As a passionate believer in the power of nutrition, regularly consuming 25 to 30 supplements a day, I was eager to dive into the personalized nutrition movement, seeking out a spectrum of diagnostic technologies to dial in my health.
On these pages in 2013, I explored what companies in the space need to do to succeed. I suggested the future may belong to a company that comes from a testing or technology standpoint and adds in nutrition as opposed to a supplement company that adds diagnostics on top of its products. I still believe that. Among the keys to success is accessibility. We should be able to lick a sensor on our smartphone and access our personal genome and other key biomarkers. We are not quite there, but we’ve made great strides in simpler diagnostics and delivery.
There are urine-testing devices and toilet-attachments that quantify vitamins and minerals. An EKG can be transmitted from phone to doctor. I still believe it’s not far off where we’ll be able to measure other inputs directly using our mobile phones for various diagnostic tests.
On my journey, I have taken 20 diagnostic tests using the inputs of blood, urine, saliva, and stool. Although some have been around for a long time—we’ve been taking blood for more than a century—analysis for DNA and the microbiome have advanced. In 2016, I paid $2,000 for a full genome test. The same test is now under $500, on its way to $100 before long.
To pair diagnostic tests with products requires transparency from the outset. Smart companies are using the tests to design a better product for individual consumers. I recently took a Sun Genomics test, a personalized program of probiotics based off stool test results. The idea is to “correct” the microbiome using the provided products. I will re-take the test in three months to learn if it’s working.
Most of the results look great, but many left me searching for the “so what?” and also the “now what?” What behavior changes could I make, and would they be easy to follow? The test results can seem overwhelming, and the results difficult to decipher. The conclusions are too often either over-simplified or too complicated. The interpretation and presentation of results are as important as the results themselves.
Robust technology is paramount, but when brands can’t explain what behaviors consumers should change and what benefits they can expect, the value proposition falls flat. I started my diagnostic journey in 2016 with a 23andMe test. My results were difficult to understand. I used the NutraHacker app to decipher the data, which told me some very interesting things, but I still needed expert help to tell me what I should take away from my genome testing.
I’ve done five personalized blood tests, six DNA tests (including my full genome) and seven microbiome tests. Some provide only results, others angle their testing to sell supplements. I’ve done a few additional tests that help me monitor those diagnostics, including the Oura ring for sleep, nitric oxide test strips for blood flow, and Zeavision’s MPOD device for measuring macular pigment (a predictor of macular degeneration and damage from blue light).
My motivation is not solely my interest in the industry, I also want to see where I can move the needle on my health and possibly catch conditions before I see symptoms. I was inspired by Dr. Larry Smarr, an astrophysicist turned computer scientist and one of the top researchers and thinkers at the University of California San Diego in the Calit2 computer engineering program. Larry combined a passion for health with his technology background to produce groundbreaking studies, most notably charting the body’s microbiome and specifically his own gut—efforts chronicled in The Atlantic as “The Measured Man.” I wanted to be the most measured man in the nutrition industry.
Despite the challenge of interpreting the reams of results, I now feel confident many of the answers I found will make a positive impact on my health. I’ve already changed my behavior in several ways. In my 23andMe test, I learned my ability to process vitamin B is reduced 40%, a variation examined by many functional/integrative medicine doctors. I don’t methylate vitamin B properly, and I need a different form of vitamin B. As soon as I started taking methylfolate, my energy increased and I felt better. DNA testing also told me I have the APOE 3/3 gene combination and not the 4/4 combination, which increases the lifetime risk of early onset Alzheimer’s disease by over 50%.
My father suffers from moderate dementia at 89 and his grandmother died at 88 with dementia. I’m appropriately but urgently concerned about my cognitive health, but I was happy to learn that I have the 3/3 combination, which only makes me 9% more likely to get Alzheimer’s. Still, I’m now looking at what I can do to stay sharp well into the century mark.
Though there is significant research on preventing Alzheimer’s—a horrible disease not only for families but potentially for the economy—many people think there’s little they can do about it. I believe the right nutrition can mitigate most diseases, and now people like Dr. Dale Bredesen, author of The End of Alzheimer’s are proving that a combination of nutrition and behavioral changes can delay early onset Alzheimer’s even for people with the APOE 4/4 combination.
Going to the gut
Obviously, the data can be confusing, and I’ve taken multiple microbiome tests all with various different reports on the hierarchy of bacteria in my gut. Detail and diligence varied. I would need an entire issue of NBJ to compare and contrast all of the various reports and conclusions from the microbiome tests, but some of the broad and general findings have changed how I eat and think about food.
One of the more extensive tests came from Diagnostic Solutions Laboratory. This DSL test goes through practitioners, and I learned from my test in 2017 that I had a high level of steatocrit, which means too much fat in the stool and poor fat digestion linked to low lipase production. I also noticed from this analysis that I had elevated anti-gliadin, meaning that I have high gluten sensitivity but shy of a celiac diagnosis. The Vibrant Gut Zoomer test validated that I have high levels of zonulin, both an indicator of gluten sensitivity and a precursor to leaky gut. I changed my diet and took additional probiotics and prebiotics. I cut out all gluten, focused on going lower carb and higher protein and as a result I lost some weight around my gut. Tested a year later, the steatocrit level was lower and fecal zonulin also normalized.
