141. Gut Check! Viome’s Momo & Guru Decode Your Inner Microbiome

[00:00:01] Erum: Momo, chief Science Officer of Viome Guru, chief Technology Officer of Viome. Welcome to the Grow Everything podcast.

[00:00:10] Momo: Nice to be here.

[00:00:12] Guru: Thank you so much. This is great.

[00:00:13] Erum: Awesome. Yeah, I mean, Carl can't be here today, but we have lots of questions to get through. I'm so excited to have you on. I've been looking at your company. It has been so exciting. There's been different microbiome adjacent companies, and but you guys were the first that got into my feed, so I'm really excited to dig in.

[00:00:33] Erum: But Viome was founded on a pretty radical idea that we could decode health from the microbiome. So what was the aha moment that led your team down the path, and what problem were you really trying to solve?

[00:00:48] Momo: I guess I'll go with this. So, my main motivation was back in two thousands I had an autoimmune disease that was not curable and modern medicine basically had no way to cure it or to reverse it. It was just a downhill slide. And the only thing that modern medicine can do is slow it down. And, after a lot of research and a lot of trial and error, I was able to completely cure myself of that autoimmune disease.

[00:01:10] Momo: And that was a big aha moment, combined with my understanding of how the human biology works and that it's not just our own genes, but it's also the genes that are contributed by microbes in our oral cavity and our intestines. that's basically the aha moment, that we are a very complex machine and that we, if we can understand how it works and how we can modulate different parts of it, that we can actually keep it healthy for a very long time and prevent illness.

[00:01:38] Erum: Yeah, I love that. I mean, listeners of the Grow Everything Podcast know that the microbiome is one of my favorite topics, not only within ourselves, but also environmental microbiome. I'll put a pin on that. But one of the things that we also talk about is that biology is code. We look at the DNA strands of, A TCG, but there's also RNA, when I say biology is code, I feel like guru, your eyes light up since you're the CTO.

[00:02:03] Erum: But, as someone decoding both human and microbial gene expression, what does this mean to you? Do you see biology behaving like a language or something more?

[00:02:14] Guru: Yeah. biology is information, at the end of the day, and information, means math, which is what I care about a lot. And I work on a lot for many, many years, for actually many decades now. So, I'm super excited to be able to get the kind of high resolution, high fidelity data that we are able to get in bio on many, many fundamental aspects of biology.

[00:02:40] Guru: I have always believed that, modern biology is really based on data science and ai, just because of the amount of data that we can collect about individual molecular processes. And the interactions among so many different data points that could possibly, not be understood by any human brain.

[00:02:59] Guru: It really requires a tremendous amount of additional, AI and data science processing to be able to understand. and it's interesting that you say that this, might look like language. I have grown up in the world of natural language processing and, the usual kinds of things that we work on in ai.

[00:03:17] Guru: But, I still think of language as one dimensional, It's a sequential set of symbols. but biology is not one dimensional, right? Biology is four dimensions, You have the three dimensional structure of most molecules. and the bigger the molecule, the more complex it is, protein molecules and the nucleotides and so forth.

[00:03:37] Guru: But there's also the time dimension, it's changing all the time. So it's four. Dimensions, three space and one time. And that makes it, I think, a lot more complex. I think the kinds of interactions that happen among molecules and data points in this sort of four dimensional space is something that we can capture to some degree, in vi's data.

[00:04:01] Guru: and I will say that the scale of the data that we have in Viome actually makes it even more interesting. Viome has the largest meta transcriptomic dataset that I know of, and that has been the most exciting part of joining Momo to create this company and to create a platform that can actually bring this modern sort of information science oriented biology to the masses.

[00:04:26] Guru: so, yes, I'm super interested and, work every day on figuring out this. Biology's code or biology is a data model idea and creating digital twins so that we can actually, solve real problems and so forth. And yeah, I can go on forever on this because, I've, so many different thoughts about how this modeling of biology can actually bear fruit in solving practical problems.

[00:04:49] Erum: Yeah. I mean, let's dig into the data a little bit. So, a lot of microbiome tests analyze DNA, but I believe volume focuses on RNA. and our listeners will be familiar with that. Look up the central dogma of biology and, you guys will be able to dig into the different, we like to say the biological stack.

[00:05:08] Erum: so why does that distinction matter for understanding human health, DNA versus RNA?

[00:05:16] Momo: Okay, I'll go with this one. So Yeah, that's a huge distinction. And in fact, no other company provides RNA sequencing because it's very challenging. But we spent many years developing this technology at Los Amos National Laboratory, and that's what we licensed, at vial. So there's a fundamental difference, I wanna portray that in both the human side and the microbial side.

[00:05:36] Momo: So on the human side. We know that a human body will have tissues like liver or organs like liver, kidneys, and brain. What most people don't quite click right away is that all of those tissues contain the exact same DNA. So every cell in our body, whether it's a skin cell or neuron, it'll have the same DNA that we inherited from our parents.

