Can we spin Viome test results into health gold?

We spent our summer COVID isolation gardening and completing home projects. But also reading and researching for Aging With Freedom®. What caught our eye is the emerging science of our microbiome. That is the role in health and disease of bacteria in our guts. The gut or alimentary or digestive tract includes especially the stomach and intestines. There are both bad and good bugs interacting in the gut. Encouraging the good and discouraging the bad helps wellness and longevity. We went down the rabbit hole connecting the microbiome to aging. Why not? It’s not like we could go to Disneyland. Seemed like an ideal chance to try an at-home microbiome testing kit. The most well-known example. Viome. A real gut check. We volunteered as our own lab rats. Our hypothesis? Turn Viome test results into success.

Confession. After careers on the bleeding edge of changing industries? We look for emerging trends and new opportunities. Change is how to outperform the average. We thought manipulating our microbiome posed a good chance to age better than average. Viome could tell us both our current microbiome health status. And how to improve our gut health.

The Alternatives

We didn’t mindlessly go with the most popular option. See our prior article, What Gut Testing Is Telling You. We scanned the market and examined the pros and cons of the science and business models offered by each. Several companies currently provide at-home microbiome testing kits. Products we considered are:

  • Biom
  • Ixcela
  • Verisana
  • Wellnicity
  • Thryve
  • Viome

Independent Advice or Conflict-of-Interest?

Now, which to test? All these companies provide an at-home test. The test yields a summary report of your individual microbiome makeup. And recommendations to enhance your microbiome.

We selected Viome from the pack. From what we could tell reading websites and reviews? Viome was unique among this group. At the time, Viome only reported recommendations for both food and supplements. They did not sell supplements. To follow Viome’s recommendations, we could buy over the counter from whoever. Not from Viome, but from somebody else. In other words, it was independent, nonconflicted advice. In an evolving market, you might reach a different choice.

The test reports covered both foods (diet) and supplements. Both the foods and supplements to emphasize. And those to avoid. Viome’s approach left us with greater control and knowledge of what we were taking. And more negotiating power to shop for responsive food and supplements.

Trusted Third-party Validation

Also, Viome had a research partnership with Mayo Clinic. A third-party endorsement of credibility.

That was our plan. . . But you know how plans go. What’s the old saying? Humans plan and the gods laugh. We may have met Loki the trickster along the way.

OUR SUMMER PLAN: VIOME TESTING RESULTS

Here’s how our summer went with Viome.

The adorable collection box arrived in the mail a few days after we ordered. Sample collection? Not to be too graphic, but we had to get our sh*t together. A sample of poop. The tail-end of the digestive tract. Complete with detailed, clear instructions.

We downloaded their app to our smartphones. Then registered our individual collection boxes identifying code. To track each sample. After registering we were given steps to collect a pea-size stool sample (YUCK!). Trips to the veterinarian came to mind. Place the small sample in the provided collection tube. Then send it off to the Viome labs.

A lengthy online questionnaire had to completed. The detailed collection process and instructions are graphic but easy to follow. Step-by-step. Collect the sample. Place the sample in the test tube. Seal the tube. Shake the tube to dissolve the sample in the suspension solution. Enclose the tube in a bio-sample safe mailer. Mail it off.

Next, a lengthy questionnaire (approximately 30 minutes to complete). Questions were answered through the app and grouped into categories –Personal, Wellness, Nutrition, Symptoms and Lifestyle.

Then…we waited. Excited to get our results!

The results arrived in a couple of long weeks. Viome test results arrive electronically through Viome’s website and mobile app. You receive a series of e-mails to keep you apprised of progress. Including, an e-mail to alert you to look at your results. And our reports went on for pages and pages! Though a lot of it read like boilerplate in a legal contract.

Long in Detail, Short on Context

This is where the “professionalism” of the company began to show some cracks. The report is detailed and extensive but hard to follow. And poorly formatted and scattered. It contains unobvious links. We had to reformat to print it out for daily reference. Related information wasn’t necessarily all in one place. The “customer experience” is weak.

Recommendations could be clearer, both in the scientific foundation and the implementation. The why and the how.

