporting molecules are called lipoproteins.

Essentially, when you have too many of these lipoproteins which carry cholesterol around in the blood, what they do is they can smash into the artery walls and get into the arteries and start clogging them up and causing problems. When we test cholesterol, what we're doing is breaking up these particles and measuring the cholesterol that's inside them. But what's more important than the actual amount of cholesterol is the number of particles.

If you think of it like a motorway, you've got cars which are travelling around carrying passengers. The passengers are the cholesterol, and the cars are the particles. What I'm saying is that it doesn't matter how many passengers on the motorway so much. What's more important is the number of cars. If you've got too many cars, you end up having more accidents, and that's essentially what arterial disease is.

Charlie: They're all smashing into the hard shoulder.

Vish: Exactly.

Greg: That's right. Going back to what Vish was saying, I completely agree about the importance of ApoB. And if you don't have that test but you did get a regular blood test and within that your blood lipids, which is typical for something like an NHS test, then you can look at your non-HDL cholesterol. It's like a poor man's version of the ApoB and therefore might be an option for people who can't necessarily afford to spend money on an additional ApoB test.

Going back to wearables, a £25 blood pressure cuff is a fantastic investment in your health. And some of the best companies like Omron offer devices for around that price point. Better still would be to measure your blood pressure around the clock. And now there are wearables that do that. But a blood pressure cuff is a great way to go because it's just so important for your cardiovascular risk.

Charlie: Perfect. Metabolism. How would you test your metabolism?

Vish: I think one of the simplest things you can do is measure your waist circumference. You can measure your waist-to-height ratio. That's a good validated way and tracks with metabolic outcomes. So that would be my easy thing to do at home.

Greg: Yeah, I completely agree. And I think there's another instance where technology is somewhat interesting, because now there are lots of apps that are available that based on a photo that you take of yourself will give you a rough estimate of your body composition. And they've been validated against things like DEXA scans, which do give quite a good approximation of body composition. And honestly, these apps perform quite well.

Vish: Yeah, for sure.

Charlie: The next healthspan area is hormones. How do you track your hormones?

Vish: Hormones are a fairly broad topic. There are lots of different hormone systems within the body. The easiest way of testing hormones is with a blood test. Certain hormones are useful for everyone to test. One example would be your thyroid hormones.

Your thyroid hormones control your metabolic rate. If you've got too much thyroxine, which is a thyroid hormone, that speeds up your metabolism and you might feel hot and flighty. If you are not producing enough thyroxine and you are hypothyroid, that might result in you feeling tired and sluggish and cold. So it's important to make sure that you've got the right amount of thyroxine. We know that these issues tend to occur in women more than men, but it can be helpful for everyone to test, to get a sense of what their levels are.

Other hormones that one might test or be interested in are the sex hormones. These are hormones such as testosterone and oestrogen. From an evolutionary point of view, your sex hormones are there to help you reproduce. But if you're not getting enough nourishment, essentially if you're starving or you're not well, your body switches off reproduction as a priority and diverts resources to keeping you alive.

If we take that framing in mind, that helps explain some of the things that switch off testosterone production. If you're constantly stressed and worried about your survival, if you are undereating, if you're not sleeping enough, these are all factors that will impact your production of testosterone. It's one of those areas that is so affected by your lifestyle. I think that's a really valuable test to track. And we've talked about how it's important to take that in a standardised way, so you want to be doing your testosterone levels in the morning, having fasted.

Charlie: I had my testosterone level tested. I thought it was... it sounds, I think naively, like it's more of a test for males to have done, but I had mine tested as well.

Greg: No, I think it's really important for quality of life for females too. Vish, do you agree with that?

Vish: Yeah, absolutely. A hundred percent.

Charlie: Sort of health in general?

Vish: We know that if you've got too much testosterone as a woman, that can affect things like your skin. It can affect your fertility and your menstrual cycle. And later in life, if you're not producing enough testosterone, that can affect your libido and your sense of vitality.

Charlie: How would people measure their strength?

Vish: You can measure your grip strength. That's a really well-researched tool. You can buy a device which measures your grip strength in kilograms. If you don't want to do that, you could do something like a dead hang, which is a proxy of your grip strength and upper body strength. You are literally hanging up from a bar and seeing how long you can hold yourself up. I think those are very good, easy ways of measuring overall strength.

Charlie: And just on grip strength. I'm just curious how that's measured as a representation of fitness and health?

Greg: Yeah, it's helpful because we know a huge amount about it because it's so easy to test in very large groups of people, and it's an okay representation of whole-body health. That really is its magic. There's nothing specific about the grip. I'm seeing this hilarious trend in social media where lots of people are now doing specific grip work because it's got this association with how long people live. So they think if I have a stronger grip, then that's going to make me live longer.