[00:05:58] Momo: So how can we now sequence DN, A and say what type of a cell it is? we can't, because by sequencing, DNA, what you can say is the potential. You can say, this person, this DNA sequence has a potential to be a skin cell, a kidney cell, a liver cell, a brain cell, but you don't know which one it is. The only way to know that is if you sequence the RNA and the RNA tells you by quantifying RNA, it tells you.

[00:06:26] Momo: Which of the 22,000 human genes are activated and to what level they are activated. And so if you sequence someone's kidney, liver, and brain using RNA sequencing, you can tell with absolute certainty that's a kidney tissue or liver tissue or central nervous system tissue. So that's one very important distinction that it's the RNA, that determines the function of an organ and not the DNA.

[00:06:50] Momo: And second very important, topic for our conversation is that RNA can also determine the healthy from a disease state. And so if we just focus on one organ, let's say liver, and we ask the question, okay, what does a healthy liver looks like look like? Well, a healthy liver is going to be expressing maybe 2000 genes from those 22,000 genes encoded by DNA.

[00:07:13] Momo: So we will see RNA for about 2000 genes and these genes. Are activated in liver and they perform the function of detoxifying our body. And if they're activated and at certain level of activation that liver is healthy. But when some of those genes are activated too much or too little now you can have a diseased liver.

[00:07:32] Momo: You can have a liver that is either hyperactive in certain FA functions or underactive in certain other functions, meaning it's not performing them well. And now you have a diseased liver. So not only can RNA tell you what type of a tissue it is and what kind of functions it's performing, but you can actually distinguish very easily between a healthy state and a disease state.

[00:07:53] Momo: And then last but not least, these levels of gene activation, both on the human side and the microbial side, can be modulated mostly with our nutrition. so the nutrients that we ingest determine the level of these gene activations. And if you can now identify which genes are hyperactive, you can learn how to slow them down.

[00:08:13] Momo: To bring them back to healthy levels. And if you can quantify genes that are underactive, you can now learn, how do you actually accelerate them? How do you activate them more so that you can bring them back to healthy level so you can basically modulate human physiology.

[00:08:27] Erum: Yeah. Oh, wow. I love that. I mean, the terms that you're using, and I know it's often used in biology, like expression modulate, that's really a moving right where DNA is like a blueprint. It's static. When you're talking about RNA, it sounds very much like a concert. Like you have to observe this.

[00:08:44] Erum: And it's living it sounds like it's living data but that means that uncertainty is the norm when you have a lot of RNA going on and you are taking snapshots. But with that in mind, can you share a time when you guys experienced maybe a failure or total surprise that reshaped your approach?

[00:09:03] Erum: Was it always RNA from day one?

[00:09:05] Momo: Yeah, it was always RNA from day one. So this is back in 2010. I was a scientist at Los SMOs National Laboratory, and I wanted to understand and quantify all parts of the human body that are relevant to our health. And at that time, I analyzed all of those layers that we discussed in terms of, genetics, DNA.

[00:09:23] Momo: transcriptomics or RNA and then proteomics protein, and then metabolomics, metabolites. And it turns out that in my strong opinion, meta transcriptomics or RNA sequencing is the single most important technique. And the reason is because it both provides you the function and the composition.

[00:09:41] Momo: So you can profile oral commu, oral microbiome community or stool microbiome community with RNA, and you can get two very important pieces of information. You can understand who is there at the highest resolution, which DNA analysis can also provide, but now you can actually quantify what functions are those microbes performing and to what level.

[00:10:02] Momo: then you can understand are they performing beneficial functions for you, and to what extent are they performing harmful functions for you and to what extent? And then you can provide nutritional advice to modulate those functions back to healthy.

[00:10:14] Guru: If I can give another, Perspective on the same topic. again, I just wanna go back to the idea that, the reason we started bio was because we wanted to tackle the huge epidemic of chronic disease on the planet, Especially in the developed world where lots of different factors have contributed to an extraordinary growth of chronic disease, especially in the last few decades.

[00:10:39] Guru: And it's become a common occurrence everywhere. And in my case, as an example, right? A lot of people in my family had many different chronic diseases. That was one of the reasons I wanted to get into this field. but I want, wanted to go back to this idea of the dynamic nature of RNA. And, it's impossible for us to understand why chronic diseases develop.

[00:11:03] Guru: And chronic diseases resolve. If you are simply looking at a static molecule like a DNA, right? You have to look at something that's changing dynamically, which contributes and explains the onset and the progression of chronic disease, So one of the, most important aspects of this dynamics of the biology is understanding sort of the nature of, biochemical interactions as early as possible.

[00:11:31] Guru: So when, you go back to the, the central dogma, if you are waiting until, the metabolites are already, being produced and you're looking at some of the proteins, they are already downstream of what you might want to see.

[00:11:46] Guru: If you want to track early signs of chronic disease. our point was, the reason we wanted to pick on RNA is because we think that getting to the earliest possible signals that, that say that chronic disease might develop will be easiest to look at when you have transcriptional and RNA type information.

[00:12:06] Guru: That's point number one. Point number two, I wanted to also mention you, you asked about whether, , we had a total surprise that reshaped our approach, right? On the machine learning side. On the machine learning side, on assuming that, we end up having the right kind of data, which we do.