And we’re not sure of the foundation of the distribution curve for various measures. If we’re in the top 10% or the bottom 15%, what does that mean? Compared to who? We’re 60ish in good health. If the sample population is all twenty-year-old athletes? We could understand an under-performing outlier result. But we don’t know who we’re compared against. What demographic adjustments, if any, did Viome perform? For instance, is the data adjusted for age, sex, or genetic background? As of March 2020, Viome had sold about 100,000 test kits according to Forbes. What’s the context of that sample set compared to our circumstances? Are we comparing ourselves to other 60-year-olds? What’s the self-selection bias? Are most customers motivated to test due to pre-existing health challenges? When results are relative, we need more details on relative to what? Compared to whom? More context required.

But at this point, we remained committed!

We examined our tree-killer level Viome test results. Two documents. The Viome test results are eighty pages long. The recommendations for foods and supplements are another seventy-some pages. We reformated and printed the associated recommendations for foods to avoid, minimize, or enhance. We created a supplement list and daily dosage schedule for each of us. Posted our two lists to the refrigerator and ordered our recommended supplements.

After ninety days we’d test again and see.

Practical Implementation Problems

The first problem? While there was some overlap, our individualized recommendations were not the same. A superfood for Dan might be an avoid food for Lori. And vice versa.

Now construct a menu from the center of the Venn diagram – the permitted overlap. Eliminating foods that either of us can’t eat. And including foods permitted or recommended to both. Making sure each of us gets some of our strongly recommended superfoods.

Viome didn’t do the integration of our shared foods into a practical shopping list or menu. A couple that cooks and eats together needs that. So we had a lot of work to convert the recommendations into meals we could fix and eat. That alone would be a great value-add for Viome to consider. As is, Viome left us to fend for ourselves. We were grateful to be a couple and not a large family with multiple test results to coordinate!

The second problem? Many of the recommended foods were exotic to never-heard ofs, and not available. Especially in rural Iowa from mainstream grocers. Our local grocery options include Aldi, Walmart, Fareway, and Hy-Vee. So, a better range of size and choice than many non-urban locations. We hunted down many of the new options. But far from all. Even added some new favorites to our diet. Maybe an urban Whole Paycheck store would have more of the exotic recommendations. For those exotics? We didn’t because we couldn’t.

But we soldiered on.

Sample Viome Test Reports

We’ve attached Dan’s reports as PDFs to the article so you can see samples.

Viome Company background

According to a Forbes March 2020 article? Viome is the brainchild of former InfoSpace billionaire Naveen Jain. Jain made his first billion by selling internet content to cellphones. But there are a lot of questions about Viome. And the validity of Viome’s individualized reports dense with dietary recommendations. Viome avoids health claims that would attract the Food and Drug Administration’s (FDA’s) ire. But implicitly suggests health benefits. Some experts in the field are emphatic that Viome is out ahead of the science. From Forbes,

“Viome’s claims are not supported by any scientific literature,” says Jonathan Eisen. [Eisen is a medical microbiology professor. He] directs microbiome research at the University of California, Davis. “What they’re saying is, in fact, deceptive.” A dozen former Viome staffers. . . believe the company was selling a product of dubious value. Six of those ex-staffers describe the food recommendations as “pseudoscience.”

Forbes, Drugs From Bugs: Why Gates, Zuck And Benioff Think The Next Blockbusters Will Come From Inside Your Gut, February 7, 2020

But Viome is also ahead of where the market going. So, we thought it was still worth the experiment.

Challenging Viome Test Results

We followed the Viome recommendations to the letter. Some of them weren’t easy.

Our foods to avoid include many favorites. And there’s a lesson there.

An example? Tomatoes. According to VIOME, our guts both harbored a tomato-borne virus. The virus DNA was present in our stool samples. Viome recommended we avoid tomatoes. Entirely.

Totally avoiding a popular, pervasive, and favorite food is challenging. Could you cut tomatoes out of your diet? That includes sauces and pastes. Not just whole tomatoes. Pizza. Pasta. Salads. Chili. Ketchup. Not so easy right? Remember we were also gardening through the pandemic. Guess what? Before taking the Viome tests? We’d already planted a dozen or more tomato plants. Yes, we’re geniuses. Not.

BUT. . . we questioned many of the recommendations. And this turned out to be an unforeseen benefit. The questions lead us to important lessons.

