The first wave: From wearable hype to hangover
It’s been a little more than five years since the first FitBit was sold. Despite hundreds of wearables being sold to date, with 1 in 2 Americans owning one, research shows that at least half of consumers abandon such devices within six months (Rock Health, 2016). Taking thousands of steps doesn’t mean you got results, just that you made an effort. Wrist-based heart rate measurements are also notoriously unreliable.
Result: Once serious players such as Nike and Under Armour have pulled out of a now saturated market split between three companies — FitBit, Apple and Xiaomi. The hope is that these generic devices can be upgraded to provide new value, such as sweat analysis or glucose monitoring, in a way which is consumer-friendly yet accurate.
The second wave: Biometrics in athletics
In 2015, Mark Melancon, pitcher for the SF Giants, made headlines for his pioneering using of high-frequency blood testing (every two months) to optimize his diet and performance. A number of companies, such as InsideTracker and Blueprint For Athletes, provide detailed diet recommendations by comparing a comprehensive blood test against a food database. Other athletes have since followed suit, with the practice spreading to leagues such as the NBA and NFL.
“I think it’s very important to understand what your levels are and why it’s important, but also what helps those different levels, your vitamin levels, and just how your body reacts in different ways according to if you’re low on certain things or high on certain things” — Mark Melancon, SF Giants
Another development in athletics has been the widespread adoption of high-spec wearables and other devices which track vital signs and movement. Whoop, an activity tracker which tracks five metrics to minimize strain and improve recovery and sleep, has seen significant adoption in professional and college leagues. Recently, such devices have begun filtering through to the mainstream, with Whoop adopting a low-cost subscription model, and with the release of the Oura ring.
The third wave: Genetic testing and the microbiome
In the last few years 23andMe and uBiome have made kit-based health testing a popular practice. Gut health in particular is flavor of the month, because it offers to tell consumers what they are doing wrong and how to change it, rather than just what they may be predisposed to. The idea of “diet made just for you” is a powerful marketing tool, with numerous companies promising personalized recommendations in return for your poop and a modest fee. Having good gut health may also help us live longer, healthier lives — in a 2017 study, Chinese who lived to 100 with no known medical concerns or history of disease had a similar gut bacteria to those of healthy 30 year olds.
In reality however, research on the microbiome is still in its early stages. A key issue is separating correlation from causation — to what extent are obesity or diseases like diabetes caused by having certain gut bacteria, and to what extent are those bacteria there because of having that condition vs one’s diet? The credibility of the diet recommendations given by services like uBiome and Viome has also been called into question. Lastly, it seems unlikely that the microbiome will become testable at home— faeces are a non-sterile solid, which creates major hygiene and technical challenges. It also creates a big data gap, because the microbiome changes constantly in response to our diet.
“In one person, if you have your microbiome sequenced, even day to day there are going to be variations.” Dr. Hecht — Professor of Medicine & Microbiology
The next wave: Continuous glucose monitors and urine analyzers
Continuous glucose monitors have until recently only been used by (and available to) diabetics, who need to keep careful control over blood glucose levels. They are also very expensive, with a Dexcom CGM typically costing $1,200 and around $300 for a pack of replacement sensors. Startups such as Sano are trying to make CGMs available to consumers for a fraction of the price — a massive technical challenge, but which if successful will give us much deeper insights into our carb consumption, insulin sensitivity and energy levels than can be obtained from a blood finger prick test. It’s possible that such sensors will become able to track other markers continuously, but that seems unlikely to happen any time soon.
We also believe it will become common for people to test their urine as part of their daily routine. Urine is a sterile liquid which we produce in significant volume every day as a matter of biological necessity, which makes it ideal for health tracking. It contains thousands of biomarkers on our dietary, metabolic and hormonal health, which right now are mostly only accessible via a testing lab. At Bisu, we’re making a bathroom-based device which makes it possible for anyone to capture this data and get results in just a few minutes, so they can get insights into and guidance on their health every day.
But that’s enough shameless plugging — let’s talk about the future.
Integrative omics: The final frontier?
Integrative omics is an exciting area of research which combines genomic testing with something called proteomics and metabolomics to derive deeper insights into our health than isolated genetic, blood or other tests can provide. Proteomics is the study of proteins and metabolomics the study of metabolites, in each case as contained in blood and urine. One of the leading researchers in this area is Prof Mike Snyder, Chair of the Stanford Center for Genomics and Personalised Medicine. While his primary focus has been on the risk of diseases such as cancer, integrative omics also has applications to behavioural health tracking. In a recently published study, Snyder used such techniques to assess the metabolic and inflammatory effects of weight gain and loss in both insulin sensitive and resistance subjects.
“(1) Weight gain is associated with the activation of strong inflammatory and hypertrophic cardiomyopathy signatures in blood; (2) although weight loss reverses some changes, a number of signatures persist, indicative of long-term physiologic changes; (3) we observed omics signatures associated with insulin resistance that may serve as novel diagnostics; (4) specific biomolecules were highly individualized and stable in response to perturbations, potentially representing stable personalized markers” — Integrative Personal Omics Profiles during Periods of Weight Gain and Loss (2018)
There is also developing research to show that it may be possible to identify different dietary patterns based on certain metabolite signatures. By combining this metabolite analysis with detection of inflammation markers through proteomics, the body’s response to such foods can be monitored also. I believe in our lifetime we’ll have a mass spectrometer in our toilet gathering huge amounts of protein and metabolite data every single day, and cross-referencing these against our genetic profile and other data such as our heart rate, blood biomarkers, sleep duration and quality. This data will be shared automatically with an AI acting as our personal, secure health advisor, before it even reaches our physician, and will be used to provide personalized advice, food and supplements. That’s a health future to get excited about!
“My money is on the toilet…based on biometrics, considering all that can be done by sampling by what’s going on with someone, believe it or not, we can learn a lot about your health with a smart toilet “ Ted Smith, CEO @ Revon Systems