Quarterly Health Goals

Better than a New Year's resolution!

As 2022 comes to a close and we head toward a new year in 2023, many of you are likely making New Year’s resolutions.

Setting a New Year’s resolution can be an effective way to set a goal and meet it. However, those who run gyms or work as trainers know that most people’s New Year’s resolutions seem to lose steam come March.

New Year’s Resolutions Have Low Long-Term Success Rates

A Swedish study published in 2017 found that over 75% of New Year’s resolutions are health-oriented. “Success” was defined as at least 70% agreement with the statement “I am, by and large, sticking to my New Year’s resolutions.” By the end of January, 89% of participants were successful, but this dropped to 55% one year out.

My suspicion is that this is overestimating success. For example, how many of the 20% who chose “weight loss” lost the weight they wanted to lose, and kept the weight loss through the next holiday season? Probably fewer than the number of people who 70% agreed with the statement that “I am, by and large, sticking to my New Year’s resolutions.”

An older but longer study from the 1980s found 77% kept the resolutions for one week but only 19% had maintained them at the two-year mark.

Quarterly Health Goals

I propose an alternative: quarterly health goals.

These are not mutually exclusive. For example, the New Year is a great time to develop a set of quarterly health goals, and your resolution could be to implement a set of these goals for the year.

However, I propose here that quarterly health goals be the central organizing principle of your health trajectory.

Here is the process:

• Set a goal for the quarter.

• Set a key performance indicator that you will use to objectively measure your success.

• At the end of the quarter, evaluate your degree of success. See if it still makes sense to move on to the next goal in the following quarter, or whether you need to do more work on your first goal. If the latter, use the insights you gained to make your next-quarter goal more attainable.

• Once you achieve success with one goal, develop a metric that you will continually use to ensure you maintain that goal over the long term, checking in with it on whichever interval makes the most sense.

If you feel confident in the organization of your goals and have enough mental bandwidth, you can set a secondary or even tertiary goal for the quarter. However, this has to involve far less mental effort than the primary goal and must not interfere with meeting the primary goal. It also must not take anything away from your maintenance of the previous quarters’ goals. If all of that is too much to handle, stick to one new goal at a time.

There are a few reasons I like the idea of quarterly health goals more than New Year’s resolutions:

• The smaller time horizon facilitates biting off something easier to chew.

• The quarterly reevaluation establishes a pace and rhythm that prevents mid-year drop-off.

• Quarterly divisions are intuitive. You may work in an area that requires quarterly reports; if not, at least the seasons are intuitive to you and their transitions largely line up with the fiscal quarters. For example, we just entered winter a few days ago and will start the new fiscal quarter in less than a week. A quarter is also fairly close to what many training cycles might last in the gym, and is enough time to let most dietary changes generate clear results.

• While monthly and yearly divisions are also intuitive, I think one health goal a year is not ambitious enough, and 12 is scatter-brained. Even if the only goal you can think of is to lose weight, you probably want better body composition and you could probably benefit from turning that into four goals where you focus on gaining muscle in one, losing fat in another, and maintenance of each in between. Trying to generate 12 primary goals, however, doesn’t allow sufficient focus on any.

The Birth of Quarterly Health Goals

I first thought of this concept in mid-2021 and established it systematically in 2022.

At the Ancestral Health Symposium of 2021, I had recovered from my second case of COVID but had a lingering cough. James Nestor spoke about nose breathing and other breathing techniques outlined in his book, Breath: The New Science of a Lost Art.

I also talked to a poster presenter who had similar head tension issues that I had been suffering from since 2007. He had a connective tissue disorder and had a neurosurgeon install bolts in his cervical vertebrae to stabilize them, leading to relief. There was no way on earth I was going to get bolts in my vertebrae, but my discussions with him motivated me to finally get to the bottom of what was causing my head tension, something I had many times pursued in the past but usually with too little success to stick with anything. The only sustainable way of mitigating it I had found was 30 minutes a day on the elliptical, which I wrote about here.

I bought Nestor’s book on Kindle, and read half of it in the airplane on the way home. While I was reading it, I implemented his basic breathing pattern, which involves nose breathing for relatively slow, rhythmic inhales and exhales, with an emphasis on achieving a very deep exhalation.

