Minding the Borderlands

Mark Koester (@markwkoester) on the art of travel and technology

Biomarkers: What Are They? Why They Matter? And How to Use Them to Improve Our Health?

When it comes to making improvements in your life, it helps to have some indicator of how you are doing. This is especially true when it comes to your health and wellness but it can apply to anything in our life.

When you think about indicators of your health and wellness, we use the term “biomarker,” which is short for biological marker and in its simplest definition stands for anything measurable that can indicate something about our health.

Alternatively in other contexts like biology (and outside the scope of this article), the term “biomarker” refers to substances that indicates something is alive or living organism. For our purposes, we are looking at biomarkers as indicators of either health or disease.

Biomarkers are in many ways the key to understanding our health, since biomarkers act as an indicator of the presence (or absence) underlying disease states. On an individual level, they also act as benchmark to one’s optimal health but also as a way to measure the effectiveness of a new drug or therapy.

Here are a few examples of biomarkers: LDL Cholesterol, Blood Pressure, Heart Rate Variability (HRV), Vital Capacity, VO2 Max, etc. Each of these can be used to understand your health status and predict risk of certain diseases.

While many biomarkers have been found and are well-researched and documented, biomarker discovery remains an active field in medicine and pharmaceutical industry since blood tests and biomarkers can serve as intermediate markers of a disease in clinical trials and help understand if a drug (or drug target) is effectively treating that disease.

In this on-going series of posts on blood tracking and biomarkers, we are looking at how blood tests and other biomarker data can be use to to help self-trackers and people in general understand their health. In the first post we looked at Benefits of Blood Testing and, in the second, we looked a project created to curate and catalogue the most common blood tests and biomarkers.

In this post, I want to take a step back and try to better define what are biomarkers and understand why they are so important. Specifically why are biomarkers the key both to the medical field and to us as individual humans trying to live well. While the stated goal is to live longer, healthier and more productive lives, I also simply want to have indicators of where I am on the health journey too. Finally, we will conclude by looking at how biomarkers in general and health tracking can be integrated in order to use them as a reliable feedback loop. The goal of health tracking with biomarkers isn’t just to collect data (health or otherwise), but to engage with those health metrics so it informs our decisions and leads to appropriate changes. Hopefully we can better understand what are biomarkers and how to leverage them in your own data-driven health journeys.

Biomarkers: What are they?

The National Institutes of Health defines a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”

What Makes an Ideal Biomarker?

An biomarker has certain characteristics that make it useful for checking on one’s health or disease conditions. An ideal marker should be:

  • Safe and easy to measure
  • Cheap or cost effective so we can do follow tests
  • Changeable with treatments like lifestyle changes, supplements and drugs

Let’s look at a few examples.

Blood Test Biomarkers

Many common blood chemistry tests are biomarkers, meaning that the results can be used to understand if you have a certain disease or not or if you have certain normal biological processes.

A few examples include LDL Cholesterol, which can indicate cardiovascular disease; PSA (Prostate Specific Antigen), which can indicate prostate cancer by measuring a rapid increase in the size of the prostate; or Creatinine, which can indicate the state of your kidney function.

In the process of researching and cataloguing biomarkers, I was surprised by just how many exist already. Several thousand at least. Still a lot of effort is with more research and filtering this down to key metrics. Fortunately about 30-40 blood chemistry biomarker make sense for most baseline measurements.

There is currently an explosion of biomarkers for cancer. In recent study, “researchers identified 788 biomarkers in blood that could be used to develop an early stage cancer screening test for the general population.” The dream is that “the screen will pick up even the small amounts of these biomarkers that might be in the blood at an early stage of the cancer, without necessarily identifying which cancer they relate to. Patients would then be referred for more specific tests, that could narrow down the tumour type.”

All of these examples of biomarkers are all gained by drawing some blood and then running an analysis on it. A lot of hype and disappointment came from the various claims around blood testing with just a pinprick. Unfortunately, besides ketones and glucose monitors, which can be measured with a pinprick, most blood tests require drawing blood.

