Preventive Data-Driven Health Management to Reduce Chronic Disease
Though we are living longer compared to any other time period in the past, we are experiencing an epidemic of chronic diseases. This is affecting our quality of life negatively as we age.
According to Rand Corporation, 60% of adults in the US live with one or more chronic conditions. 42% of adults live with multiple chronic diseases, and this jumps to 81% in adults 65 years and older.
Chronic disease often begins long before an official diagnosis is made. By then, the condition is usually too advanced and complex for prevention and reversal. Can early intervention help to stop or slow down the progression of these diseases?
In my previous article, I walked through my personal and professional healthcare journey and explained five imminent changes that have the potential to improve chronic disease care. In this article, I will dive deeper into the idea of a data-driven approach to make chronic disease management more preventive.
What does Data-Driven Preventive Care Mean?
Let’s take insulin resistance (IR) as an example. Insulin resistance (IR) leading to Type 2 diabetes may start a decade before any symptoms are noticed. According to a research paper published in JAMA, more than 37% of the US population has some level of insulin resistance, a precursor to Type 2 diabetes and many other diseases.
With nearly a decade before a diagnosis of type 2 diabetes, can we intervene during the early stages of insulin resistance to slow or stop its progression? Advances in medical and data science suggest it may be feasible to detect insulin resistance early and treat it with a personalized data-driven approach of lifestyle modifications and medication, leading to the prevention or delay of numerous chronic conditions.
Taking a data-driven preventive approach has vast potential to improve patients’ quality of life and reduce the burden of these illnesses.
According to the CDC, 90% of the nation’s $4.1 trillion annual healthcare expenditure is for people with chronic physical and mental health conditions. By utilizing technology and advanced medical science to tackle chronic disease, we have an opportunity to lower healthcare expenses while enhancing the quality of life.
What Changes are Needed to Make The Care Truly Preventive?
1. Personalized Therapy to Reverse Chronic Disease in the Early Stages
In the 20th century, great progress was made in treating infectious diseases with single-drug therapies. This approach worked well as infectious diseases often have a dominant contributor. For instance, pneumococcal pneumonia is caused mainly by pneumococcus and can be cured with a drug like penicillin.
Now, compare an infectious disease with a chronic illness like Alzheimer’s disease (AD). AD is different from infectious diseases because it has multiple contributing factors, none of which may be dominant. The latest research indicates that AD is caused by the complex interplay of interconnected physiological systems. The Amyloid Precursor Protein (APP), a protein in the brain, is a key player in AD and regulates neuronal growth (neurogenesis) and synaptic plasticity. When functioning properly, it allows for brain growth, learning, memory storage, and adaptation to the environment. The APP relies on the metabolic system for resources, including energy, hormones, and micronutrients to function effectively.
When the metabolic system malfunctions and fails to provide the necessary resources to support neurons and synapses, the APP takes measures to protect itself by causing neuron death and shrinking synapses through the formation of toxic amyloid plaques. This results in brain shrinkage and is associated with the classic symptoms of Alzheimer’s disease, such as memory loss and cognitive decline.
The metabolic disorders, which cause amyloid plaques, have various causes, including chronic inflammation, imbalanced nutrients and hormones, and exposure to toxic substances such as metals and mold. Chronic conditions like hypertension, cardiovascular disease, diabetes, and stroke can also contribute to metabolic system malfunctions. Additionally, having the APOE4 and APOE3 genes can accelerate AD development. All of these can be linked to lifestyle choices, environmental pollution, and stress.
As demonstrated above, determining a single primary cause of AD is not straightforward. AD is a complex and multifaceted illness that encompasses interactions across various biological systems.
In the book “The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline,” Dr. Dale Bredesen discusses 36 factors that may contribute to AD. The factors range from chronic conditions like heart disease and diabetes to vitamin and hormonal deficiencies, undiagnosed infections, and even long-term exposures to toxic substances. For an individual patient, many of these 36 factors could simultaneously play a role in the progression of the disease. Also, the factors may vary considerably from one individual to another. Thus, a single drug treatment, similar to those used for infectious diseases, is unlikely to be effective in treating AD.