Discovering New Favorites

An example? Viome’s recommendation to eat chicory root as a “Superfood.” Who knew?

Why chicory root and where can we find it? Why? Chicory is anti-inflammatory. But in North Iowa? Chicory is not a grocery store staple. So, we looked for other sources. This led us to discover a wonderful coffee option. And a new potato alternative.

Café Du Monde

In New Orleans, chicory coffee blends are a staple of Cajun cuisine. This local preference dates back to the Civil War. Chicory was a coffee substitute when coffee was unavailable. The Federal naval blockade of the Confederacy blocked coffee imports.

In modern-day New Orleans, Café Du Monde is a French Quarter culinary institution. We’ve been there. Who doesn’t love a beignet with coffee? Indulgent. Unbeknownst to us, the not-so-secret ingredient in that distinctive coffee is chicory.

Café du Monde sells its chicory coffee online. We now order it by the case. We’re raving fans and enjoy it every morning. Does this coffee truly enhance our microbiome? We hope. But it was a good discovery for us nonetheless. It tastes great. We love the body and aroma of this coffee. It brings back good memories of time spent working in New Orleans. And especially memories of enjoying the quality restaurants there. A small pleasure, every morning!

We did try at least one cheaper chicory coffee alternative from another vendor. Not as impressed. More Butter-Nut level compared to the superlatively rich and aromatic Café Du Monde.

We’ve included an Amazon link if you want to try Café du Monde Chicory Coffee, Jicama (see below) or Viome for yourself. We may get a small referral fee from Amazon if you do. Please note, we are NOT a Viome affiliate.

Jicama

Jicama is another new favorite find. Also known as Mexican radish. Jicama is a crunchier alternative to the Viome banned white potatoes. It’s a great complement to the allowed sweet potatoes. Found it in small quantities at our Fareway store next to the potatoes. Jicama is about the size of large grapefruit. Has a rough and tough outer skin to peel before revealing the crisp white core. Good cooked or uncooked.

The Same-Old, Same-Old Diet Invites Problems

Back to the tomato challenge. Resisting and avoiding tomatoes was hard. But to do it, we wanted more explanation than the original recommendations provided. Start with why.

We contacted Viome for more detail. To their credit, they responded. It turns out that the tomato-borne virus requires an ongoing supply of tomato in your gut to survive. Cut off access to a particular enzyme, specific to tomatoes? And the virus dies off from your microbiome. So, the ban on tomatoes wasn’t lifelong. It only required diet modification for 45-60 days. Enough time to break the virus’s food chain.

This was not clear in the original recommendation. It should be. Again, there’s room for Viome to improve the customer experience. Better explanations with greater clarity of both why and how.

Of course, you could always be re-exposed, but the virus is still rare. Not all tomatoes carry it.

Dietary Monotony

A pattern emerged. Several of the problem foods are a function of a diet based on a few staples. Similar issues with bell peppers and onions. And other examples. The solution is at least partly increased food diversity. And not only switching to another different but still monotonous diet. A new, narrow, non-diverse diet just invites another and different set of problems. The big lesson was the need to expand the diversity of food in our day-to-day diet.

Quality and Clarity of the Scientific Evidence Varies

But we also saw another more problematic pattern. Viome recommendations vary in the qualitative foundation of the underlying science. And in the clarity of explanation. Extensive studies with good repeatability and other indicia of reliability support some recommendations. But not all. Others appear based on less solid research that is at best suggestions for further study. This observation supports Forbes’s cautionary summary. Viome is not transparent about the foundation for recommendations. The curious will want more and better explanations. Like us. “Trust me,” isn’t enough. If you find yourself asking, “But why?” A lot? Viome will frustrate you.

Back to the Experiment – Lori’s Viome Test Results upon Retest

After ninety-days of our experiment? Almost $400 for the initial tests. And 90-days of a restrictive diet. And a couple of hundred dollars of supplements? Both recommended by Viome. More than a $600 investment. Followed religiously. Lori retook the test. Another $149. Now north of $700 into the experiment.
On almost every single measure of the assessment, Lori was worse. Not better. You can imagine. Nonplused. Not, just disappointed, but shocked and displeased. Enough so that we called Viome customer service to ask, “How can this be?” Their answer was even worse.