Prior to this, I was having spontaneous coughing fits at random times, usually at night. However, in less than five hours I had cured myself with this one breathing technique. In the few days after this, I coughed once or twice each night, and then I stopped coughing altogether.

Thus, by the time I got home, I was very impressed with what I was learning about breathing, and I was very motivated to get to the bottom of my head tension.

My first goal for Q3 of 2021, which ran into Q4 2021, was this: breathe better. My approach was to go through the appendix of Nestor’s book, which had many different breathing exercises for different purposes. As part of my morning routine, I would practice one of them. I would stick with one till I got good at it, and then try another one.

During this time I also initiated testing of my neck situation, which involved an MRI and a bunch of X-rays from different angles and with me doing different things with my neck and jaw. It turned out that I had practically no curve in my neck, and this led to the vertebrae crushing my discs. I had two bulging discs, and one of them had two tears. The doc recommended several physical therapists in the area who might be able to improve the curve in my neck.

In my first PT appointment, my therapist saw that when I extended my neck, I only used my top two cervical vertebrae, while the other 5 failed to join in the movement. When I rotated my neck to one side, my thoracic vertebrae would not counter-rotate as they should, and my manubrium and first rib would not descend as they should. She took the position that our goal should not be to obtain a specific amount of curve in my neck, but rather to achieve optimal function of all the vertebrae when I move my neck.

While I started with the breathing in August, my MRI and X-ray results didn’t come back till October. By the time I had a physical therapy appointment, it was the end of October. By the time we had a clear action plan, it was November. By complete happenstance, a very active PT program became, in retrospect, my primary health goal for the winter. That is, for Q1 of 2022.

It was not until the spring, the start of the second quarter or Q2, that I actually started thinking of these in quarterly terms.

Here is how I had mapped it out on my white board:

At this point, my “functional anatomy” plan had expanded to include training in Functional Patterns (FP), and the PT portion of it had expanded to include an increasingly unwieldy number of home exercises and even home cupping therapy. Part of this was because the sheer quantity of dysfunctional things to work on in PT had mushroomed as we peeled back each layer of the onion. Another was that the body is so interconnected I felt I needed to make sure I was being comprehensive in improving how I function so that dysfunction in one area would not limit improvement in another. The reality was I had already bitten off more than I could chew in this area and I was in no condition to add a new primary health goal, but I naively thought I could relegate this all to a “secondary” goal while I pursued biochemical optimization as my primary.

One very worthwhile piece from the whiteboard is that under “others” I came up with a plan to continue the most useful things I learned from the breathwork. This included the slow, rhythmic nose breathing throughout the day as well as ten cycles of an inhale-4-hold-4-exhale-6-hold-2 box breathing pattern to stimulate my parasympathetic nervous system before I fall asleep. It has been almost a year and a half since I first read Breath, and I still practice these religiously.

Another thing that made sense was a simple metric I could use to make sure the “COVID weight” I lost the year before stayed off. In retrospect, we could say losing this weight was my primary goal of Q2 2021.

Nevertheless, it rapidly became apparent that I was spreading myself too thin. I was doing way too many things for my “functional anatomy” bucket to have the bandwidth to take on anything else, and it was clear that my primary goal for Q2 needed to be to narrow my focus in that area by making the action plan more specific, more precise, and more manageable.

Thus, at the close of Q2 I evaluated everything in that bucket. I cut out FP, relegated many of my daily exercises to once a week, cut many others out, and cut my PT appointments from twice a week to once a week. I reduced my home regimen to less than 30 minutes a day. My PT and I decided together on a plan to narrow the focus of our sessions toward achieving success on a single key performance indicator: 100% full, pain-free range of motion (ROM) of my neck in flexion, extension, rotation to each side, and side bending to each side. Once I achieve this, we agreed, I would rerun a selection of the X-rays to see whether the pressure on the discs had been removed.

This would free up bandwidth in Q3 to move forward with biochemical optimization.

And thus was born the refined plan for quarterly health goals: bite off only a chewable chunk; have a clear key performance indicator; put into a place a manageable maintenance plan before taking on a new goal.

