How A Non-Invasive Hemoglobin Tracker Is Helping Two Ironman Athletes
Ben Hoffman
Ben Hoffman and Sarah Piampiano are two of the best Ironman triathletes in the world. They train and compete through a grueling schedule that lasts almost all year, culminating in the Ironman World Championship in Kailua-Kona, Hawaii in October. It takes an unwavering competitive fire to prepare for the 140.6-mile race, but a little device called Ember has given them the spark they need to train themselves better.
The Ember device, which was created by the California-based company Cercacor, uses advanced LED technology and algorithms to non-invasively and painlessly measure up to seven different biomarkers that can help athletes better understand their bodies’ inner-workings. The device is about the size of a deck of cards, and it is connected to an LED light sensor that is placed on the athlete’s finger. Using a technique called absorption spectroscopy, Ember can calculate the levels of these biomarkers through the finger’s blood flow and send the information to a smartphone app in as fast as 30 seconds.
“We’re shooting light through the finger,” said Greg Olsen, the Director of Industrial Design and User Experience at Cercacor. “When we do that, we’re actually counting how much of it gets absorbed. So, once we shoot light through the finger, on the other side we detect what light did not get absorbed and what light did. And with that, we start to understand what the properties are inside your blood.”
Among those properties are hemoglobin values, pulse rate, and perfusion index, all of which can be measured in the $399 Ember Sport model. If athletes choose to buy the Ember Sport Premium model for $699, their device will also be able to calculate oxygen saturation, oxygen content, respiration rate and pleth variability index. That may sound like a lot of confusing information, but for professional endurance athletes like Hoffman and Piampiano, it’s a gold mine of data.
“I’m using the Ember device multiple times a day,” said Hoffman, who is one of the ambassadors for Ember. “Every single day, I’m taking a measurement first of day, I’m taking measurements pre- and post-workout, I’m taking resting measurements throughout the day, and then also an end-of-day measurement. Basically, that’s just giving me really concrete evidence to go along with the way that I’m feeling. It’s also informing my decisions about training — recovery, hydration, things like that.”
The ability to measure hemoglobin — the protein in red blood cells that binds to oxygen and carries it from the lungs to the rest of the body — is perhaps the most significant aspect of the device. While traditional methods for measuring hemoglobin require blood to be drawn, Ember is the first device that can measure it non-invasively. That’s a big deal for athletes, especially those who train at high altitudes.
Many athletes undergo high-altitude training in order to give themselves a competitive advantage when they race at lower altitudes. Since there is less oxygen in the air at high elevations, athletes’ bodies will acclimate to the conditions by increasing their concentration of red blood cells and hemoglobin. When the athletes return to sea level, their hemoglobin values will remain elevated for a period of time, which allows for better oxygen delivery throughout their bodies, thus improving performance. The problem is that it’s harder to train in high-altitude environments, and each athlete’s body responds differently to the training.
“One of the things that’s really important is knowing how long you need to be there, maximizing the benefit, and then also not overdoing it,” said Hoffman, who spends a good chunk of his training schedule in Boulder, Colo., which is 5,430 feet above sea level. “It’s easier to end up fatigued and over-trained when you’re at altitude, and it’s just harder for your body to recover overnight.”
That’s why Ember’s non-invasive technology is beneficial: it allows athletes to frequently and painlessly check their hemoglobin values to determine the rate at which their bodies are acclimating, in addition to telling them how long the effects of the training will last.
“It’s really something that helps you titrate how to train those athletes,” Olsen said. “They now have some feedback about what their bodies are telling them, instead of just saying, ‘I woke up today, and I’m feeling so exhausted. I think the altitude is getting to me.’ Now they can at least see the changes happening in their bodies and start to piece that together with how they are feeling.”
While Piampiano doesn’t do much altitude training, she does use her hemoglobin readings to assess her response to fluid intake, especially when she’s doing heat training. She’s also particularly fond of Ember’s ability to measure pulse rate, which helped her manage her training after a near-disastrous crash in June.
“I was getting ready for Ironman Cairns which was the Asia-Pacific Championship in Australia,” she said. “Eight days before the race, I actually got in a bike accident. I was fine — I didn’t break any bones or anything like that — but I had to get stitches, and I had road rash and a mild concussion.”
Even though the triathlon was barely a week away, Piampiano’s coach told her that she needed to get at least three days of rest because her body had to focus on healing itself. Piampiano was itching to continue her training and felt like she didn’t need the rest, but Ember convinced her otherwise.
