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Will Fitbit, 23andMe and "self quantification" change medicine and the nutrition industry?Will Fitbit, 23andMe and "self quantification" change medicine and the nutrition industry?

Insiders discuss what the nutrition industry can expect from self-quantification technology including fitbits,smart-phone blood pressure apps, personal genomics and big data analysis.

February 3, 2014

15 Min Read
Will Fitbit, 23andMe and "self quantification" change medicine and the nutrition industry?

The intersection of consumer technology and health rarely ends well for health. More often than not, health splatters across technology’s windshield in a smear of hydrogenated fat. Television gave birth to the couch potato. Teenage boys play more video games than baseball. Facebook made staying home a social event.

That doesn’t mean technology condemns us to a sedentary life ordering hot wings via mobile app. A new kind of consumer technology is putting lab-level health analysis into the hands of consumers, giving them tools to "self-quantify" everything from their genomes and calorie counts to the number of steps they take on their lunch-hour sanity walk and how well they slept the night before. Far beyond glorified pedometers, future generations of fitness trackers like FitBit and Jawbone envisioned as "passive health monitors" will reel out a granular medical history split down to the second with always-on EKG and time-stamped blood pressure readings. Digestion, exhalation and drug reactions could be overlaid across a fully sequenced personal genome paired with a constantly updated census of the trillions of gut bacteria that make up the human microbiome.

Bring that data and a report from your genetic counselor to your next doctor’s appointment and come home with a health regimen tailored to you and not some approximation of your age, gender and cholesterol count. Your genetic and lifestyle data stream, set against several million equally detailed data streams, may finally hand the nutrition industry the grail it has sought for decades—the one engraved: "This stuff works. And here’s how."

That engraving is years away but to grab that grail, the nutrition industry needs to start thinking, and acting now. NBJ talked to people watching and working in this emerging field to find out what the coming revolution means for nutrition. Here is some of what they had to say.

The revolution will be digitized

Health gadgets grabbed 40 more percent more floor space at last month’s 2014 Consumer Electronics Show than they did a year ago. Jawbone and Fitbit are the market leaders for media recognition but big names like Motorola, LG and Sony introduced their own gadgets. The heart rate monitor pioneers at Polar showed their V800 fitness smart watch and Garmin, the company that brought GPS to sports, demonstrated a fitness band that sets personalized daily goals. Those were just the fitness monitors.

A Silicon Valley company unveiled a wearable EKG device that continuously records heart function to an iPhone and a finger-tip sensor that will record 1,000 hours of pulse and blood oxygen levels. There are also Bluetooth bathroom scales, a fork that tells you when to stop eating and a smart kitchen scale with separate pads for protein, veggies and grains. What you did, what you ate, how your heart reacted and how well you slept illustrate just a few offerings from a few booths in a field in its infancy. It’s not difficult to imagine passive monitoring devices that could track drug reactions, toxicity, cholesterol, brain states, digestion and more. Again, even that would be just the beginning.

All of this accumulated time-driven data will eventually be compared against the subject’s fully sequenced genome and driven through big data engines to deliver plans and protocols personalized down to a one-size-fits-one-patient pinpoint. "This revolution is actually happening," says Jeff Bland, president of the Personalized Lifestyle Medicine Institute. "And it’s happening now. It’s building a $58 billion business that didn’t even exist five years ago."

Jonathan Hirsch founded Syapse, a medical data platform ramping up to divine the plans from the perplexities, and he sees what could look to some like a FitBit fad rapidly evolving from a cult of self-quantification into a true form of self-managed care. "We need to move to a point where we have passive tracking quantification of our bodies and then, when something goes wrong, we have the information at our fingertips," says Hirsch, from Syapse’s Palo Alto offices. "Or we can even prevent something going wrong."

The technology and the data infrastructure are not at that point yet, he says, explaining that innovators need to look beyond any device or protocol that requires uploads and effort from the user and build the sensors and recorders into our ubiquitous, indeed quasi-umbilical, smart phones. "A lot of this will have to be passive if you want to get the mass market involved," he says. But it is coming. "There’s a ton of room for FitBit, Jawbone and all the other companies to create medically actionable quantification."

Early adapters

Few lasting movements start en masse. Tattoos were for sailors and bikers long before soccer moms started sporting ink to PTA picnics. In self-quantification, from wearing fitness trackers at their standing desks to ordering 23andMe workups, the early opt-ins come from some of the usual suspects with a few specialized subsets.