In 2019, I went deeper into my microbiome with three different tests from three different companies. Sun Genomics is more focused on selling supplements than selling tests. DayTwo sells no products, but recommends changing diet based on how certain foods affect glycemic response. Owned by practitioner-channel brand Thorne, Onegevity provides test results and makes product recommendations. Most of those products are made by Thorne, which raises questions of disclosure.
Much of the actionable data from these tests centered around the diversity of my gut. The Onegevity test determined that 91% of the population had a less diverse gut than me. This was validated with the test from DayTwo which gave me a gut diversity index of 9.91 and ranked me at the 99% level in diversity compared to the general population.
DayTwo also ranked foods based on how they impact glucose levels. After logging my meals into the app for three days, DayTwo identified foods such as coconut and strawberries that would support a healthy glucose response. When I pick foods now, I try to pick those marked green on the DayTwo app. Benefits I can expect from these changes include more energy, weight loss, less food cravings, and a lower A1C3 marker. It did not indicate how long I needed to make these changes before I saw results.
All of this sounds easier to interpret than it was. You almost need to be a microbiologist to understand all the details of the report, and I don’t think the average consumer will be likely to see a “so what?” and “now what?” I was also concerned that some of same bacteria percentages varied by company.
In the Onegevity test, I was told that gut inflammation is bad, that certain bacteria can contribute to gut inflammation, and that I needed to reduce certain bacteria in my gut. The report did not give me specific guidance on how to increase or decrease certain bacteria, although they did make product recommendations.
At the end, Onegevity recommended a boiler plate ketogenic diet and recommended foods to include and avoid on this diet. It also made recommendations of Thorne supplements to maintain normal inflammatory processes in the intestines, support my gut immune function, and nourish my beneficial gut flora in the intestinal track.
Interesting, but actionable?
The key behaviors that I changed as a result of all this testing include being more aware of how foods affect my microbiome. I’ll be supplementing missing microbes with key probiotics, and I’ll take prebiotics to feed the health-promoting bacteria in my gut.
I also learned that decreasing stress benefits the microbiome. I’m trying to meditate more, which has proven to be difficult. I’m monitoring sleep quality with the Oura ring, which measures REM sleep, deep sleep, and heart rate variability (HRV). These are important measures that contribute to my overall sleep score. Having the daily monitor on my phone helped to change some of my behavior around this all-important part of life.
I’d still like to discover the impact of certain foods on circadian rhythms. Based on my results and my genome testing and my microbiome testing combined, I believe that certain patterns of eating might be better for me. The science on intermittent fasting is coming on strong. If these tests would tell me not only what to eat but when to eat it, that would be enormously helpful.
Actionable and affordable?
I believe that over time, just as the genome test cost has come down, microbiome testing will be less expensive. The prices for microbiome tests were anywhere from $175 to $400, an expense almost never covered by insurance. As science gets better and more people take these tests, I think the price for microbiome testing should cost less than $100. Still, there’s debate whether a simple stool test can deliver accurate and/or applicable microbiome results. What a user ate the day before can make a big difference. Two tests to the customer, one before intervention and one after, might provide a better value, but the microbiome is inherently a moving target.
In the end, personalized nutrition can only be brought to the mass market consumer when they’re ready for it. As an NBJ Summit speaker said last year, people are not ready to do all the testing that I did and will likely find it impossible to interpret and then use the results to make actionable changes in their health. I think we need to meet the consumer at the very basic level and make it as easy as possible for them.
One of the more interesting companies along the easy-to-do curve is Baze, which has technology to measure blood through a microneedle device. The test is done at home and provides levels for eight basic vitamins. Other companies are offering at-home urine tests. This is how I think personalized nutrition diagnostics will meet the consumer in a massive way. Stanford Behavior Scientist BJ Fogg Ph.D. says, “Behavior change occurs when a behavior is easy to do and someone’s motivated to do it.” If both of those things aren’t true, people don’t cross over the action line and achieve behavior change.
As personalized nutrition gets easier for consumers and meets them where they’re motivated to make change, I believe we’ll begin to see the beginnings of this new field approaching the promise so many see in it. As these tests get easier—and cheaper—we’re going to see which supplements make a difference and which do not. The tests will bear out which products are efficacious and which are not. Can you imagine taking a test and then taking a probiotic that doesn’t improve your gut? I would be disappointed in a product if it didn’t move the needle on my test results. This will be disruptive to our industry in the best possible way.
Personalized nutrition has so much potential, but the industry has to live up to its potential. Consumers will be watching, one test at a time.
This piece was originally published in Nutrition Business Journal's Personalized Nutrition Issue.