Quarterly Health Goals for 2021-2023

To summarize the above:

• Q2 2021 primary goal was to lose my COVID weight. My key performance indicator and my maintenance rule was to stay under 159 pounds (unless I decided to revise this upward after a muscle hypertrophy goal) and under a 30-inch waist.

• Q4 2021 primary goal was to breathe better. The metrics were poorly defined, but the maintenance rule was to continue the slow rhythmic nose-breathing through the day.

• Q1 2022 primary goal was to address the underlying cause of my head tension with PT. This turned into an exploratory quarter.

• Q2 2022 primary goal was to narrow my functional anatomy plan into something specific, narrow, and manageable. This led to the ultimate key performance indicator of 100% pain-free and full-ROM cervical flexion, extension, and side-bending to be followed up with normalized X-rays. While this goal was put into pursuit, the PT plan was rendered sufficiently on autopilot that it became relegated to secondary status in Q3 forward. I have written about this in more detail in the second section of Three Health Issues Converge on One Bone, and will write more when I finally do the followup X-rays.

• Q3 2022 primary goal was biochemical optimization.

The lab testing I did in Q3 revealed one abnormality that dwarfed anything else that was off in my lab work: my serum biotin, which I had measured for the first time ever, was in the bottom 10.25% of the normal range even though my biotin intake had to be in the top 95th percentile of the unsupplemented population.

This wild discrepancy led me to a hunch that I may have a defect in biotin transport that explains the last 40 years of my health history and provides an answer to a question that has been gnawing at me for 20 years: why veganism led to catastrophic levels of neurological dysfunction that completely recovered on a diet rich in liver and egg yolks.

As my hunch grew stronger that this one finding could have such enormous import, I decided it was of both personal and scientific interest to study my metabolism in what I believe to be a mildly biotin-deficient state.

As I described in High Protein? You Need More Biotin, biotin is a cofactor for pyruvate carboxylase. If it is deficient, this could lead to paradoxical production of ketones from glucose, and could lead to glucose intolerance that is, contrary to healthy or even diabetic individuals, mitigated by consuming protein. Since biotin is necessary for energy production, and energy deficiency hurts methylation, this should lead to a low-methylation state even if everything normally considered methylation-related is optimal. The lack of anabolic activity should compromise hormone synthesis, and the low-methylation state should compromise the removal of estrogen.

Thus, I decided to devote Q4 2022 to characterizing my health in as much detail as possible, especially around everything I would expect to be related to biotin, in a state that I believe to be mildly biotin-deficient.

In doing this, I have also taken on the scientific question of which micronutrient panel would be best to catch this issue. So I am also running all these tests as well.

Thus, my Q1 2023 goal will be to replete my biotin levels and fully characterize all the health impacts this has, and to repeat all the micronutrient levels to see which one does best at both capturing the deficient state and the optimized state.

Currently, I expect to devote Q2 2023 to optimizing my zone 2 cardio, and Q3 2023 to investigating whether any residual anxiety is hurting my cardiovascular function, and resolving it, if it is. In Q4, I will likely pick something fitness-related, but I am going to wait until then to decide exactly what that will be.

Throughout this time, I have maintained my nightly breathing practice, and my weight and waist circumference cap. Once my PT goals are met, if the X-rays are convincing, I will keep the 100% pain-free neck ROM test as my maintenance metric. Once I am done with my biochemical testing, I will select a biotin-related metric and an interval with which to measure it to make sure I keep my gains over time.

What Are Your Quarterly Health Goals?

If you want one-on-one help with your own quarterly health goals, you can work with me as a consulting client, and schedule four appointments three months apart in 2023. I would be your data analyst and strategist. It would not be my purpose to coach you or act as an accountability buddy, but rather to help you analyze your data to come up with strategic goals and key performance indicators related to micronutrient status and energy metabolism.

Or, join in the monthly Masterpass Q&As to bounce your goals and performance indicators off me in a community setting.

Do you have a set of quarterly health goals for the new year already? Share them in the comments!

To those celebrating, Merry Christmas Eve and Happy 6th Day of Hanukkah!