Growing up, I saw more of Earl Mindell’s Vitamin Bible than the Good Book itself. Before he bought a health club, my dad was the kind of guy who jogged till his toenails fell off. This may mean I’m more susceptible than most folks to outlandish claims like, "Chronic illness can become a choice rather than just a matter of bad luck." Either way, when I read that statement from Naveen Jain, CEO of the wellness monitoring service Viome, I felt totally down for maximizing my wellness. With Viome, this means collecting and shipping my poo.
There’s mounting evidence to suggest that gastrointestinal microbes play a role in a number of health issues, including cancer, diabetes, obesity, Alzheimer's, Parkinson's, coronary and artery disease, psoriasis, lupus, autism, and depression. The oral microbiota in colorectal cancer is distinctive and predictive. Flemer B, Warren RD, Barrett MP. Gut, 2017, Oct.;():1468-3288. Innate Viral Receptor Signaling Determines Type 1 Diabetes Onset. Morse ZJ, Horwitz MS. Frontiers in endocrinology, 2017, Sep.;8():1664-2392. Oral Lactobacillus Counts Predict Weight Gain Susceptibility: A 6-Year Follow-Up Study. Rosing JA, Walker KC, Jensen BAH. Obesity facts, 2017, Oct.;10(5):1662-4033. Microbiota and neurodegenerative diseases. Marizzoni M, Provasi S, Cattaneo A. Current opinion in neurology, 2017, Sep.;():1473-6551. The gut microbiome in atherosclerotic cardiovascular disease. Jie Z, Xia H, Zhong SL. Nature communications, 2017, Oct.;8(1):2041-1723. The Role of the Skin and Gut Microbiome in Psoriatic Disease. Yan D, Issa N, Afifi L. Current dermatology reports, 2017, Apr.;6(2):2162-4933. Control of lupus nephritis by changes of gut microbiota. Mu Q, Zhang H, Liao X. Microbiome, 2017, Jul.;5(1):2049-2618. Cross Talk: The Microbiota and Neurodevelopmental Disorders. Kelly JR, Minuto C, Cryan JF. Frontiers in neuroscience, 2017, Sep.;11():1662-4548. The microbiome as a novel paradigm in studying stress and mental health. Liu RT. The American psychologist, 2017, Oct.;72(7):1935-990X. Yeah, that's... pretty comprehensive. The way to know what those microbes are is through stool samples.
A number of companies have sprung up recently that will test your microbiome (via your poop), including uBiome, MapMyGut, and the aforementioned Viome. There’s also the American Gut Project, which initially sounds like an opportunity to get in on a research study (i.e., get paid to mail your poo), but no such luck: You still have to pay to play. But the question remains: Are any of these services are actually useful?
One of the chief problems with microbiome testing companies is a lack of FDA approval—primarily, that none of them have it. After Theranos notoriously failed FDA testing of its blood screening services, some customers have become leery of any testing services out of Silicon Valley, particularly for a new field of study like this.
Scientists may have linked some common intestinal microbes to various symptoms and conditions, but that’s not the same as demonstrating cause. However, there is something to be said for the intuitive sense this kind of testing makes: You are what you eat, after all.
And since I’m, you know, somewhat paranoid, of course I went for it. Not that I didn’t have concerns. What would I tell the postmaster when she asked if my package contained anything fragile? Was poop considered fragile? Or hazardous? It turns out I didn’t need to fret, because my kit came with a self-addressed stamped envelope. After collecting my sample in a paper net (which the company supplied), I put the vial in the padded envelope and made sure I wasn’t home when the postal worker showed up.
I also tested my blood sugar, using a glucose testing unit that came with my kit, and self-checked the pH levels in my saliva and urine, but the latter was just another color chart, and all were self-reported numbers I filled out on the Viome app. In truth, I had to buy another glucose test because I’m not good with needles, even just the tiny ones that just prick your finger.
The company claims their service is (surprise!) better than others like it because they do "metatranscriptome sequencing," as opposed to the more common 16S RNA-sequencing. What this really means is that I had to take them at their word that their process is more thorough, identifying bacteria beyond genus and family, all the way to the strain level. Again, it makes sense that more is better when it comes to looking at the 40 trillion microorganisms living in your gut, but it remains difficult to say whether this information can provide more than a highly specific snapshot. (Indeed, other folks have found that the same samples produce different microbial results.)
It’s clear that none of these tests would predict the likelihood I’d be cancer-free for life, but I was still intrigued to know if I’d get good grades on my poop test. I have no health problems and take no medications, but would my results show subpar health? Would a less-than-rosy picture make me change anything? The answer to both these questions turned out to be yes.
My results came in, revealing… I wasn’t exactly sure what. On a traffic light color wheel, my overall score was yellow.
My partner, on seeing the results, asked how I’d like to be buried. I asked how he could possibly forget that I’d made it very clear I wanted to be cremated.
When I dug into the numbers, however, it wasn’t as bad as it seemed. Or was it worse? Here are two charts that illustrate what I mean.
I got 100 percent for this thing I immediately nicknamed the tomboy virus (of course). But is more actually better? When I click on the Latin, I get the following pop-up: The significance of this organism in your microbiome is currently being researched (sic on every instance) and will be updated when new information is available.
Uh, OK. Thanks for nothing.
Then there were longer lists, like this.
I received that same message on all my other gut inhabitants except the last one, which read: "This is a eukaryotic organism (a yeast). They are commonly found in the human gut and thrive on a high-carbohydrate diet. More is to be learned about their function in the human gut."