[00:12:21] Guru: In fact, in Viome there's always a question about what are the best methods. machine learning is a very vast field with many, many methods, and the question always is, what methods in machine learning would really work for this dynamic biology? And we had to experiment with many different machine learning methods.

[00:12:45] Guru: in the beginning I thought that we might end up having enough, let's call it ground truth, or some kind of labels that we could end up learning through those labels. But later on we realized that most of the methods that tend to work in this world of dynamic biology is unsupervised methods, which are picking up signals and interactions among various molecules without any.

[00:13:13] Guru: any given ground truth, meaning that no supervision needs, to be around you just pick up in an unsupervised fashion. What are the covas of many different, factors what RNA molecules are expressed when other specific RNA molecules are expressed, right?

[00:13:30] Guru: That's a covariate factor that you can pick up by using unsupervised machine learning methods. So that type of approach, I would not have guessed very early on, but as we got more and more data, we use different methods. And now we are looking at self supervised methods in machine learning, which is the one of the rage rages right now in ai, transformer models and so forth.

[00:13:53] Guru: So we are looking at self supervised methods and unsupervised methods way more than, supervised methods. We do use supervised methods in some cases, but we use all these more advanced machine learning methods as well.

[00:14:04] Erum: Yeah, no, thanks for sharing that. I was listening to a podcast between Huberman and Lex Friedman where he was talking about the. Self supervised being that next level, the level shift for, machine learning, which is very interesting and it's great that you're looking at different models to see what is best for your use case, and your use case being understanding health and how we can help people through their biomes.

[00:14:31] Erum: So you're analyzing gene expression and you're collecting samples from gut, saliva and blood. And you are looking at, you're seeing RNA, I'm looking at RNA and that, gives you a high resolution, but can you give us a little bit more insight into what's actually happening in the body? Like how does that shape the recommendations via makes to people?

[00:14:54] Momo: so let's talk about these functions. So we have many synonyms for these biochemical activities. So we call them biochemical functions or just functions. There's also a term called pathways. But I want everyone to take away what a biochemical function is that everyone is familiar with, which is making beer.

[00:15:11] Momo: How do you make beer? You basically start with something that we, that chemists call substrate, which is barley, and you add yeast. the yeast performs several biochemical functions which transformed that barley into ethanol or alcohol. a simple biochemical function is simply using a substrate molecule to produce a product using a bunch of chemical reactions performed by enzymes.

[00:15:35] Momo: so if we just then expand that to the human oral microbiome and gut microbiome, there are several thousand such reactions occurring when the flood of. Substrates arrives every time we feed. So a typical diet, omnivorous diet will introduce about 15,000 different kinds of molecules into our digestive tract.

[00:15:57] Momo: And these mo and these molecules act as substrates. And so some of the most common things that people will be familiar with that have tracked, the, microbiome field would be the production of short chain fatty acids in the colon from undigestible fibers. And so you have a very similar reaction where you have conversion of polysaccharides into these short chain fatty acids what is very important for people to understand is that, not only does our f do nutrients in our food feed ourselves, but they feed our microbiome. And the reason that's happening is evolutionary, develop co-development, basically co-evolution of these microbes with humans, where we now expect the microbes to provide certain benefits to us by consuming the food we provide to them.

[00:16:45] Momo: And I'd like to give one example, which I think is super important. The very first thing that happens to a human when it's born that is super important for his or her development, is the acquisition of a healthy microbiome that is literally minutes after birth. That is the most important event that's going to decide how healthy that person is going to be in terms of immune health, cognitive health, mental health, and physical health.

[00:17:13] Momo: And , what we have. Evolved to do is to transfer poop from the mother to the baby's mouth during birth. , that's basically how it's happened for hundreds of thousands of years. We have now started cutting out that by saying, Ew, poop is bad. We need to get rid of it. And so now everything is sterile, everything is, super clean. But that transfer from the mother's gut microbiome to the baby's gut microbiome is extremely important. And it has to be done at that moment of birth. And it has to be done, in, that moment because there are a lot of bacteria that cannot survive in oxygen environments. There are anaerobic bacteria, and so they're transferred then.

[00:17:52] Momo: one example that I want to give here is that humans have evolved to produce breast milk, where a significant portion of the calories in breast milk cannot be consumed by the baby. They cannot be basically utilized by the baby. the calories are specifically meant to feed very specific bifidobacteria that are beneficial for the baby's development.

[00:18:16] Momo: those bifidobacteria are specialized in consuming these human milk oligosaccharides, and then they create basically a very healthy environment in the colon that not only helps the baby develop, but prevents pathogens from coming in. that basically, synergistic relationship persists throughout our lifetime.

[00:18:36] Momo: And we can now see with many studies that older people who are healthy have a different microbiome than older people who are not healthy.

[00:18:44] Erum: Yeah, I mean, that's incredible. We, interviewed, her, Her name is Stephanie Color from Per Seny Biosciences. And they work on creating, a formula that had different microbes in it for babies, especially for, babies that are born in.