While a PEW study found seven out of ten Americans track their health, the definition of "tracking" lumps in habits as simple as mentally recording what they see on their bathroom scale. To take the technology up a notch requires at least enough income to own a smartphone, and income trends with education. With those factors worked in, Jim Kean at WellnessFX, the San Francisco-based company offering personalized diet and fitness plans based on blood-based biomarkers, says interest in self-monitoring tends to kick in at 35 and jokes that the population of converts is geographically weighted to areas with "the highest number of Whole Foods stores."

Motivation however, is not entirely income, technology or zip code driven. At the moment, the only data collected by many thousands of FitBits could be how often the user opens the drawer they threw the monitor in three weeks after receiving it through the company wellness plan. Right now, the people taking the closest look at their data are the people looking for answers they are not finding anywhere else. Will Van Treuren at the American Gut Project puts it broadly: "Individuals with chronic conditions and athletes trying to optimize performance appear to be the earliest adopters because they have the strongest external motivation."

Hirsch points to conditions like Crohn’s disease and ulcerative colitis not always treatable with simple solutions. He calls such disorders "relatively age agnostic or even diagnostically biased toward a younger demographic." "Where there is a disease, a tech savvy population, and quantified tools including genomics that play into it, from our vantage point, that’s where we are seeing rapid adoption," Hirsch says.

Passive constraint

What consumers in those ready-now niches look for varies by the condition. What they can find is limited by a combination of technology, regulation and vision. For all the ink and pixels garnered by Jawbone and Fitbit, the passive activity monitors are at the moment little more than a digital nag. Kean doubts Nike Fuel or any device in the first wave is going to change the game. "The strategic limitations of this area are that none of these companies are tracking anything meaningful from a health indicator standpoint. Passive activity monitors are carefully avoiding measuring anything meaningful that would fall under the new FDA definitions of Medical Mobile Applications (MMA) which are going to be treated as medical devices. To get into this market, they would need to completely redesign their products and organizations," Kean says, citing the need for a true health-first company to enter the space.

To leap outside the chronic condition core, passive quantification, as Hirsch points out, is the first of many steps. Neil Thanedar, whose Labdoor web site and app is building steam as a disruptive force in supplements with products ranked by lab results, has a Jawbone he stopped using but he views the state of the art as still floundering in the '80s brick-sized cell phone era. "I think we're still stuck at version one," he says, explaining that the industry needs to be looking toward "version five." First, it has to be no-interaction-required passive. "They are trying to create a low-friction environment," he says of companies he’s watching that are looking past the Jawbone vision.

But with the input taken care of, the output has to be engaging, empowering and actionable. "At some point, the output data becomes more interesting," he says. For himself, he’d be much more interested in his cholesterol count than how many steps between the parking lot and his desk. "I think we just have to let the technology run its course," he says.

Hemi Weingarten’s Fooducate app will help build a diet for you but it won’t make you stick to it—or even make you feel bad when you slip—but he can imagine a day when the technology is passive and pervasive. "Even with the coolest calorie tracking apps, most people find it difficult to maintain a food diary for more than a few days. It’s a pity, because people who journal lose twice as much weight as those who don’t. Imagine a tracker that is implanted in the roof of your mouth and tracks everything you ingest."

If nothing else, Bland says, the early "front edge" of self-quantification technology is sowing the seeds of the next great idea. "This is all part of people getting personalized information, not waiting for a doctor and getting a lab test. The more information we have about ourselves, the more we are in control."

Data as doctor

When the devices catch up with the dreams and the data gets tamed, the possibilities appear promising if not outright endless. At the simplest level, easier access to data makes smarter consumers who make smarter choices. Consumers can already find out if they are vitamin D deficient but not many are doing the follow-up testing to find out which supplement or solution had the best benefit. Any technolology that makes that easy means more consumers will take the steps to optimize their nutrient profile and then keep taking those steps.

More complex questions means more complex data, and that is where the genome might be paired with the information gathered by the passive health monitor and then be compared against a sea of data from similar subjects. "Imagine if you are a patient with breast cancer. There have been 50,000 patients with breast cancer who look like you right down to your genome. Wouldn’t it be great to know how they were treated?" asks Hirsch. "What were their outcomes?"

If the "let food be thy medicine" mantra is to become a reality, that data will have to include nutrition and, according to Bland, the research is exploding. "Just query the number of studies that are being published each year in the last five years on genes and nutrients and what you will see is this exponential rise," Bland says. "The doubling of information happens in far less than two years."

