The Radical Idea of Avoiding Sickness

“Your TMAOs are a little high,” said Ginger Hultin, my personal health data coach. She was on the phone going over a report that I had just received online from her company, called Arivale.

A few weeks earlier, this Seattle-based startup took copious amounts of my blood, saliva, and stool to test my DNA, proteins, metabolites, blood chemistry, and the microbiome in my gut. Plus, it sent me a Fitbit and had me answer what seemed like hours of questions on my health, happiness, stress, and I can’t remember what else.

Now Hultin, a dietitian, was directing me to my TMAO report online under the heading “Microbiome.” I clicked on it and saw that she wasn’t kidding. My TMAO was more than a little high. It was deep in the red zone.

“That looks awful,” I stammered, not knowing, of course, what the hell a TMAO was. Thirty seconds earlier I had never heard of it.

Hultin explained that TMAOs are metabolites called trimethylamine-N-oxides that are produced by bacteria that populate our guts. These metabolites can be measured in our blood. Having too many TMAOs appears to contribute to hardening or narrowing of the arteries. Hultin, however, was upbeat. “The good news is we can fix this,” she said. “You can bring those down by changing your diet.” According to studies, she added, high levels of TMAOs are probably caused by eating red meat and pork, and, to a lesser extent, eggs.

Busted, I thought. I do like eggs. And meat? I feel like I’ve cut way back. But maybe I should eat even less?

The TMAO test is just a small part of a radical wellness profile offered by Arivale, co-founded in 2014 by Leroy Hood, the co-founder and president of the Institute of Systems Biology in Seattle. Hood, who turns 79 next week, is also one of the original pioneers of genetic sequencing technology, having co-invented the first auto-sequencers in the 1970s when he was at Caltech.

What Are Your Genes Telling You to Eat?

Now Hood is trying to keep me and other people healthy with Arivale, a company that he co-founded with health care venture capitalist Clayton Lewis, who is the CEO. It’s the commercial culmination of 50 years of work in genetic sequencing, personalized medicine, and systems biology, which aims to overturn traditional medical practices that think of the body as disparate, siloed parts. Systems biology tries to see how everything works together, and Hood sees it as the foundation of what he calls P4 medicine: predictive, preventive, personalized, and participatory.

That philosophy runs through Arivale. It’s one of the first companies to offer a panoply of molecular and traditional tests and attempt to make sense of the resulting crush of data in service of keeping people well — rather than waiting until they’re already sick to treat them.

Arivale’s testing used to cost $3,400 and included a whole genome sequence, which it performed on me. The company now offers a less-thorough genetic screen, plus a battery of other tests and three discussions with a wellness coach, for $999. You can continue the coaching indefinitely for $125 a month.

Born in Montana in 1938, Hood is a brilliant curmudgeon. He had a falling out with Caltech in the 1980s over his insistence, as a physician-biologist, on bringing engineering and other specialties into interdisciplinary efforts that were then quite new and still controversial among traditionalists. Later he clashed with administrators at the University of Washington and left to found the Institute for Systems Biology.

Hood didn’t launch Arivale as just a commercial vehicle. He wants to have the company’s customers help him study what it means for people to be healthy. He hopes to better understand what happens in the earliest stages of when a person shifts to a state of non-healthiness, instead of waiting until symptoms show up.

A study published in Nature Biotechnology in August analyzed 108 healthy Arivale participants. It was too small a population to detect much, but it pointed to the kinds of intriguing correlations that might crop up more frequently as more data that usually isn’t collected together begins to be combined. For example, blood tests on people who have an increased genetic risk for inflammatory bowel disease — but who have not yet developed the disease — showed that they had low levels of cystine, a form of the amino acid cysteine that is a precursor of a powerful antioxidant. People who already have been diagnosed with the disease generally have lower levels of cystine. This means, Hood says, that the people who don’t yet have the disease could keep their risk down by taking cysteine supplements.

I’m still sorting out how valuable Arivale’s findings about me will be. In the meantime, I caught up with Hood on the phone to talk about how Arivale fits into his career as a physician-scientist. Here are the highlights of our conversation.

What has been the reaction to the Nature Biotechnology study?

There are people that thought it was revolutionary. There were people who didn’t care. And there were people that were skeptical because there was such a small group of participants. But the overall feedback that I personally have gotten is that many see this as a revolutionary and transformative approach to health care. One of the challenges is to educate physicians and health care professionals, helping them realize that scientific wellness, with its testing and analysis, is going to enormously extend what they can do as physicians.

What is your goal with Arivale?

We have three main aims. First, to create more science around scientific wellness, so that we can transform health care by applying dynamic data clouds of information and following wellness as it goes through health-state transitions. Second, we want to get biomarkers for those transitions for all the common diseases and, using the systems approach to medicine, work to reverse at the earliest transition point diseases such as Alzheimer’s. Finally, we want to argue for the importance of scientific wellness coaches, so that they become a major component of health care delivery. Because they can persuade people to make the lifestyle changes essential to improving their health.

But how do you make sense of the firehose of data that can be gathered now about one person?

This has been a huge challenge. Sequencing is less expensive, and so are many other tests. That’s why we’re working very hard to understand how this data correlates for first healthy people, and then those with diseases. We’re developing computer-driven analytics, but I wouldn’t say it’s AI. That term is so overused.

You were part of the planning for the Human Genome Project, which was officially finished in 2003. Did it produce the results you thought it would?

The Human Genome Project has transformed virtually every field of biology. It’s transformed how we understand evolution, and it’s allowed us to integrate biology, engineering, and computer science. The idea of biology being cross-disciplinary was revolutionary at the time. The genome project also defined all genes, and by inference, it identified proteins, so that we could start thinking about systems experiments in human beings beyond genomics. It is foundational for this new concept of scientific wellness, where your genome sequence is the framework on which we integrate and analyze all the other types of data.

You have an outsized personality. How had that affected your career in science?

I think there’s only one thing that’s really important in biology and that is: what have you done? I know a lot of outsize personalities that I consider utterly trivial, and others who are quite modest that have really accomplished remarkable understandings. I always make bold and often too many unreasonable proposals, but on the other hand I’ve done that my entire career and generally have accomplished my ambitious goals in the end.

You’re stepping down from running the Institute of Systems Biology as president, but you’re staying on as chief strategic officer and member of the board. You’re not really slowing down, are you?

Nathan Price and I are going to be writing a book on scientific wellness that describes it in a historical context and provides the framework for where we are today, and what this will mean for the future of health care. I will also continue in my role as chief science officer and executive vice president at Providence St. Joseph Health [a nonprofit hospital system].

The other thing I’m doing is I’m slowly trying to move myself from 100 push-ups to 120 push-ups. I’d love to say I’ll increase my ability to do exercise by 20 percent in another year, by the age of 80.

This story was updated on October 18, 2017, to remove an outdated reference to whole genome sequencing. Arivale no longer offers it.

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