[00:18:58] Erum: a microbiome light environment. I'm trying to think of the words to use here, , it's, This whole topic of getting a head start with your microbiome is really important. And then there's some people that don't, and for many different reasons, they have some issues. And we wanna know what is it?

[00:19:16] Erum: Is it the microbiome? And you can learn about this through biome. So Viome reports offer food supplement longevity advice. I would love to know, so we talked about decoding or understanding through RNA sequencing, and how do you get from that to personalized insight? and what role does AI really play here?

[00:19:39] Guru: Yeah, let me take that. the amount of data that comes out of any given biological sample that is sent to bio is really very huge, We are looking at tens of millions of sequencing reads that come out of a sequencer like Illumina using all the methods that Momo and team have developed in the wet lab.

[00:20:02] Guru: But then the question is, how do you take all those sequencing reads, make sense outta them, and then turn them into meaningful advice and recommendations and insights for individual humans, especially even if they don't have. deep scientific background, So how do you make all of that stuff consumable to the masses, So we have, indeed applied a number of AI steps in that process from the sequencing reads, all the way to the information that you can see on your mobile app when you get a biome test. and let me just lay out a few of those steps. I think, the rest we can talk about if there's time, but there are three or four pretty key steps.

[00:20:46] Guru: Step number one, I would say is, bioinformatics, where every read, which is approximately, let's say 150 nucleotides, that comes out of the sequencer. Every read is aligned with a genome that corresponds to one of the micro microbiomes or microbiome organisms that we are looking for.

[00:21:05] Guru: And what are the specific genes or functions that we are looking for so that we can understand not just the taxonomy of the organism, but exactly what is the function that is currently being expressed by that organism? Because remember that the same organism can be commensal most of the time, but under certain circumstances it can become pathogenic.

[00:21:33] Guru: So the question is, which specific gene and function is being expressed? So that requires an alignment of the read that comes out of the sequencer with the specific genes from a vast catalog. Currently, our catalog consists of almost a hundred million different genes that come from microbial repositories from around the world that we have curated, many of which, something like 10 million of them are currently already seen.

[00:22:01] Guru: In our dataset. So we do this decoding from the reads to the genomes and genes that are aligned with the reads. That's step one. That's what I'm calling bioinformatics. Step two is, once you know which genes or essentially functions that have been identified from that biological sample, what are the biological functions that are being, activated or deactivated?

[00:22:29] Guru: in order to do that, we develop models of multiple biological pathways. for example, Momo discussed short chain fatty acids just now. so if you wanna look at short chain fatty acid pathways, there are obviously a number of enzymes that are, Expressed by the microbiome that takes, a polysaccharide into a short-chain fatty acid like brate.

[00:22:52] Guru: And in order to do that, there are specific steps in the pathway that we have to expect will follow one after another. So understanding that pathway and modeling that pathway so that you can see the extent of activity of that pathway gives us a very good idea of the amount of butyrate production that is happening in your gut, which then can help us identify that, you probably have all the beneficial effects of the short-chain fatty acids, like the anti-inflammatory effects, like the, energy production effects and like the immune effects, all of the good things that short chain fatty acids provide us in the gut.

[00:23:29] Guru: We can take that as an in inference from the level of activity of the short chain fatty acid pathway. So that requires developing these models. Which we have now built using multiple AI techniques that I was mentioning earlier, that we use unsupervised machine learning techniques. So we've done that with very large groups of, samples, and we've determined how to understand the activity level of these pathways.

[00:23:54] Guru: So that's step two.

[00:23:56] Guru: Step three, we also, understand the basic functions of an individual at an even higher level. for example, your glycemic response, Does your blood glucose spike when you eat certain foods? let's say you eat banana, I eat banana as well.

[00:24:15] Guru: Does our blood spike the same way? Actually, it does not. you might have a muted response to a banana. I might have a spike response to a banana and I might have a muted response to a piece of bread. You may have a spike response to a piece of bread. And that type of analysis of, glycemic response from a given food, to an individual biology, including the microbiome, is another machine learning model that we built.

[00:24:40] Guru: So that's another model that ca came out of a study we did with more than a thousand people from both the US and Japan. And we looked at many foods that were given to these two populations over a period of two weeks. And we looked at their continuous glucose monitor and we looked at the specific expression of the various microbial functions.

[00:25:02] Guru: And we've determined that for a new individual who might come in, we can predict. The glycemic response for any food out of our hundreds of foods in our food ontology. So that's another step in the process of our recommendations where, so when we predict that a certain food is gonna spike for you, we tell you to minimize it.

[00:25:21] Guru: If it will not spike your blood, then we tell you to enjoy it. So that's another kind of analysis we do that's based on ai. And finally we have a number of, let's call it literature driven, , , knowledge that we have curated over many years now. And we have encapsulated that in another knowledge based and inference based system that then finally provides the exact foods that you should.

[00:25:49] Guru: Maximizing your diet, the foods that you should minimize or avoid in your diet. So all of these steps in the AI pipeline, so to speak, from the sequencer all the way to your app, are responsible for getting you the specific food and supplement recommendations. And just one final step, because everybody's talking about LLMs and transformer based techniques today and so forth, we look at that as the sort of the final step of the user interface.