Speed bumps

When industries appear overnight, the gas pedal can get sticky but in the wake of last year’s FDA warning letter ordering 23andMe to stop selling its personal genome product as medically actionable information, few would predict a smooth road ahead. Hirsch says he has already seen a "chilling effect" from the 23andMe rebuke. "We have already witnessed companies shutting down and not entering the genomic space because of this decision, companies that would provide highly actionable, validated information about drug reactions or disease predisposition. They decided after the letter came out not to enter the space," Hirsch says. "That’s a terrible outcome of this."

Kean is less pessimistic and calls 23andMe more of an example of "bad management and hubris" than a warning shot from the FDA. "Pathway Genomics is an example of a company that pivoted with input from the FDA and has prospered since," Kean says. "WellnessFX provides direct-to-consumer blood diagnostics and never once had problems with the FDA."

Thanedar believes in caution but not in waiting for the perfect technology with perfect results. "Let’s let version one fail. Let’s let version two be sort of okay, and then just go from there," Thanedar says. "I don’t want the industry to be afraid of technological disruption in the space."

Weingarten isn’t worried either. "Regulators and innovators have always tangoed," he says. "In most cases, once the dance ends, innovation wins."

Speed limits

Not everybody is convinced technology is going to transform nutrition any time soon. The talked-about intersection isn’t on any discernible map yet. Spiral Genetics CEO Adina Mangubat says genetic research will spin off more products for the pharmacy than the supplement shelf for the near future. She counsels patience for the nutrition industry. "For the next five years, I think that they are probably best waiting because we just don’t have that much information and the consumers don’t have enough information either," Mangubat says.

Nutrition faces different challenges than pharmaceuticals to get into this dance. Drugs can be designed to target variations in the human genome, but for nutritional products to have an effect they have to make it past the microbiome—the teeming bacterial diversity of the human gut.

"I don’t think there’s enough knowledge about the genome right now for supplement makers to do much with it at this point, especially because the vast majority of it is really going to be highly tied to the microbiome and the microbiome is in an even earlier stage than the genome is," Mangubat explains.

Traffic cops & gatekeepers

With so much complexity, Mangubat worries about consumers interpreting information that future technology might throw at them. "A lot of doctors don’t have training to interpret all of the genome information. It’s usually one semester, maybe two, of training in genomic anything," she says. "There’s going to be an entirely new wave of medicine that has to be done."

Acting on genetic information is almost certainly beyond the ken of the average consumer, Mangubat predicts. She could see the specialty of "genetic counselor" arising but she is not sure how many people have the interest, and the extra money, to invest in quality testing and solid interpretation. "I hope it’s not an app," she says.

Hirsch concurs with that assessment. Nutrition executives developing genomic-based products should expect professional, likely medical, gatekeepers. "I wouldn’t ignore or underemphasize the doctor for a little while," Hirsch says. "The doctor will play a critical role and the traditional medical system will play a critical role."

Bland also sees physicians in the picture. "I think where this starts is in the early adopters in the medical professions," Bland says.

Responsible companies may want to maintain that relationship lest the self-quantification movement go fringe. Van Treuren worries that too much information too poorly understood could cast a shadow over the potential technologies. "Life hacking can easily become an end-goal of its own, when the point should be healthier day to day living. Balancing the desire for more data about myself and the danger of letting that data obscure the real goal is a key challenge that I think more people will face as these technologies become ubiquitous."

Intersection or on-ramp?

However it plays out, the convergence of citizen and science carries profound meaning for supplements. Consumers will be able to put their hands on more data and, at least in the case of nutrition, take more action. Battered by headline after headline that questions the validity of the industry, self-quantification technology offers a promising path to proving efficacy one consumer at a time. People will know what nutrients they need and they will look for the products that deliver those nutrients best. Eventually all that self quantification leads to a purchasing decisions. "There is no point in having the dashboard if you don’t have the steering wheel," Thanedar says.

For supplement users, their wallet is the steering wheel. Self-quantification, personalized medicine and technologies not yet envisioned could well turn that steering wheel into a microscope. Supplement makers will have to watch the science closely to know where that microscope will focus next.

Keeping up on the research needs to be permanently inked into the day planner, Bland says. "Anybody who stops following what’s going on on a week-to-week basis, they are stillborn. They are intellectually in a museum."



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