Switching Microscopes on Us

We suspect we’re not the only ones to question the results. The first question “How faithful were you to the recommendations?”

Pretty darn faithful, including dropping several standard foods from our diet. No oatmeal, no blueberries, tomatoes, green peppers, almonds, and more foods to avoid. Easily 95%+ compliant with the restrictive diet. So, few customers would or could be more compliant. COVID isolation helped. Enforcing very few restaurant meals over the three months. We controlled the inputs.

Some supporting evidence in our favor? The tomato-borne virus was gone. Lack of compliance wasn’t the reason.

The next excuse? Viome said that our prior tests weren’t comparable to the most recent test. What…why? Viome had improved their methods to detect even more gut microbes. The representative’s analogy? Like comparing an initial optical microscope slide with an electron microscope scan.

If so, that defeated the purpose of our before-and-after experiment. They wrecked the experiment by changing the measuring device mid-experiment.

But the microscopes are still supposed to be looking at the same thing. Improved precision or resolution? Shouldn’t impact the relative placement on the distribution curve. We didn’t think this was a credible answer.

Also, if the testing method changed? It wasn’t obvious from any change in the format of the analysis or recommendations from the retest.

An Unscientific Response for a Science-based Company, “How do you feel?”

Then the worst answer. The customer service rep said, “The real test is how do you feel?”

Ever hear of the placebo effect? What a terrible answer for a scientific testing company. It undermines any confidence in accepting the quality of Viome’s “microscope” (the test). Or the scientific foundation of their recommendations. Or the efficacy of following their recommendations. We weren’t looking for subjective improvements. We bought Viome seeking objective improvements in health and wellness. Especially for an investment of more than $700. The whole point of a test is objectivity. So, a testing company selling subjectivity is nonsensical.

We’ll note that Forbes points out that Viome’s CEO is not a scientist, but a marketer or promoter. Is that you, Loki?

Dan started the experiments a couple of weeks later than Lori. We never spent the last $149 to retest Dan. By the end of Dan’s ninety days? It was obvious Viome had destroyed our experimental rationale.

New Conflicts

And the change in testing method wasn’t the only change. Remember we chose Viome over competitors to avoid conflicts of interest. Between our first test and Lori’s retest? Viome started selling supplements. Trickster.

Albeit individually tailored supplements. Arguably there’s a unique value proposition in doing so. Customers don’t have to take a handful of pills from many sources. This is like composing a menu for the supplements. But selling the menu separate from the recommendations.

But the inherent conflict? Selling tests and selling answers to the problems highlighted by the tests? Still a concern for us. It undermines trust in the reliability or objectivity of the test. There’s a clear conflict of interest. It’s no longer independent, disinterested advice.

Sour Grapes?

What about all the enthusiastic online Viome reviews?

Take any review with a grain of salt. Including ours. Look for patterns. But be aware that Viome now has an affiliate marketing program. What’s that mean? Many online reviewers are potentially influenced by financial self-interest. Reviewers can make money by selling more Viome test kits or supplements. This is also relatively new. https://www.viome.com/teamviome

But there’s also well-intended confirmation bias. With better Viome test results that could have been the problem with our review. We often find what we expect to find. Hey, we believe in it. Progress in manipulating the microbiome is a big part of health improvement’s future.

So, does Mayo Clinic. And Mayo is expanding their partnership with Viome. https://www.globenewswire.com/news-release/2020/09/03/2088534/0/en/Mayo-Clinic-expands-collaboration-with-Viome-to-include-heart-disease-obesity-and-insomnia.html

Are Viome Test Results All Bad?

With Mayo Clinic as a partner, can Viome be all bad? Unlikely. The test and the interpretation of the test are two separate things. Viome may be ahead of the science on advice. The advice relies on the test. But the test can still have validity. The test may lead to improving medical practice and diet. Even if the current recommendations aren’t as solid as the underlying test.

Better recommendations based on the Viome test results will evolve. Viome is likely to continue as an important testing company. But we also think the quality of analysis and recommendations must and will improve. Both Viome’s own recommendations. And interpretation and recommendations by others using the Viome testing results. Like Mayo.