A personalized precision medicine approach that considers the patient’s data and targets the underlying causes may be the optimal solution.
AD does not develop suddenly, but rather emerges over a period of time. The decline in cognitive function may begin 10 to 20 years before a diagnosis is made, and the patient may experience stages of Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) before being diagnosed with AD. Although symptoms may be worsening in these stages, the patient will likely continue to carry out daily activities. Early on, neuropsychological tests may or may not reveal a decline in memory.
Our current strategy of treating AD, which involves single-drug therapy after the disease has fully developed, is not effective. Can we look at a more proactive approach? By utilizing data science to identify individuals at risk when cognitive decline first begins, we may halt or slow the progression of AD. We may address the underlying causes in the early stages of the disease, before significant brain damage occurs and daily life becomes difficult.
Because the root cause of AD varies from person to person, can we determine the most effective therapy for each individual through a data-driven approach? Such a data-driven, preventive approach has already demonstrated promise by Dr. Dale Bredesen in his Recode Protocol, as described in his book “The First Survivors of Alzheimer’s: How Patients Recovered Life and Hope in Their Own Words.”
AD is not the only disease with this type of progression — many other chronic diseases, such as kidney and liver disease, follow a similar pattern. There are usually no symptoms in the disease’s early stages; thus, it can go unnoticed until kidney and liver function has declined significantly. Many other disorders can benefit from proactive, data-driven personalized therapy.
2. Empower Healthcare Providers (HCPs) with Real-time Patient Data
The goal of the healthcare system should be to enable individuals to lead fulfilling and healthy lives. However, due to systemic issues, many interactions between patients and healthcare providers (HCPs) have a transactional and reactive feel, typically only occurring during scheduled visits or when the patient is ill. HCPs rely on verbal updates from patients to assess their health. These reactive updates result in the prioritization of managing symptoms over promoting wellness.
With continuous monitoring of a patient’s physiological markers and data, HCPs can take a proactive approach to manage overall health.
Continuous monitoring has the potential to enhance people’s overall well-being. Regular diagnostic tests may indicate normal results, but other factors such as energy, sleep, and stress can also impact a patient’s health. By monitoring daily vital signs and symptoms, HCPs can improve early detection, enhance diagnosis accuracy, personalize treatment plans, and increase patient engagement in their care.
Continuous monitoring will also enhance healthcare providers’ understanding of health trends, leading to more efficient health management. I have seen this firsthand while working on a remote patient monitoring product for COPD patients. Initially, HCPs had a limited fixed view of standard respiratory patterns. 24/7 data, including physiological and respiratory data before and after exacerbations, revealed significant variations among patients. The information allowed for deeper and more contextual conversations with patients, and personalized recommendations based on data.
Continuous monitoring will play an essential role in many other diseases as wearable technologies evolve. Take, for example, seizures. The type and location of a seizure is usually determined through a combination of MRI, EEG, and caretaker interviews. However, interview data may not always be reliable, and an EEG performed days after a seizure may not provide much insight. Real-time monitoring of brain electrical activity during or leading up to a seizure can provide a deeper understanding of the type, location, and underlying cause of that seizure. Improved knowledge of the brainwave mechanisms behind seizures can lead to a more personalized and accurate treatment plan. Currently, seizure medications are effective for 65–70% of patients, and the choice of drug is often determined through trial and error.
3. Empower Patients to Prevent Chronic Diseases by Self-Managing Biomarkers
As discussed in the previous section, chronic diseases don’t happen suddenly; they happen because of a systematic decline in our biological systems over time. Many factors play into this decline — lack of sleep, the food we eat, the stress of modern life, inactivity, etc. I know friends and family members who struggle with biomarkers like their lipid panels, vitamin D, blood pressure, and cholesterol. Many don’t sleep well.
Even if biomarkers are out of what’s considered the standard range, medical intervention may not be provided. Our HCPs are swamped and time-constrained. Because of the sheer volume and complex health conditions of many other patients, it’s not practical for them to assist every patient with a personalized plan.
