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BridgeWell Briefs #3: Biohacking Is Coming Into Your Exam Room. Are You Ready? · The Integrative Clinician by BridgeWell

• 0:00
  Speaker: Welcome to the Integrative Clinician.
• 0:01
  Speaker: I'm Dr.
• 0:02
  Speaker: Sheri Erwin, and this is Bridgewell Brief, a short clinical conversation designed to give you one idea you can take directly into practice.
• 0:10
  Speaker: Today I want to talk about a word I suspect we're going to hear more about in healthcare: biohacking, continuous glucose monitors in people without diabetes, wearable rings tracking sleep and recovery, red light therapy, cold exposure, infrared saunas, peptides, neurofeedback, supplements, devices promising better mitochondrial function, cognition, recovery, longevity, and metabolic health.
• 0:42
  Speaker: But depending on who you talk to, biohacking is either the future of preventative medicine or an expensive collection of gadgets with really good marketing.
• 0:52
  Speaker: I don't think either answer is particularly useful for clinicians because our patients aren't waiting for medicine to decide what it thinks about biohacking.
• 1:02
  Speaker: They're already doing it.
• 1:03
  Speaker: And that's why I think nurse practitioners need to understand it.
• 1:06
  Speaker: First, what exactly is biohacking?
• 1:10
  Speaker: There isn't really one universal accepted clinical definition.
• 1:14
  Speaker: Broadly, biohacking refers to using lifestyle interventions, biological data, technology, supplements, or other interventions with the goal of improving health, performance, or longevity.
• 1:30
  Speaker: When you define it that way, something interesting happens.
• 1:35
  Speaker: Some of what we're calling biohacking isn't particularly radical.
• 1:40
  Speaker: Sleep optimization, exercise, nutrition, tracking glucose response, heart rate variability, those concepts overlap considerably with preventative lifestyle and integrative medicine.
• 1:55
  Speaker: The difference is often the technology, intensity of measurement, and optimization mindset surrounding them.
• 2:03
  Speaker: And that's where things get clinically interesting.
• 2:06
  Speaker: Take continuous glucose monitoring, for instance.
• 2:09
  Speaker: CGMs were developed for diabetes management, but now we're seeing people without diabetes wearing them because they want to know what happens to their glucose after they eat oatmeal versus eggs, after a poor night's sleep, after exercise, or after stressful meetings.
• 2:28
  Speaker: And I understand the appeal.
• 2:30
  Speaker: Instead of telling someone this food may affect your glucose, they actually can see their glucose response.
• 2:37
  Speaker: That feedback can be incredibly motivating.
• 2:41
  Speaker: But here's where the clinician has to enter the conversation.
• 2:44
  Speaker: More data does not automatically mean better medicine.
• 2:49
  Speaker: A glucose excursion is not necessary pathology.
• 2:53
  Speaker: A wearable alert is not a diagnosis.
• 2:57
  Speaker: A sleep score isn't the same thing as sleep disorder.
• 3:01
  Speaker: And an abnormal looking number without clinical context can sometimes create anxiety rather than health.
• 3:09
  Speaker: That's the distinction I want integrative clinicians to understand.
• 3:13
  Speaker: Don't ask is biohacking good or bad?
• 3:17
  Speaker: Ask what are we measuring?
• 3:19
  Speaker: What are we measuring it for?
• 3:22
  Speaker: Is the measurement actually valid?
• 3:24
  Speaker: And does changing it improve a meaningful clinical outcome?
• 3:29
  Speaker: And will having this information actually change what I recommend to my patient?
• 3:35
  Speaker: Those questions completely change the conversation because now we're looking at evaluating trends or practicing clinical reasoning.
• 3:44
  Speaker: Here's the framework I would use.
• 3:46
  Speaker: When a patient brings in a biohacking intervention, I think through it in four ways.
• 3:52
  Speaker: The first thing I look at is mechanism.
• 3:55
  Speaker: Is there a biological plausible reason this intervention might work?
• 4:00
  Speaker: That's useful, but remember that mechanism is the beginning of the evidence conversation, not the end of it.
• 4:09
  Speaker: The second thing is evidence.
• 4:11
  Speaker: Do we have human clinical data?
• 4:13
  Speaker: What population was actually studied?
• 4:16
  Speaker: Was the outcome something meaningful or simply a surrogate marker?
• 4:22
  Speaker: And does the evidence support the claim being made?
• 4:25
  Speaker: Third, risk.
• 4:26
  Speaker: Could this intervention cause harm?
• 4:29
  Speaker: Could it interact with medications?
• 4:32
  Speaker: Could the patient delay appropriate diagnosis or treatment because they believe they've found an alternative?
• 4:39
  Speaker: And don't forget financial harm.
• 4:42
  Speaker: A $30 intervention and a $5,000 intervention deserve different conversations when the evidence supporting them is equally uncertain.
• 4:52
  Speaker: And the fourth, clinical utility.
• 4:55
  Speaker: This may be the question we forget most often.
• 4:58
  Speaker: What are we going to do differently with the information?
• 5:01
  Speaker: If your patient tracks 14 biomarkers every morning, but none of that data changes a meaningful clinical decision, we haven't necessarily improved their health.
• 5:12
  Speaker: We may have simply created more data.
• 5:14
  Speaker: And this is where I think integrative clinicians have an important role.
• 5:19
  Speaker: We don't need to reject innovation simply because it didn't appear in our NP curriculum.
• 5:25
  Speaker: But we also shouldn't embrace something simply because it's labeled functional, integrative, longevity, or biohacking.
• 5:33
  Speaker: Our job is to stand between innovation and hype, to be curious enough to explore new tools, skeptical enough to ask for evidence, and clinically grounded enough to recognize when conventional evaluation still needs to happen.
• 5:48
  Speaker: And thoughtful enough to recognize when a new tool genuinely gives our patients useful information, because some of these technologies may ultimately become part of routine preventative medicine.
• 6:01
  Speaker: Others probably won't survive good clinical research, and many will land somewhere in between.
• 6:08
  Speaker: That's okay.
• 6:09
  Speaker: We don't have to know today which category every new intervention belongs in.
• 6:14
  Speaker: We need a framework for figuring it out.
• 6:16
  Speaker: So the next time a patient walks into your office wearing a new device, carrying three months of wearable data, or asking whether they should spend hundreds of dollars on the latest longevity intervention, don't dismiss it.
• 6:29
  Speaker: And don't automatically endorse it.
• 6:32
  Speaker: Get curious and ask what they're trying to accomplish.
• 6:36
  Speaker: Look at the evidence, consider the risk, and determine whether the intervention gives you information or outcomes that actually matter.
• 6:45
  Speaker: That's integrative clinical reasoning.
• 6:48
  Speaker: Not chasing every new tool, not rejecting every new idea, learning how to tell the difference between an interesting mechanism, a promising intervention, and something that is actually ready for clinical practice.
• 7:02
  Speaker: I'm Dr.
• 7:03
  Speaker: Sheri Erwin.
• 7:04
  Speaker: This has been a Bridgewell Brief from the Integrative Clinician.
• 7:07
  Speaker: Until next time, keep asking the questions that change everything.
• 7:12
  Speaker: What is the physiology telling me?