The truth is that it wouldn't be the most accurate prognostic marker for someone's risk of various different health problems in the future. There'll be other strength tests that would have more predictive power. Because if you think, for example, the fact that people don't typically live long after they fall and break a hip, it's really important to have strong muscles in your legs and hips and lower back to minimise the risk of you falling. Therefore, I actually think that tests of lower body strength would more strongly relate to future health outcomes than grip strength. And there is some research indicating that, it's just not as widely studied.

In terms of accessibility, a dead hang is great in part because you are measuring your strength relative to your body weight. That's your relative strength and that's really important.

Charlie: Thank you. The last healthspan area is skin and sensory.

Vish: Yeah. I think it's quite common to test your eyes. If you notice that you're not able to see, people are not very reluctant to go and get their eyes checked, and that's often easily fixed with glasses. It's just another way of showing the effects of those disease processes.

I think an easy test to do is a hearing test. This is super important. People, I think, are fairly reluctant to test their hearing. People have preconceptions about how big hearing aids are, and they may not want to wear a hearing aid. But we know that hearing aids have become a lot smaller. They're inconspicuous nowadays. What we know is that hearing loss is a major risk factor for the development of dementia, and it is entirely reversible if you fix the hearing loss. I think that's something that people should track.

Charlie: How? Because I don't think I've had a hearing test since I was at school. How often would you be going for one?

Vish: I think it depends on what your hearing is. But from middle age, I would say every couple of years. If you have less sensory input, parts of your brain are not stimulated, they're underused, and in basic terms, start to switch off. I think it matters more in later stages of life, but one to definitely keep in mind.

Charlie: And you can... I think my optician does them, which feels ironic, saying that, going to your optician for a hearing test.

Greg: The Thriva category is skin and sensory, so it's referring to all of our different sensory capacities, which include hearing and vision and so on. So get your hearing tested and get your eyes tested too. Vish, I was just curious about whether you have any thoughts about skin health, not just the superficial side of things necessarily, but also what matters in terms of risk. And obviously here I'm thinking about things like cancer too.

Vish: I wouldn't say there are any major tests, but I would want to point out that skin can be a useful window into your overall health. Sometimes when your skin looks off, that can be the first sign that you have something going on that's affecting your health.

If you've got fair skin, sun protection matters because UV exposure doesn't just increase the risk of skin cancer. It can also speed up skin ageing. So you may notice pigmentation changes or wrinkles. And then you can also consider what's required from the inside for good skin health. Because your skin cells are renewing so rapidly, they need a lot of nutrients. Nutrients such as B12, folate, and iron, because these are important for making new cells. If you're low in any of those nutrients, that can sometimes cause hair loss, or it may make your hair more brittle. With your skin, you might notice that it's more dry or just doesn't feel as youthful.

If any part of your health is concerning you, if you've got a rash that's not going away, those are worth seeking advice for. I think the most important thing with respect to skin health is cancer prevention. It is very important that you get your moles checked. If you've noticed any changes in their shape, if they've looked like they've grown, they've become a different colour, if they're itchy or bleeding, those are symptoms that are worth worrying about and speaking to your doctor. A lot of the time you can get some advice through a pharmacy. You can try some simple things first and they may be able to recommend treatments. But again, if things are persisting or you're worried, then that's a good time to go and see your doctor.

Charlie: Obviously I'm conscious we've covered a lot of topics there, from eye health to cholesterol. Is there one place that people could just go to get started? There's probably a bit of anxiety around ripping the plaster off if people think they're going to uncover something terrifying from a blood test.

Vish: Yeah, I think that anxiety is fair. People are worried about finding things out that they don't want to learn about. Are they sick? But I think it's better to have information and act on that earlier rather than later. You can get started by doing a simple blood test at home, and some of the other non-diagnostic things that you can track does give you a lot of information and a comprehensive view of your health. I would say that you can definitely improve your health no matter where you are. And you can start to feel better very quickly. As soon as you start making changes to your lifestyle, it's not just your long-term outcomes, you do notice changes pretty quickly.

Charlie: So obviously we've talked about the science of healthspan and how to actually establish a baseline in practice. Now we're going to move into the experience section. What it's really like when people try and put this into action.

So our first listener question comes from Rod in Cambridge.

Listener: Hey, my question is about whether there is any research into dependency or dependability between strength and sudden death or death in general. Whether if a person is strong, that person has a lower chance of dying prematurely. Thank you.

Vish: Yes, at a population level, stronger people have a lower chance of dying prematurely. There are associations between strength and cardiovascular mortality, but it's also associated with reduced risk of fractures and also cognitive decline. Whether there is a causal relationship between strength and mortality, we're not really sure. But it's definitely something that tells you something important. I know that Filippo, the previous guest, introduced an idea that actually your loss of strength is a trigger for ageing rather than being a hallmark of ageing. I'm not sure which way that is round, but I know that it's important.