So that was more information... sort of. Except how can I have only .24 percent (compared to a "healthy" 78.53 percent) when I eat carbs pretty much daily?
My results weren’t fully processed, so I hadn’t gotten my dietary recommendations, just more Latin (which I won’t torture you with) and charts. Like this one.
That looks better than the first one, right?
Oh yay! No need to pick out the urn. Yet.
My body shape, lifestyle choices, and symptoms? I’d reported via questionnaire that I don’t drink or smoke, I exercise every day, and in general, I feel really good. Could my height-to-weight ratio be the culprit? I’m not trying to change anything there, just maintain my weight (which wasn’t an option on any of Viome’s questionnaires, by the way). So I asked the folks at Viome if they were saying I was fat.
"Oh no, your BMI is perfectly fine," said Debra Heald, a doctor of naturopathic medicine and translational scientist at Viome. "We see the shedding of human RNA; human cells are dying off."
I have no idea how I could’ve gleaned that news from the information I’d been sent, and those results didn’t sound... awesome. But when I asked, Dr. Heald told me it was "great feedback." She explained that she could see I was shedding 1.57 percent of my RNA both from my results and from symptoms I had reported, but that something else might be negatively impacting my microbiome (and score): my allergies.
It’s clear that none of these tests would predict the likelihood I’d be cancer-free for life, but I was still intrigued to know if I’d get good grades on my poop test.
"You could be eating a food that’s causing a histamine release in your gut," Dr. Heald said. "The diet recommendations we gave you are pretty basic, but looking at your profile, we want to start at ground zero and then ask your microbes what they want."
Normally, I would wonder if this was some kind of sales job, but as Jain had pointed out to me in a conversation about his company, "We’re not trying to sell you anything." And so far, they weren’t hawking supplements at me or anything, so… this approach felt comforting, at least until I finally got my dietary recommendations.
Right on the overview page, there was a link to supplements I could purchase to help me rebalance my microbiome.
So I went back to Viome. Through email, Jain said, "We work with four to five different companies who are the best in the individual supplements that we recommend. We are always looking for the best products for our customers."
Whether it’s a money-making scheme or not, I’m about as interested in taking six supplements a day as I am in taking six prescribed medications, which is to say, not at all.
"There are workarounds you can do with food," said Fran MacElwaine, a health coach based in France and not affiliated with Viome. "But I do recommend daily probiotics."
When I dug into my recommended food list, I had even more questions. While the "foods to avoid" tab included items like candy bars and fast foods, there were foods I consider pretty solid, like almonds, cherry tomatoes, and yogurt.
While milk (whole and 2 percent) were listed on foods to avoid, skim milk wasn’t on the list at all. Based on what I could figure from other recommendations, I didn’t think I could assume it was off the table.
For instance, I can "enjoy" pomegranates (which means I can eat them every day), but should minimize pure, no-sugar-added pomegranate juice (which means two or three servings per week, max). What about my beloved pomegranate popsicles? I would guess no, but can I be sure?
In the recommended foods list, not even all apples are created equal. A Pippins apple is a yes, but the Granny Smith apple is nowhere to be found. Who made this list? And what’s a Pippins apple?
"They’re making quite sensible food recommendations," says MacElwaine. Straight away, she lets me know that skim milk is a no. "They strip out the fat and all that’s left is the sugar. Low-fat diets generally do more harm than good... fats in your food tell you when you’re full." She also points out that juicing strips healthy fiber out of fruits and vegetables, which explains the apparent discrepancy.
MacElwaine agrees that individuals metabolize foods differently, but she also points out that the microbiome is the collection of microbes that live in and on the body, not just in the stool. In her own practice, she may test blood, stool, and urine. "But you don’t absolutely need the tests," she says. "There’s an element of overindulgence that’s being pandered to."
However, according to Dr. Heald, who admits that this research is in its infancy, Viome’s testing is superior. In her former practice, she’d used the same tests that MacElwaine referenced, that paltry old 16S business. "It isn’t specific enough to say whether they’re good or bad [bacteria]." Perhaps most importantly she adds, "you should consider your initial test a baseline."
So what exactly can we glean from this data? “Nothing at this time,” says Embriette R. Hyde, PhD, with the American Gut Project, who is not affiliated with Viome. Hyde says we’re going to need much more data before any medical inferences can be made. Acknowledging that “the microbiome can vary day to day,” Hyde says we need, “enough data to move above the background noise.”
And yet, I’m curious to know what kind of effect their dietary recommendations would have on my microbiome. Only, I already know I’m not going to be able to do them. I mean, no coffee?
"There is no magic bullet," says Wendy Wesley, RD. Wesley also agreed that their diet recommendations were standard, but wasn’t sure how useful they ultimately were. "Eating right means putting in consistent effort. All the information in the world can’t fix a bad diet."
But I have to wonder if there isn’t something to the personalization that will be helpful eventually. It might not tell me what may be killing me, like I was hoping, but if my results mean that I get more energy or stop waking up with a stuffy nose, it’s totally worth it. And at $599 for a 12-month subscription versus $100 to $200 per visit to a nutritionist, it could simply be a more affordable option. With all that leftover cash, maybe I’ll splurge on a nutritionist to interpret my results.
Lisa L. Kirchner is the author of the critically acclaimed Hello American Lady Creature: What I Learned as a Woman in Qatar. She was once simultaneously the dating columnist for an alt weekly, bridal editor for a society rag, and the religion reporter for a gay and lesbian newspaper. Find more at LisaLKirchner.com or follow her on Twitter @lisakirchner.