[00:26:18] Guru: So in the very end, when a user has to understand all this information that I just described, for every food, for every pathway, for every microbial activity function, how to put all of that together to understand what they should do and what's going on in their biology, that interface we provide through A large language model based user interface where you can chat, you can ask questions, and you can understand in your own terminology and you your own framework. So all of these steps and different approaches to AI and methods of AI have been integrated into this solution that we call the Biome Personalized or Precision Nutrition Program.

[00:27:01] Erum: Wow. Yeah, that's interesting. I intentionally have not used VI yet because I wanted to come at this interview with a fresh perspective and So I wouldn't have biases. We should bring you eyes on again later after I do this. But the fact that there is this LLMI think is really exciting because you can get tested regularly and, see how it learns about your health and being able to have this conversation.

[00:27:24] Erum: it's really good for you. X people as we know, have adopted the ability to, chat. And, I'm curious to know if there's a personality. 'cause I use my different ais and there's definitely a personality there that makes it friendly and easy to talk with. we can get to that later. Yeah.

[00:27:41] Guru: Yeah. Do you, mind if I just clarify something there? So I still do think of the LLM part as more of the conversational front end user interface. the core AI techniques that we use underneath for understanding molecular data, that's goes so far beyond LLMs. It's, not large language models.

[00:28:00] Guru: These are large molecular models, so to speak, right? And they come in, different flavors and we've tried to put all of those together as well. the kind of AI that we talk about underneath the surface, underneath the user interface, I would put that more in the category of something like alpha fold and, those kinds of molecular, models rather than a large language model.

[00:28:22] Guru: The large language model is just like the last step, so to speak, for the user interface to work. The rest of it is all molecular science stuff.

[00:28:30] Erum: That's why I hear you because like you're the CTO and we know that the technology is, really deep it's so funny because it is important. It's where you get the like massive insights. But I would argue from like the, branding, comms is that the UX is also important to get people coming back.

[00:28:47] Erum: But obviously the insights too, it's a match made in heaven. but let's talk about the sequence data, because you guys have sequenced like hundreds and thousands of people. Your company's very, far along, you guys aren't just a tiny startup. You guys have lots of information.

[00:28:59] Erum: based on looking at all this data, have you have any patterns emerged that are unexpected? what are you seeing in this massive transcriptomic database?

[00:29:09] Guru: Well, I'll take a quick shot. I'm sure Momo will have some things to add to it. So, first of all, absolutely. We have now more than a million samples that we have processed through our Meta Transcriptomic platform. and, those samples come from almost or around, half a million individuals from, more than 100 countries around the world at this point in time.

[00:29:29] Guru: So it's a very broad data set. and it also then gives us insight into many different aspects of this very large population. So, I'll pick one interesting, insight we got from this massive dataset. there's, literally hundreds, and I could go on and on forever on this topic, but one that comes to mind right away is that, people always ask, is the microbiome very different between people in one country versus another country?

[00:30:00] Guru: or, one part of the world to another part of the world, and so on, the answer has always been. Given in the context of taxonomic analysis of the microbiome, and typically in the context of a 16 s type of analysis, which we know very high, level, meaning low resolution data.

[00:30:17] Guru: and it's also very limited because it's looking just at one narrow piece of the genome of, high level of the taxonomy tree, so to speak. that answer traditionally has always been, yes, there is a huge difference between the microbiome of, yeah, let's say somebody from the US and somebody from Japan.

[00:30:35] Guru: But it turns out the interesting thing, the insight that we found is that when you look at the functional expression of the microbiome, the similarity between a random person in the US and a random person in Japan is double. Of what you would see if we were just looking at taxonomy.

[00:30:57] Guru: So in other words, yes.

[00:30:59] Guru: if you just look at the organisms themselves, there's gonna be a huge difference between somebody who's born and brought up in the US and somebody else who's born and brought up in Japan, because probably those microbes have organized themselves, the genes themselves as horizontal gene transfer, all kinds of things going on in the microbial world, they probably constituted themselves differently in terms of the organism boundaries in the two, pop in the two geographies. But when you look at the biochemical functions that are being expressed, it turns out that most of it, something like two thirds of the functions of a random person in the US and a random person in Japan are

[00:31:35] Guru: similar. Only about a third would be different. and tho those differences matter, Those differences may actually be the reason why. somebody develops a disease, whether somebody doesn't develop disease, and so on and so forth, but the commonality is very high, even when somebody is brought up in very different parts of the world.

[00:31:53] Guru: That's an example of an insight that we found that I, wasn't obvious to us before we started this.

[00:31:59] Erum: Nice. What about you, Momo? Any unexpected insights across a large data set.

[00:32:04] Momo: I'd say some interesting insights that are good takeaways for people would be that the stool microbiome or the gut microbiome is very stable or can be very stable. So many people would say, well, what's the point of sampling it today? Because tomorrow's going to be different. we have now done analysis on thousands of people, and we show that there are circumstances where the microbiome, gut microbiome can be stable for years.