Conversely, patients in the early stages of disease progression don’t know how to manage these conditions. Many patients want to live healthy lives but are confused about how. They receive a generic answer: eat well, sleep well, manage stress, and exercise. They are unable to translate that answer into actionable steps.
There is a good chance that patients don’t require prescription medicine or a medical procedure at this stage. A simple tweak to their lifestyle may help improve sleep, stress, and biomarkers. Those tweaks can be personalized to the patient’s needs and preferences. By combining advancements in medical science, technology, and data science, we have an opportunity to enable patients to prevent health decline, which leads to chronic disease. We can allow people to self-manage their biomarkers, and escalate to HCPs when needed.
In the long run, this approach will reduce the burden of chronic disease and free up HCPs to focus on patients with complex health conditions. Of course, this will also require a shift in the economic model, which I discussed in my previous article. The good news is that companies such as Level Health and Inside Tracker are using this model. Of course, a lot more work is needed to develop and mainstream this approach.
4. Offer Long-Term Health Planning Using Real-Life Historical Data
Financial planners use real-life historical data to help us plan for long-term financial security. Through technology-driven visualization, we can understand the risks and returns of various investment options. Is it possible to do the same for long-term health security using population health data?
Patients in the early stages of health degradation may not realize the long-term implications. It may start with sleep issues or degradation of biomarkers connected to the immune system, metabolic, or endocrine functions. Because symptoms are typically mild at first, and the patient may not be aware of long-term implications, these symptoms may be ignored or simply treated through mono-therapy. In reality, the body is an interconnected system and chronic diseases begin with minor symptoms that spread over time.
Wearable technology can help gather real-life data and create time-series models to understand the long-term consequences of early chronic disease related degradation. This knowledge can aid individuals in making better decisions for a healthier future.
In Conclusion
Over the past few decades, there have been significant advancements in our understanding of the human body and the connection between physiological and psychological issues and chronic disease. We have more knowledge of gut and brain health, and their relationship with each other. The field of diagnostics has also progressed tremendously.
Concurrently, the user experience of technology has vastly improved, making wearable technologies more practical and user-friendly. Technology has also evolved to provide consumers access to contextual information through their preferred channels, promoting education and awareness. Data science plays a crucial role in comprehending the correlation and causation behind the progression of chronic disease, which is influenced by multiple interrelated physiological and psychological factors. With its ability to analyze progression patterns across a large patient population, data science holds the potential to aid in precision medicine and improve overall population health.
The convergence of medical science, data science, and technology has the potential to revolutionize healthcare and make chronic disease management more proactive, preventive, and personalized. By leveraging advancements in diagnostics, wearable technologies, and data science, HCPs and patients can gain a deeper understanding of chronic diseases and their progression, leading to earlier intervention, improved patient outcomes, and a higher quality of life for those affected.
References -
- Dr. Christopher M. Palmer MD (Assistant Professor of Psychiatry at Harvard Medical School) -
- Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health — and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More (Book)
- Podcast — https://open.spotify.com/episode/6GEZVm18mwx76rWJueFHGj
2. Dr. Emeran Mayer, MD (Distinguished Research Professor in the Departments of Medicine, Physiology and Psychiatry, UCLA)
- The Mind-Gut Connection: How the Hidden Conversation Within Our Bodies Impacts Our Mood, Our Choices, and Our Overall Health (Book)