In view of the fact that your blood cells are replaced every 3-4 months, that means blood tests are not something you can do daily and are best done every few months to check on changes.

Non-Invasive Biomarkers

Several noninvasive metrics can be used as biomarkers too. Many can be done at home or with a wearable. These might be the key to getting a much more real-time feedback on yourself too.

For example, Blood Pressure is one of the most common used to check on heart diseases and cardiovascular risk. Similarly, Low Heart Rate Variability (HRV) and and an irregular heart beat can all indicate a problem, and they can be measured used a heart rate monitor.

Vital Capacity (VC) is another interesting one. VC measures the maximum amount of oxygen a person can expel from the lungs after a maximum inhalation, is well-researched and has been used to help diagnosis lung disease. VC is also an indicator of overall health and wellness too. Currently testing VC requires a lab visit or doctor, but this feels like an area where one day we will have an at-home monitor like we do for blood pressure.

Body measurements are often used as biomarkers too. For example, your weight, body mass index (BMI), and waist-to-hip ratio are commonly used for assessing obesity and metabolic disorders.

VO2 Max is another potentially useful biomarker, since it measures your fitness level and is a good indicator for your risk of heart attack, stroke, etc. A VO2 Max Test involves either running or cycling while being attached to a max that measures your oxygen exchange. As you increase the intensity of the fitness aspect, your oxygen rate is measured until you reach your limit. Having a high VO2 Max is a great indicator of your overall health too.

There is some debate about the reliability of these non-invasive biomarkers, especially compared to blood chemistry tests. In many ways, these biomarkers are more like “proxy” biomarkers compared to lab blood tests. The healthcare and medical research tends to place more credence on traditional blood tests, though time will tell as more tech and data is used.

Biomarkers: Why do they matter in the medical field?

While the term isn’t necessarily used by your doctor or medical professional, biomarkers are a well-established aspect of the medical field. Several are already part of yearly health screenings, and there is a good chance that more biomarkers will be added in the future.

Some medical experts believe that finding and detecting more complicated biomarkers could lead to quicker and more accurate health diagnoses, including mental health.

When it comes to drug and therapeutic development, biomarkers are critical too. In order to get a therapy approved, it must show that it works in a clinical trial. That often translates to showing how the therapy improved one of these biomarkers.

The Food and Drug Administration (FDA) uses biomarkers to determine if a therapeutic works. To understand if a drug or therapy works, you measure the effect on biomarkers. The FDA currently lists over 40 biomarkers that could be used as outcomes for FDA-Approved Therapeutics

In the medical field, your doctor uses biomarkers to check on your health or diagnose diseases. For medical research, biomarkers are critical to developing new drugs too.

Beyond Symptoms: Why do biomarkers matter to us as normal people?

One day you start feeling a bit off. You feel a bit tired and achy, and you have the tinge of a headache. The situation devolves from there: sore throat, cough, loss of appetite, fever, and exhaustion. You are sick with the flu, and these are some of all the various symptoms you might experience.

For most people, the journey into understanding (and improving) our health often starts with the very personal experience of being sick. It might start with the sense that we don’t feel right. Eventually it could turn into any number of symptoms have when they are sick or have a disease.

A symptom is “a departure from normal function or feeling which is noticed by a patient, reflecting the presence of an unusual state, or of a disease.” In contrast, in medical parlance a “sign” is something that can be observed or measured by others. For example, a symptom might be someone feels a tingling or light-headed, while a sign would be high blood pressure or a high temperature. Doctors use signs and symptoms to diagnosis what is aligning you.

These definitions of signs or symptoms seem reminiscent of biomarkers. All reflect the state of homeostasis in our biological systems. There is some overlap between measurable signs and biomarkers, but biomarkers go beyond symptoms and signs.

Biomarkers often reveal a biological situation that we might not have any observable or felt symptoms for. The classic example is pre-diabetes since various biomarkers and blood tests can reveal changes towards the disease before actually being sick. The power of biomarkers is in their predictive value, since you can start to make improvements before you actually get sick.