[00:32:29] Momo: and we are preparing a publication on that, showing that in fact, we have two people who carefully, maintain their diet as healthy. They eat organic produce, they do not take antibiotics, they do not use mouthwashes. they do not consume foods with, preservatives and so on.

[00:32:45] Momo: And they have a very stable microbiome over a period of years. In all other people, we have shown that, within days and weeks, the microbiome does not change very significantly unless someone takes an antibiotic. And that it really takes about six months on average for the microbiome to change significantly.

[00:33:01] Momo: And so these are not rapid changes, and I think that an interesting point to take. I also want to, put one other takeaway, which is that antibiotics make a huge negative impact on the microbiome and often a long lasting impact. And last I want to mention is that we, unfortunately, in the United States and in other developing countries, we have a lot of customers who have depleted their microbiome to the point where their microbiome no longer is capable of performing healthy functions for them because they are, they have lost those members.

[00:33:37] Momo: so when we talk about. Very healthy metabolites that are produced by the gut microbiome, by consuming the food we feed them. If those microbes are gone due to overuse of antibiotics, due to having too sterile of a lifestyle due to consuming foods that have antibiotics, that have preservatives and so on, they have physically lost those members whose metabolic activities or functions are essential for our health.

[00:34:03] Momo: for those people. There is no food that they consume, or supplements they can take, to make them healthy. They have to rewild their microbiome. And so I would like to encourage the audience to read about rewilding, their gut microbiome, because even if you have a normal microbiome, it's a good idea to maintain it.

[00:34:20] Momo: And if you just look at our ancestors two to three generations ago, they didn't have Purell for their hands 10 times a day. They didn't use antibiotics, they didn't have a clean lifestyle. They gardened every day. They ate produce with their hands and food with their hands. And that's the lifestyle that maintains that sort of very diverse microbiome.

[00:34:39] Momo: That's extremely important for our health.

[00:34:41] Erum: Yeah, we started wearing shoes more often. That's a big thing that contributed to, I mean, there's this whole nother world that I would love to talk to you guys about. I know we don't have to have limited time, but the idea of worms being crucial to our. Different tiny worms being crucial to our, immune system and our health.

[00:34:58] Erum: anyway, we'll talk about that later. it's just to me, I love the fact that you have, reached so many people, Hundreds of thousands to half a million. I'm sure they've reached out because this is a very personal thing. And for them to have a clear look at how their health is, or at least how their microbiome's working and they're getting tested and they receive these insights.

[00:35:19] Erum: Can you share any outcomes or maybe even testimonials? I know there are, there's some on your website, but just something that has stuck with you that, like something that a customer revealed to your team that keeps you motivated, whether it's, maybe improved biomarkers or inflammation reduction.

[00:35:35] Erum: Share a little bit about what's happening to your clients.

[00:35:38] Guru: mean, there's so much. we have literally thousands and thousands of people who get back to us with positive outcomes of every different type that you can imagine. Weight loss, improvement of their hba one c, for example. reduction of gut, symptoms, that they were dealing with, abdominal pain or bloating, increase in energy, sleeping better, So we take every, quarter or so a survey among randomly chosen customers of ome and we ask them, a set of questions. and we always get, for all of these factors that I just mentioned, we always get eighties and nineties in terms of the percentage of people who saw at least one of those five or six areas that I mentioned.

[00:36:24] Guru: that they say they have improved dramatically, even if one of those is better, we've changed, we've touched somebody's life, we have made their quality of life better, and that's what keeps me motivated, Because we get so much feedback from them. Now, the other thing I also mention is that when people retest, and, there's a lot of people who retest, many of them have subscriptions to the volume service.

[00:36:48] Guru: So after six months, nine months or a year, they might come back and say, alright, let me retest and see whether all the lifestyle changes have made, has made a difference to results. And they come back to us, and of course we take another survey and, through a questionnaire at that point in time, and we ask them how do they feel now compared to what they did in the first.

[00:37:07] Guru: Test. then some people do the third and the fourth and the fifth and so on. personally have, half a dozen or more, data points in my own life. Momo has, a lot as well. So what, we see is that for people who comply with our recommendations, there is a marked improvement in the biomarkers.

[00:37:29] Guru: when you see the difference between time 0.1 and time 0.2. And we have done a number of different analyses that just look at, the data between time 0.2 minus time 0.1. And we see improvements in inflammation markers. We see improvement in immune system markers.

[00:37:45] Guru: We see improvements. Actually, I was just looking up inflammation markers, and I saw that in the latest analysis that we did, it was something like a 15 point improvement. between time 0.1 and time 0.2, when we know that somebody's immune or inflammation functions were not doing very well, and we actually provided an intervention to address specifically those problems, we saw that improvement happen over a period of approximately six months.

[00:38:12] Guru: we have seen those kinds of markers as well. So, you not only see first of all, just, how do you feel type of questions, which keeps you motivated all the time through these testimonials and what have you. But you also see actual biological changes happening that tell you that yes, we are making, in fact, the underlying molecular biology do better, based on the scores and markers and pathways that we are currently measuring in bio.