Greg: Just to add to that, there is also interesting evidence that a combination of having high levels of strength but also high levels of stamina is more protective than one or the other. And so it can be helpful to periodically test your endurance. The gold standard test would be something like a VO2 max test, typically done on a treadmill. But also you could assess your performance in an endurance task, like how far you can walk or run in 12 minutes.

That might be practical for you. But the point is, if you periodically do some sort of endurance exercise and benchmark your performance in it, that can tell you quite a lot of information as well.

Charlie: So next question we have. It's coming over email, so they've asked: I don't like to weigh myself very often because I find it stressful, but I know that weight is a part of tracking your health. What can I look at instead to make sure I'm staying on top of things without using scales?

Vish: Great question. I think lots of people do feel triggered by weighing themselves, and it's not something they want to do. Your weight is an important marker, but it can be sometimes misleading. You can be heavy but because you have a lot of muscle mass, that's not necessarily a bad thing for your metabolic health.

I think one thing that you could do is look at your waist circumference. You could measure that. You could see how well your clothes are fitting. Those are two things that you could keep an eye on. You can get an internal view of your metabolic health. Things like a triglyceride test, a lipid test will give you some information as well. So there are some other things that you can do.

Charlie: Next question we have is another voice note.

Listener: Hi, I'm here with a question for Dr Vishal. I find proactive tracking and monitoring health really helpful, particularly because I feel that the modern world is not really a great setup for supporting healthy living. There's a lack of movement built into our daily lives, and availability of processed food can be quite overwhelming.

But there's a balance, I think, to be struck. I'm just wondering how Dr Vishal thinks about supporting people he works with to find the right balance between checking, monitoring, to support holistic health, and that overload. Thanks so much.

Vish: Yeah, I think this is a great question. My thoughts are, tracking should serve you rather than control you. When I work with people and help them decide what to track, I try to ask them: what are you tracking this for? Can I do something useful with this information? And also, how does it make me feel tracking?

There's two sides to it: utility and how it makes you feel. If you take something like a sleep tracker, some people check how they've slept the night before every day. And for some individuals that can be quite triggering, and that can stress you out. You've already had that night's sleep.

Charlie: Can't do anything about it.

Vish: What can you actually do about it? So for something like sleep, I think it might be more useful to look at your average sleep duration over a week or two. So you have a bit of emotional distance between you and that bad night's sleep. You can then maybe make some decisions and think about what you can change to try and improve your sleep.

Whereas for example tracking your steps, I think that's something that is worth tracking every day. You might find that you've gone through the day and only done a couple of thousand steps and then that might prompt you to try and get outside and take a walk. I think it's just about what is it doing for you? Is it serving you? Is it helping you and encouraging you and motivating you to make changes that are helpful for your life? If tracking is making you feel anxious rather than empowered, then I think that's a signal to take a step back. But the goal really is to try and understand your health, make adjustments, and then just get on with your life.

Charlie: Just on the point of tracking your steps, Vish. Is it total amount of steps, or a consistent amount of steps? I have Monday, Tuesdays in the office normally, and so my step count on these days is really low. But then I'm marathon training at the moment, so I think my weekend steps, my Saturdays, are like 50,000 or something wild. Is it better to have more consistency every single day? So aiming for six to seven thousand a day if you were a bit more sedentary, as opposed to having a couple of days that you're only doing three or four thousand and then days that you're doing huge amounts to try and bank them back?

Vish: Yeah, my understanding is that it is better to have consistency. There is some research which suggests that you can't outrun a very sedentary lifestyle. The amount of time that you spend sitting is an independent risk factor for poor long-term health outcomes. You want to break up your day by moving more, and I think it tends to be better for your body to move more every day rather than just fitting it all in a couple of days on the weekend.

Charlie: Final question, Vish, and then we will let you go back to your very busy day. Someone has asked: I eat a plant-based diet and I have for years. I know you need to be careful with some things and take B12 supplements, but are there other things I should be testing to make sure I'm healthy and getting the right nutrients? And that's from Anne.

Vish: I think it's great that you've already thought about vitamin B12. That would be the main vitamin that people on a plant-based diet need to worry about, because you have no sources other than animal products. But other nutrients that are important are vitamin D and your iron levels as well. Those are worth testing.

The other main nutrient to look at or keep an eye on is omega-3. Most people get long-chain omega-3 fatty acids from oily fish. The important thing to know is there are three types of omega-3 fatty acids. One which is common in plant foods such as flax seeds, and the other two are only available from marine sources.

These two from marine sources are very important for your brain cells and also important for your eye health. The trouble is, if you are on a plant-based diet, you're going to struggle to get these other two omega-3 fatty acids. Your body can convert them from the one that is plant-based, but that conversion is very inefficient.