Biomarkers are like the roadmap and markers in a lifelong journey of health and sickness until death. Biomarkers indicate a problem before a disease or health problem appears. For example, a number of tests can be used to tell if someone has early signs or high risk of cancer, heart disease and many other situations.

No one wants to be sick or get a disease, and in this way biomarkers provide an opportunity to notice dangerous changes before they become full blown disease, sickness or cancer.

For research purposes, a biomarker is a substance in the body that can be measured and used to tell doctors and scientists something about the state or health of a person. Biomarkers are often useful for diagnosis and monitoring of disease. But as normal people we want to have longer, healthier, more focused and happier lives. Biomarkers can provide a potential key to get there.

Conclusion: A Data-Driven Health Feedback Loop with Biomarkers (or how we can use biomarkers to improve our health?

We can use a lot of ways and data to measure our lives. For productivity, you can use time tracking or task logs to understand if you are getting things done. For fitness you might use your training logs and race times to gauge your fitness progress. For me and other “quantified self” enthusiasts, we use tracking and personal data to make our lives measurable. We can then use these metrics as a dashboard or feedback loop to understand our productivity, personal goals, fitness and even health.

Similarly, when it comes to our health, we use biomarkers. Biomarkers are measurable indicators about our biological systems. In this post, we looked at what is a biomarker and why are important in research and personal health. There are increasingly a number of non-invasive yet measurable biomarkers today include heart rate, HRV and others, but in general the best biomarkers remain blood chemistry tests, which require periodic blood to be drawn. For research, biomarkers provide a “yardstick” to know if a drug or treatment works. The FDA even has a list of specific biomarkers. For individuals, biomarkers provide a way to get beyond the signs and symptoms of sickness, since biomarkers can indicate a potential risk of disease or sickness before it becomes a problem.

There is still much to be learned and developed from all of the data collected from blood tests and biomarkers. Some biomarkers are well-understood as a specific indicator, but increasingly it’s important to understand the convergence of multiple biomarkers in complex biological systems. As such, biology and medicine are increasingly reliant on data science, statistical methods, and so-called machine learning to unravel how drugs and lifestyle choices affect our bodies. Basically the question is how multiple (or multivariate) biomarkers can indicate a particular situation or range of situations. It’s an exciting time for science, health analytics companies and tech products, but we are still in the early days of what’s to come.

Similarly, while many people might get a yearly blood test, most people take the tests, get their doctor’s thumbs up on being normal, and forget about it. Unfortunately while you might be normal, that doesn’t mean you are optimal. Doctors and medical field in general are in the business of treating sick people. That results in little focus on treating and improving our wellness. This is where taking a bit of ownership of your data and health metrics matters.

You need to take care of yourself. That doesn’t mean go against your doctor or medical advice, but it does mean that you can be more proactive about your health outcomes and your health data. For example, by studying and understanding your biomarkers, you can know your own health “score.” Your biomarkers could be positive or negative, neutral or complicated, but ultimately they are yours.

I believe strongly that smarter technologies will help us to engage with our biomarkers and health data. I’m even building health tools and health analytics databases that will hopefully get us there.

For me the end goal and “big vision” dream is to turn your biomarker data into a data-driven health feedback loop. It starts by first getting your blood work tested using reliable, well-research and affordable biomarkers. You need to aggregate and store your health records, in particular these blood chemistry tests but others too. Then you need to create an engaging dashboard or portrait for your health. In my mind this is a combination of long-term health metrics you get from blood, genetics and predictive analytics as well as well as shorter term real-time data you can get from wearables and self-tracking. All combined I want to create a clear feedback loop between our tracked data, especially from our blood, and good interventions to improve our health.

Biomarkers are the key since they provide objective and measurable indicators of our biology. Am I or will I be sick? Do I have a disease or potentially in the future? What’s my risk for a certain problem? What steps can I take to not get sick or have a disease? And beyond the sickness, what things can I do to be optimal? These are all important questions that our biomarkers can help answer, and I’m excited by what’s to come.

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