[00:38:36] Guru: And then beyond all of that, we end up doing controlled. Experiments, and I would like to pass it to Momo to talk about the controlled experiments, whether they're, placebo controlled or not. where we also see differences between, multiple arms of a study. So, Momo, go ahead, please.

[00:38:53] Momo: Yeah, I also wanna mention, in response to one of your previous questions was, how do we convert molecular data into nutritional recommendations? We actually published a paper on that. It's a scientific paper published in the American Journal of Lifestyle Medicine back in the fall of 2023.

[00:39:07] Momo: And I just want to mention that, all of our publications, scientific publications from Via, can be found on via.com/publications, and that's one of the papers. And so if people want to geek out and really dive deeper, they can see how we do that. And speaking of papers, we published the preprint of our first.

[00:39:27] Momo: Blinded placebo controlled randomized trial, for type two diabetes. to expand upon that, we have now preliminary results that show efficacy of bionutrition for people with constipation, people with pre-diabetes and diabetes, and, people with anxiety. and we're still continuing to run additional randomized controlled trials.

[00:39:47] Momo: So the ultimate proof that this works is not in these anecdotal pieces of evidence, although they're very powerful to us and we know that it works, but it's really in these gold standard blinded placebo controlled trials. so those are gonna be forthcoming as publications from ome. We're currently writing our second paper on a second trial for constipation, and we have great results.

[00:40:08] Erum: No. Yeah, that, that's great. I mean, I was just going to ask you more about, the clinical studies. Do you work with any organizations? Do you partner? Has there been peer review? We'll just know a little bit more about that.

[00:40:19] Momo: Yeah, so we do a lot of what we call observational studies where we collect samples from participants. And on those studies we do collaborate with many organizations, both in the United States and outside. So we have active collaborations with universities in Brazil, Australia, New Zealand, and so on.

[00:40:36] Momo: We are restarting a big collaboration in Japan that guru spoke about. in the United States, we are also collaborating with some institutions on observational studies, but when it comes to randomized controlled trials, we perform those. By ourselves in-house. And we do what is, what We follow what is called a decentralized model.

[00:40:55] Momo: so decentralized model means that we can recruit anyone in the United States as long as they meet the inclusion criteria. and then our coordinators handle the whole process of testing and delivery of supplements and nutrition and helping them with that. And in two of our trials, we also have to send our participants to Quest Labs to get gold standard lab tests performed.

[00:41:17] Momo: And we have a contract with Quest where we can send people like that. So that's the newer model, which is far more efficient. we have tried to work with hospitals on randomized controlled trials, but it gets pretty slow and pretty expensive very

[00:41:28] Momo: quickly.

[00:41:30] Erum: yeah. No, I hear you. that's exciting. I

[00:41:32] Erum: in terms of clinical validation, I also wanted to mention that, all of the tests we do in the wet lab, they are clinically validated under the clear laboratory developed test guidelines. So that's a baseline, clinical validation that we start with.

[00:41:47] Guru: I wanted to also mention that, , we have developed, clinical validation studies and shown results in our, not only in our peer reviewed publications, but also submitted them to the FDA. I received, FDA breakthrough designation for our oral and throat cancer early detection test.

[00:42:10] Guru: that I view that as another validation of, what we are doing and, you know, of course we publish oral oncology journal and so forth.

[00:42:17] Guru: So yes, we have the whole range of clinical validation, activities and, results.

[00:42:22] Erum: Yeah. You guys are doing everything. great. you're using the best technology, working with incredible organizations, getting the validation. So let's just fast forward 10 years. If Viome fully succeeds in its mission, what does the future of healthcare or even everyday life look like?

[00:42:40] Momo: Yeah, so this is the original vision that I'm very excited to share, which is that I want to basically put all chronic diseases and cancers in history books. So today we have a Wikipedia page on the Black Plague. the black plague is this, plague that hit Europe and most of the other world back in the 13th and 14th century.

[00:43:00] Momo: And at that time, no one knew what caused it, how to prevent it, how to cure it. Basically, you either dropped dead or you survived it. And it was a matter of luck because we didn't have any science. And literally seven centuries later, it's exactly the same for any kind of cancer and for any kind of chronic disease.

[00:43:18] Momo: if you ask someone, will you develop pancreatic cancer? The answer is, I have no idea. if someone gets diagnosed with pancreatic cancer, it's basically a death sentence and it's bad luck. And what I want everyone to understand is that the only reason that is bad luck today. Is because the system, meaning the big pharma, the healthcare system, the academia, have not focused on understanding what causes pancreatic cancer.

[00:43:43] Momo: It is not magic. It is not bad luck. It is simply biochemistry, biochemical reactions that we do not understand that lead to cancer. And if we can profile the human body and quantify those biochemical reactions and understand what leads to pancreatic cancer, we can prevent it. And the same thing with multiple sclerosis.

[00:44:02] Momo: Same thing with Alzheimer's disease. Every single disease. And so that's really the goal for the next 10 years is to have a Wikipedia page on multiple sclerosis that says, wow, multiple sclerosis was a disease that killed so many people and made so many other people suffer. But now we know that there are three reasons for the onset of that disease.

