Microbiome testing companies have become a thing, offering consumers a chance to see a snapshot of the billions of microbes that reside in their bodies. Some promise even more from a swab: personalized advice on how to improve your health.
“Take control of your gut bacteria to help with weight management, fitness, skin health and more!” says Thryve’s website. Meanwhile, Viome, launched with $21 million in startup funding last year, promises to help people “discover what’s happening inside your gut and get a personalized action plan to fix it,” using technology “developed for National Security.” Their competitor uBiome has a vaguer sales pitch, saying customers will “learn” and “discover” more about their microbiome — and it may have good reason to keep it simple.
There’s no doubt that the microbiome, the community of trillions of bacteria and viruses that live in a person’s body, has a profound impact on human health. But our understanding of the microbiome isn’t advanced enough, nor are the commercial tests precise enough, to guide customized health recommendations, experts told STAT.
If it were up to Rob Knight, a microbiome researcher at the University of California, San Diego, consumer microbe diagnostics would be a tool for science and curiosity, not those looking for health advice.
“It’s going to take a long time to make the methods that are used for research usable at a reasonable price point in a way that’s clinically useful or personally useful for testing,” said Knight, who co-founded American Gut, a massive citizen microbiome project that recently published results of some 10,000 participants.
University of California, Davis, microbiologist Jonathan Eisen has been outspoken in his disdain for the burgeoning biome market, calling out one of the companies on Twitter as the “Theranos of microbiome companies” a reference to the infamous blood-testing firm whose founder was indicted on fraud charges in June. There are very few examples in which scientists can reproducibly look at a microbial signature and tell people if their microbiome is good, bad, or even what to do next, he said.
“I just think that it’s early to be saying that we can make recommendations about what people should do based upon one of these microbiome diagnostics,” said Eisen.
Nonetheless, some companies are doing just that.
Ubiome offers clinical tests on the gut and vaginal microbiome that require a doctor’s prescription but also an “explorer” kit anyone can try starting at $89 or $199 to test three samples from the gut over a period of time. The company offers broad recommendations on types of food to eat (such as certain types of fiber), and how a person’s microbial diversity stacks up against its database of microbes found in healthy individuals.
Thryve, meanwhile, offers its own line of probiotics to go along with its recommendations on gut health. The testing kit costs $135 and a 30-day supply of “personalized probiotics” sells for $39 a bottle.
The firm Day Two takes a different approach, focusing on managing weight or diabetes by using the microbiome to determine which foods lead to spikes in blood sugar. Its product, which includes nutrition recommendations based on the microbiome tests, costs $349.
Viome also offers detailed diet recommendations based on a person’s microbiome with an “annual plan” costing $399. But, the company earned Eisen’s ire after it touted its testing technology as superior to other methods.
CEO Naveen Jain posted a piece on Medium that dismissed 16s sequencing, a common testing approach used in microbiome research, as “producing lots of false results,” and described how Viome can “give you personalized guidance with foods and supplements that really address what is going on in your gut.”
On Twitter, Eisen (who had previously served on the scientific advisory board for uBiome) was dubious of such claims, writing that Jain’s article “is just filled with a series of inaccurate, made up, misleading and self-serving statements that call into doubt every single thing they are doing scientifically and really make them seem like Theranos.”
UBiome staff posted their own piece on Medium countering Jain’s points. “They’re saying some very non-scientific things,” microbiologist Elisabeth Bik, the scientific editorial director at uBiome, said in an interview.
Before DNA sequencing technology was readily available, microbes had to be cultured in a Petri dish.
Decoding the trash talk
To dive into the trash talk among microbiome businesses, first you have to understand how scientists identify bacteria.
Before DNA sequencing technology was readily available, microbes had to be cultured in a Petri dish, a slow process that didn’t really work for most species.
Then, in the late 1990s, researchers began to identify bacteria using a database of ribosomal RNA — which helps assemble proteins in cells — that had been compiled to construct a tree of life. Instead of culturing a sample, they can now sequence the RNA from a particular gene called 16s, which all bacteria and archaea have. In this way, they can usually identify bacteria down to the genus, but the technique is usually not precise enough to pick out the specific species or strain. Bik said uBiome uses 16s sequencing, as does Thryve, according to its website.
In comparison, sequencing all the DNA in the microbiome, called metagenomics, can give more detailed information down to each species of microbe and identify viruses and fungi, but it’s much more expensive. That could explain the price difference between uBiome and Thryve vs. Day Two, which uses this more involved process. Along with expense, the downside of full DNA sequencing, according to Bik, is that “the databases that you compare your samples with are not going to be complete,” so, “a lot of your reads might not really give you a lot of answers.”
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