Without A Coach, Fitness Data No Help Says Omada

Wellness trackers are little value if we’re not doing anything with that data. Tech only solutions are failing to deliver on outcomes – especially when it comes to chronic diseases like diabetes prevention.

That’s according to Omada Health, a bleeding edge startup developing a tele-health program that combines technology and human coaching.

Omada Health is an evidence-based curriculum developed by CDC that has been shown to reduce the likelihood of progressing to diabetes by 58%.

Health trackers like Fitbit were supposed to drive a new wellness revolution. And big tech players like Apple are stepping into the fray with a slew of fitness and health apps, that promise to make us better.

But Omada Health’s patient data suggests that pings and alerts aren’t enough.

Decades of research in behavioral science shows that building the confidence to make and sustain changes requires consistent human support from real people.

Omada found in one clinical trial that a higher rate of social engagement with peers and discussions, led to a higher rate of lasting changes even three years after the program. In a three year outcome diabetes prevention program (DPP) patients who participated in group discussions more frequently saw the biggest health benefits.

Omada’s digital therapeutics program for chronic disease includes a variety of human and tech touch points. Each participant is paired with a professional health coach, who provides encouragement. Users get a connected health device (a smart scale to calculate BMI), and can log on to the online community for accountability.

With more than 200,000 users, Omada is trying to understand when an automated nudge is sufficient, and when a message is better delivered by a real person.

A person can be prediabetic for between seven and ten years before a formal diabetes diagnosis, according a 2017 Swedish study published in the online journal Diabetes, Obesity and Metabolism.

Omada is based on the simple idea that data from wearable health devices with no coach is no help.

Forget Light/Dark, There’s a Circadian Clock in Your Liver

Beyond social distancing, wearing masks, and hand washing a healthy circadian rhythm may increase your resilience to fight Covid-19, that’s according to Satchin Panda a scientist at the Salk Institute.

“The circadian rhythm and turning on and off of more than ten thousand genes is the largest regulatory network that we know that exists in humans,” according to Dr. Panda.

Many people will be familiar with the circadian clock in the brain. But scientists like Panda believe that other clocks play a role in immune system health.

“There is a [circadian] clock in the liver. Forget about light or dark,” says Panda. “What we have to be more careful about is when we eat and when we fast.”

As we age, there is a decline in circadian rhythms, coupled with declines in the overall metabolic tissues homeostasis and changes in the feeding behavior of aged organisms. This disruption of the relationship between the clock and the nutrient sensing networks might underlie age-related diseases.

According to Panda when the timing systems in the human body are desynchronized, essential organs are compromised, reducing the potency of the immune system.

When we start the liver clock appears to have effects on glucose, lipid and oxidative pathways and immune system rejuvenation and repair.

Panda’s research team used an app called “mycircadianclock”. In this pilot study, patients were asked to take photos of what they eat and when, and log in sleep and exercise metrics.

Panda’s team was then able to create “Feedometer” graphs using plot points.

“We wanted to see if a personalized circadian rhythm will keep us away from disease,” says Panda.

Most people told researchers that they ate in a 12 hour window. But according to the data collected, most people eat for over 15 hours.

A key finding of the pilot study was that the daily intake duration exceeded 14.75 h for half the cohort.

By reducing the meal timing from a 15 hour window to 10 or 12 hours, participants reduced important biomarkers such as for inflammation.

According to Panda his labs’ research suggests that erratic eating patterns highly influence not just body clocks, but immune system function.

A Look at Cytokine Storm in Muscles

During the global pandemic the cytokine storm and its tissue damaging impact via acute inflammation is front and center.

When the immune system is fighting pathogens such as the Covid virus, cytokines signal immune cells such as T-cells and macrophages to travel to the site of infection.

Scientists classified IL-6 as a proinflammatory cytokine. But new data is emerging in the world of sports science that muscle damage may not be required to provoke an increase in plasma IL-6 during exercise.

That’s because IL-6 seems to play a dual role. IL-6 is classified as a multi-functional cytokine, which can act as both a pro- and anti-inflammatory cytokine.

Myokines are a type of a chemical messenger in a class called cytokines. Many of the cytokines we already know about are the kind liberated from adipose tissue, your body fat, particularly the truncal fat mass that gives you that apple-shape.

The cytokines produced by muscle tissue, which are known as myokines (“myo” being the Latin root for muscles), have anti-inflammatory effects.

Aerobic exercise provokes a systemic cytokine response, but without triggering pro-inflammatory tumor necrosis factor alpha (TNF-alpha) to fight off an infection

Many of these are inflammatory cytokines, such as tumor necrosis factor alpha (TNF-alpha) and interleukin-1 family (IL-1), which are involved in a variety of disease states, including cancer.

Myokines also increase your insulin sensitivity by improving glucose utilization inside your muscles and, acting as chemical messengers, myokines help inhibit the release of inflammatory cytokines produced by body fat.

A burst in myokines was once believed to cause muscle damage.

But now science is discovering that IL-6 activated by exercise, may be necessary to confer some of the benefits of exercise such as improved insulin sensitivity.

Muscle is the seat of insulin sensitivity which is a key to both disease prevention and fat loss. Acute elevation of IL-6 was found to reduce postprandial blood glucose levels and insulin secretion by delaying gastric emptying in men with type 2 diabetes.

Cytokine storm is grabbling headlines. But the myokines produced in muscle tissue may also be an important cytokine, one that helps fight off the unresolved subclinical inflammation tied to chronic disease.

IL-6: Covid Shines Spotlight on Underused Aging BioMarker

Interleukin 6 (IL-6) may not have been a biomarker that most people were familiar with before the Covid-19 global pandemic.

But IL-6 appears to be an effective marker able to predict upcoming respiratory failure with high accuracy. That’s according to several pre-print (non peer reviewed) and preliminary clinical trial studies.

In 1993 gerontology scientist William Ershler first noted that IL-6 is one of the main signaling pathways that drives aging and chronic morbidity. In the past twelve years, IL-6 has emerged as an important hallmark of aging.

A positive knock-on effect of the pandemic, could be to bring this inflammation marker from the lab bench to the doctor’s office. Downstream of IL-6 measuring levels of C-Reactive protein, is a less expensive blood test.

A dysregulation in levels of C-Reactive protein can signal dysfunction that silently does damage to vital organs like the liver and heart, and or leads to metabolic syndrome.

IL-6 is a cytokine, a large group of proteins that are secreted by specific cells of immune system. Cytokines are a category of signaling molecules that send instructions to various organs in the body that do important things like regulate metabolism. IL-6 regulates immunity, inflammation and the production of blood cells.

Chronic elevation of IL-6 reflects ongoing inflammation and is linked to type 2 diabetes and atherosclerosis.

However medical doctors are trained to test for pathology or specific diseases like fatty liver. So the high sensitivity CRP blood test is not always ordered as part of a patient’s routine bloodwork because results aren’t specific to a particular disease.

But data from the Physicians’ Health Study found that people with elevated CRP were about three times more likely to have a heart attack than those with normal levels.

Covid has brought heartbreak and suffering. But the hope among cardiology experts is a wider use of the hs-CRP test, to improve screening for heart disease in the post pandemic world.