As the sample population size grows? So will the potential to find insights and interpret results. The larger the data pile, the greater the statistical power and granularity.

In fairness, you have to start somewhere. And perfection day-one may be unrealistic. Viome, like a lot of startups, is still experimenting. They need to monetize the testing technology.

Disappointed True-believers

We went into our Viome experiment with high hopes. We’re sold on the potential. Better management of the gut microbiome will contribute to health and longevity. We believe in the potential of individualized medicine. Viome promised both. As true believers, we wanted to believe. We were pre-sold. Instead, we came away disappointed. We conclude that Viome’s recommendations are not yet ready for primetime. Still too much marketing and not enough science. A bit of Theranos-like fever? Or fervor. But we’re also reviewing a moving target. Viome continues to evolve.

Viome Test Results are a Snapshot in Time, Not a Trend Over Time

Some of the challenges are not Viome’s fault. Their test is a snapshot in time. At $200 a shot. (Currently on sale at $149.) Ongoing monitoring, repeating multiple tests over time? A so-called longitudinal view that creates a trend line. Impractical and too expensive. Even without Viome’s midstream change in method.

One of the benefits of emerging health monitoring technology? For example wearables like Fitbit, Apple Watch, or Oura ring? Is daily, repeated, longitudinal, measurement of health metrics in nonclinical settings over time.

Trends tell you much more than individual data points. Snapshot, clinical tests like Viome are at best only a starting point.

Viome doesn’t currently have a good technical solution for trend data. Or an affordable business model to capture your evolving gut health over time. But they have to start somewhere. We expect further improvement in Viome test results and recommendations based on the tests.

Beneficial Changes Without the Testing

And many of the big microbiome lessons seem to be doable without the high cost of testing.

  • Beware of the overuse of antibiotics. Antibiotics kill both the good and bad bacteria.
  • Increase your food diversity. Get out of food ruts dependent upon a limited pallet of staples.
  • Add fermented foods like Kefir, yogurt, sauerkraut, and more natural probiotics.
  • Add a probiotic supplement like acidophilus to your health routine.
  • Eat more fiber. More fiber slows digestion and aids the good microbes.
  • A lot of the bad foods are bad for everyone. Reduce your intake of fast sugars and carbohydrates that encourage insulin resistance. Avoid highly processed foods, and bad fats, and cured meats.
  • Food diversity appears to help as much or more than supplements.
  • Supplement bioavailability is not always equal to the naturally occurring variant in food. So food diversity comes before supplements.
  • And some supplements can be inconsistent in quality. We do use supplements but prefer suppliers with quality assurance practices.

This is the Mid-term Not the Final

Think of this failed experiment as a mid-term test. Not the course final.
The whole microbiome field is rapidly evolving. We expect Viome to be a player. But to deliver value, the quality of the recommendations must improve. Both in usability and credibility. Testing accuracy alone is not enough. Major healthcare breakthroughs will emerge from this field of science. We’ll watch for improvements. Both from Viome and others.

What’s This Mean for You? And Viome?

If you have a specific health challenge linked to diet? Say celiac disease, food sensitivities, or Crohn’s? Viome may be a useful immediate aid to change your diet. And do so without the tedium of a careful, systematic elimination diet. Testing one food to eliminate, one after another takes time. Often too much time when you are in distress. Talk to your doctor. Any gastroenterologist worth their salt is paying attention to this area. Like Mayo Clinic is.

For the rest of us? Viome’s food and supplement recommendations are probably ahead of credible science. Even accepting that Viome’s tests are accurate and consistent? Viome’s testing is too costly as one-off snapshots. We need affordable trend data. There are huge opportunities for Viome to improve its recommendations. Viome should share better scientific foundations. (They have already improved their supporting research links for supplement recommendations.) Viome should focus on improving the long-term science and not maximizing the short term buck. Write recommendations with clarity. And improve practical usability by integrating recommendations into menus. Both for individuals and households.

Action Checklist

In the meantime, we as consumers?

Hope Survives, a Better Health Future Ahead

But don’t give up hope. Testing for the microbes along for the ride in our gut is the first step. Testing enables our collective ability to intentionally manipulate our microbiome. The advice will get better. Health innovations are ahead. And we think Viome is an important part of that future.