“I had so much adrenaline from the crash and also the anxiety of this Ironman race coming up in a week’s time that, in my mind, I felt like I was okay,” she said. “But when I looked at the heart rate numbers, it was immediately obvious to me that my body actually wasn’t okay, that it was really in a state of fight or flight.”
Although her morning resting heart rate is typically between 38 and 41 beats per minute in the week preceding an Ironman race, Piampiano’s resting heart rate in the morning following the crash was 63. Her evening resting heart rate, which is typically between 48 and 51 beats per minute, was in the 70s. Ember made it obvious that her body was in a compromised state, so she listened to her coach and took it easy for a few days. After the third day, her heart rate was back to normal, and she resumed her training. She went on to have a strong race at Cairns, finishing as the second overall female.
“In terms of how my body actually felt and was able to respond to the stress of the crash, having the Ember device and being able to monitor my heart rate was really quite impactful for me,” she said.
Sarah Piampiano
In addition to pulse rate, Piampiano says that pleth variability index may be the biomarker that she checks most often.
“Pleth variability index, or PVI, is something that came from a hospital setting,” Olsen said. “They found that, in mechanically ventilated patients, they could monitor lymphatics — how well somebody was responding to the fluids that they were administering to them.”
Olsen says that PVI is a biomarker that only recently entered the consumer space and that Cercacor is still discovering the applications for it. But Piampiano says it has been a great indicator of hydration levels for her, which made a big difference in the tropical climate at Cairns.
“When I was there, as soon as I arrived, I was feeling incredibly dehydrated, and my PVI levels were also indicating that I was extremely dehydrated,” she said. “So, I was just taking in so many fluids, trying to get myself into a hydrated state. Having a metric that showed me whether or not I was hydrated, something that I could check on, was pretty instrumental for me.”
Hoffman says that oxygen saturation and oxygen content are the biomarkers that he finds most useful when it comes to his training. Oxygen saturation, also known as SpO2 when measured peripherally, is the percentage of hemoglobin that is saturated with oxygen. The lower the percentage, the less effective the athlete’s muscles and tissues are.
“I think SpO2 can provide some really good guidance in your training,” Hoffman said. “I think it can tell you, more than a lot of other things, whether or not you’re fully recovered and how you’re responding to the training load.”
At rest, an athlete’s SpO2 is typically higher than 95 percent, but after an intense workout, it can fall below 85 percent. Oxygen content, which is a measure of the total amount of oxygen that is bound to hemoglobin, will also drop when an athlete is fatigued. By monitoring both values, athletes can essentially quantify how “fresh” their bodies are.
Ultimately, it’s the combination of all seven biomarkers that really empowers the athletes. Using Ember, they can overlay the trend graphs from two different biomarkers, which allows them to better understand the patterns that occur in their bodies during training. On top of that, the “smart gauge” feature allows users to compare their current readings to their moving 30-day average, which could inform them of how well their current training regimen is working. In addition, the data adds up over time.
“The more that you participate with Ember, the more it’s going to give you,” Olsen said. “We have some athletes who have been using this for multiple years. Their data sets now are so powerful and rich that they’re able to gain insights as time goes on.”
Hoffman and Piampiano, for their part, started using the device earlier this year. Although both athletes say that Ember has undoubtedly enhanced their training, they also both acknowledge that it has been an up-and-down year. After winning Ironman South Africa in April, Hoffman placed ninth in the World Championship in Hawaii in October, a disappointing result since he finished second in 2014 and fourth in 2016. After finishing as the seventh overall female at the World Championship in 2015 and 2016, Piampiano failed to finish in 2017, as her body broke down due to a large electrolyte imbalance. Still, she finished as the fifth-overall female in Ironman Arizona a month later, and she finished as the first overall female in Ironman Argentina just two weeks after that.
Whatever their results, Hoffman and Piampiano both feel that Ember is a crucial tool that helps them train their hardest without going over the edge. Hoffman also likes that the device challenges traditional notions of training, which often groups individuals together in rigid workout programs.
“It’s coming down to the science of the individual, and if you don’t have the data for yourself that really fits you and what you need, then you’re getting left behind,” he said. “That’s where I think this is really cool, and I think it’s something that every athlete can benefit from, whether they’re trying to just achieve their first Ironman finish or win Ironman Hawaii.”
Going forward, Ember will continue to grow. Cercacor recently expanded the system to be compatible with Android devices, and Olsen says more biomarkers could be coming down the pike in the future. Regardless of the features, users seem to agree that Ember’s wide array of capabilities makes it useful for a wide array of athletes.
“You may or may not use every aspect of this device and what it offers,” Hoffman said, “but even if you’re using half of it or a quarter of it, you’re going to be improving your health and improving your life — and also, of course, your performance.”