- The Gut-Immune Connection: How Understanding the Connection Between Food and Immunity Can Help Us Regain Our Health (Book)
- The Mind-Gut Connection podcast — https://emeranmayer.com/podcasts/
3. Dr. Dale Bredesen, chief resident in neurology at the University of California, San Francisco (UCSF) & Chief Science officer (Apollo Health)
- The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline (Book)
- The End of Alzheimer’s Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age (Book)
- The First Survivors of Alzheimer’s: How Patients Recovered Life and Hope in Their Own Words (Book)
- Dhru Purohit Podcast with Dr. Dale Bredesen: https://open.spotify.com/episode/1BtN7gw0CVQjlCMZ1PFke3
- Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project: https://www.apollohealthco.com/alzheimers-reversal/
4. Dr. Robin Berzin, MD (Founder and CEO of Parsley Health)
- State Change: End Anxiety, Beat Burnout, and Ignite a New Baseline of Energy and Flow (Book)
5. Dr. Mark L Hyman MD (The Head of Strategy and Innovation of the Cleveland Clinic Center for Functional Medicine, Board President for Clinical Affairs for The Institute for Functional Medicine — https://drhyman.com/)
- The Doctor’s Farmacy podcast — https://drhyman.com/blog/category/podcasts/
6. Dr. Justin L Sonnenburg (Professor, Microbiology & Immunology, Stanford — https://sonnenburglab.stanford.edu/)
- The Good Gut: Taking control of your long-term health (Book)
- Podcast: https://hubermanlab.com/dr-justin-sonnenburg-how-to-build-maintain-and-repair-gut-health/
7. Dr. Ayesha and Dean Sherzai, MD (Neurologists and co-director of the Alzheimer’s Prevention Program at Loma Linda University — https://thebraindocs.com/)
- The Brain Health revolution podcast — https://thebraindocs.com/podcasts/
8. Dr. Saray Stancic MD (board-certified physician — https://drstancic.com/)
- What’s missing from Medicine (Book)
- Documentary Codeblue — https://drstancic.com/codeblue/
9. Dr. David A. Sinclair, A.O., Ph.D. (Professor at Harvard Medical School)
- Lifespan Podcast — https://www.lifespanpodcast.com/
10. Dr. Andrew Huberman, Ph.D. (Neuroscientist, professor of Neurobiology at Stanford School of Medicine)
- Huberman Lab Podcast — https://hubermanlab.com/category/podcast-episodes/
11. Dr. Georgia Ede (Harvard-trained, board-certified psychiatrist specializing in nutritional and metabolic psychiatry)
- Insulin and the brain: The food-mood connection (https://www.dietdoctor.com/low-carb/mental-health-guides)
12. Dr. Robert H. Lustig, M.D., M.S.L. (Professor emeritus of Pediatrics, neuroendocrinology, UCSF)
- Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (Book)
13. Dr. Atul Gawande (General & Endocrine Surgery, Brigham and Women’s Hospital & professor at Harvard Medical School)
- Being Mortal (Book)
14. Dr. Brittany Henderson, MD, ECNU (board-certified in internal medicine and endocrinology — https://www.drhendersonmd.com/)
- What You Must Know About Hashimoto’s Disease (Book)
15. Dr. Steven E. Phillips, MD (Yale-trained, world-renowned expert on zoonotic infections)
- Chronic: The Hidden Cause of the Autoimmune Pandemic and How to Get Healthy Again (Book)
16. Dr. Dean Ornish (Professor of medicine UCSD & Physician Consultant of Bill Clinton)
- Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (Book)
17. Dr. Kristen Willeumier, Ph.D (Neuroscientist with research expertise in neurobiology and neuroimaging — https://www.drwilleumier.com/)
- Biohack Your Brain: How to Boost Cognitive Health, Performance & Power (Book)
18. Dr. Aseem Malhothra (British Cardiologist)
- A Statin-Free Life: A Revolutionary Life Plan for Tackling Heart Disease (Book)
19. DUTCH (Dried Urine Test for Comprehensive Hormones) podcasts —
20. American Psychological Association —
21. Rand Corporation —
22. Centers for Disease Control and Prevention (CDC)
23. Sleep, Recovery, and Activity through several consumer devices
- https://www.whoop.com/thelocker/heart-rate-variability-hrv/
- https://support.ouraring.com/hc/en-us/articles/360025441974-An-Introduction-to-Heart-Rate-Variability
- https://www.levelshealth.com/blog/5-subtle-signs-of-poor-metabolic-health
24. Research Papers
- UAB researchers find that 40 percent of young American adults have insulin resistance and cardiovascular risk factors (https://tinyurl.com/nbp9cs6b)
- JAMA network paper on prevalence of diabetes, pre-diabetes in U.S. (https://tinyurl.com/3vm5jmxy)