If you are on a fully plant-based diet, you may have low levels of the two omega-3 fatty acids that are important for brain health. The good thing is that you can supplement and fix this quite easily. There are lots of vegan options. The main one is algae oil, which is essentially where fish get their omega-3 from in the first place.

Charlie: Perfect.

Charlie: We like to leave listeners with one key takeaway from today. So Vish, what would that be?

Vish: We've talked a lot about the body being a system. And the nice thing about that is that if you pull one lever, that then helps you pull other levers. An improvement in one area does tend to help you improve other areas. Better sleep will give you more energy and that allows you to move more. If you move more, then that's going to help you sleep better. So it almost doesn't matter where you start, as long as you start somewhere, that's going to allow the whole system to shift in your favour. And that means that it takes a lot less work than you realise to start making a difference in your health. And you can notice the change in your health very quickly.

Charlie: Amazing.

Greg: I love that. Thanks, Vish.

Charlie: Thank you so much.

Charlie: Really enjoyed that. I think, gosh, he's very knowledgeable, isn't he?

Greg: Yeah, he's a gentleman too.

Charlie: Yeah. Particularly liked the mental image of cholesterol smashing into my arteries. Just thinking about that.

Greg: You don't want lots of cars in your arteries.

Charlie: No, but it doesn't matter how many passengers. What was your key takeaway, Greg?

Greg: I think Vish did a really good job with his key takeaway. That certainly was going to be my main one.

Charlie: Has he stolen it?

Greg: He stole my thunder. There was no thunder steal. It's okay, Vish. Don't worry about it. But in addition to that, I would just say it is a good idea to establish a baseline for yourself, whatever your age, and it could begin with two or three tests. Each test that you're going to do is actually going to tell you quite a lot about how the whole system is working.

The other thing that I would add is, if you are unfamiliar with the tests and what they mean, then it's helpful to have a health professional interpret your results for you if you can do so. Because I just think that nowadays lots of people go on a test safari and they end up with reams of information. I see this for example with genetic testing. People find out that they have a gene that encodes this variant of this enzyme, and then that supposedly affects their caffeine metabolism. And then they get worried about the coffee they consume and they just end up worrying about things that don't matter. So if you can have someone that can put things into perspective, then take advantage of it if you have the resources to do so.

Charlie, how about you? What were your key takeaways?

Charlie: I thought it was actually really nice at the start when he mentioned about systems working together and then when all your systems are working well together, good health emerges. It's quite nice to think about it in that way. Also, I think Vish mentioned it a couple of times, that one small change can ripple across the network and you can see improvements quite quickly. It doesn't always have to be a huge, big shift or an extreme change to your diet or your health. It could just be a small improvement.

Greg: I will add one more thing. We've spoken today about many different, more objective tests where, for example, we measure your blood or your blood pressure. But subjective tests matter too. And how you think about your health, whether you think your health is good, is one of the strongest predictors of how long you will live.

And so in addition to some of the tests that can seem more fancy, just using subjective scales can give you some insights as well. There is a particular test that I really like. It's called the SF-36, the Short Form 36. You can find it online. It's freely available, 36 items long, takes about three minutes to complete, and it gives you a multidimensional assessment of your health, including things like your mental health.

That is something that you might find intriguing, because most of us love things like personality tests and those are the tests that we so enjoy.

Charlie: I am going to go and Google it and do my 36 steps.

Charlie: You've been listening to The Method: Health in the Real World. A podcast brought to you by Thriva.

Greg: If you don't know about Thriva, it's a health tracking platform that helps you see exactly where your health is heading, what to work on, and how to do so. They use painless at-home blood testing to show you what's going on in your body. Your results are analysed by accredited labs and, based on the tests, you get personalised guidance from real doctors, not AI ones. People use Thriva like a compass, testing every few months to help steer their health to where they'd like it to be. It's a great tool to start feeling more empowered about your health and to get the information you need to make progress even when life is a bit hectic.

Charlie: Thriva also has some great content out there that can help you get to grips with complex health questions, exactly like what we try to do on this podcast. And all of that is free to access. So if you want to learn more, just head over to thriva.co. That's thriva.co.

Greg: And of course, if you loved the show, subscribe. Why would you not do that? It takes just a few seconds and you won't regret it.

Charlie: You can also leave us a review or write to us by email to themethod@thriva.co, or if, like me and Greg, you'd rather send things over by voice note, then we'd love to hear from you.

Greg: A special thanks to the Thriva team and to Lower Street for helping us bring the show to life. Content direction by Rich Cousins, Hamish Grierson, Tamar Loach, Vishal Shah, and Katie Yockey. Production from Lise Lovati with the help of Sam Datta Paulin and Daria Lawson. Sound design by Alex Rose.

Charlie: We are your hosts, Charlie Edmondson and Greg Potter, and we'll see you next time.