[00:44:24] Momo: We know exactly how to prevent all three, and going forward, no one's gonna get multiple sclerosis, and that's gonna be applicable to every other disease in cancer.

[00:44:32] Erum: I love that. That's great.

[00:44:34] Guru: yeah. I will add, I mean, I shared this, idea of, eliminating chronic disease in its, tracks and reversing back. the other angle that I also think about is that I would like in 10 years, every individual on the planet

[00:44:50] Guru: to have a biome test as part of their daily life.

[00:44:54] Guru: and every individual having enough information and feeling empowered enough with health insights that they can actually take care of themselves at home most of the time. you cannot say that acute disease will never happen. people might end up having, acute diseases once in a while, and they may need to go to the healthcare system in order to address that, but.

[00:45:15] Guru: 99% of the time you are living your normal life at home and you want to be able to take care of your health and maintain your good quality of life at home as long as possible in your life, which is what we call health span, I hope that everybody has it. I hope that everybody takes care of themselves at home first, and I hope everybody lives a long, healthy, high quality of life, across the planet.

[00:45:42] Erum: Oh, that's beautiful. Yeah. That's incredible. Great vision. All right, so this is the fun part. Just gonna say, we're gonna have some quick fire questions and we're gonna go, either of you can answer first. So what's one food you personally had to stop eating after taking a volume test?

[00:45:58] Guru: I'll go, my last test, which was in May this year, is telling me that I should avoid turmeric and, given my. Background. I actually have been using a lot of turmeric and there's also this general concept that turmeric is a great thing, anti-inflammatory curcumin, et cetera, et cetera, But it turns out that, my bile acid path pathways are not doing great, and I think turmeric, maybe an excess of turmeric is causing that. and my recommendations say avoid turmeric. So I've actually stopped reduced it by quite a lot,

[00:46:30] Erum: Oh

[00:46:30] Guru: that that's a pretty big hit for my cuisine.

[00:46:33] Erum: Yeah. Yeah. I mean, people don't know. I'm assuming grew. You're Indian. I'm Indian as well, and I feel so sorry for your family. what about you, Momo?

[00:46:44] Momo: I was sad to find out that I could no longer eat, soybeans and black beans as much as I could because they contain high amounts of oxalates. And that was a recent development just from this year. however, I was able to quickly pivot and develop, homemade tofu from lentils and chickpeas. so now I only eat soybeans for breakfast with my granola.

[00:47:05] Momo: I make a homemade soybean yogurt. and I eat that for breakfast only. And I don't eat soybeans for the rest of the day. But lunch and dinner I will eat tofu from lentils or chickpeas very often, that's just turned out to be great.

[00:47:19] Erum: Oh wow. Interesting. Oh my gosh. Now I really wanna take a vy test, just understand a little bit more about my eating habits. okay. Prebiotics or probiotics, if you had to pick just one.

[00:47:29] Guru: I would pick prebiotics for sure, for multiple reasons. One, there's just not enough probiotics that are available in the market for everything that you need, number one. Number two, I would like to feed my microbiome the right stuff and develop it and sustain it for the long term rather than bet my life on, having a few probiotics, attach themselves and survive and sustain for the long term.

[00:47:54] Guru: I would rather make sure that my existing microbiome is properly fed and maintain.

[00:47:59] Momo: Yeah, I would say it depends on, it depends. so if you already have all the probiotics in your body, you don't need any additional ones. Or if you consume many fermented foods, you probably don't need any prebiotics. I also don't think you need any, if you're eating a varied, highly plant-based diet. But of the two, I would say prebiotics as well,

[00:48:21] Erum: Okay. Craziest biotech idea you've secretly loved.

[00:48:25] Guru: Well, I guess it's no longer gonna be a secret after this, but, would love to be able to build the Uber Foundation model for biology,

[00:48:34] Erum: Mm-hmm.

[00:48:34] Erum: Yeah.

[00:48:35] Momo: the ones who rule them all,

[00:48:37] Erum: Yes.

[00:48:37] Guru: to rule 'em all. Exactly.

[00:48:38] Momo: my craziest secret idea, which is not patented quite yet, but soon will be, is to develop anti-aging vaccines.

[00:48:47] Momo: And they would be personalized, personalized vaccines that basically clear out senescent cells from your body and maintain youthfulness as you, chronologically age.

[00:48:57] Erum: that's a big one. Oh my gosh. All right. Almost gonna say bye. I am starting a new company. I'll help you out there. That sounds incredible. Okay. All right. So what's the weirdest gut health myth you've heard lately?

[00:49:11] Guru: Oh, somebody told me, recently that probiotics, they take probiotics because it works for everybody. And, they were in a drug store, looking for probiotics in one of those freezers. And, that's a pretty crazy myth in my mind. It's a weird myth. I would say that, First of all, like we've said before, It depends on your specific biology and your specific microbiome as to which probiotic should work for you and would not, And second of all, maybe you don't even need probiotics. Maybe you can get, a lot of additional health just by doing better nutritional, daily, food and, good plant-based meals and other kinds of, important activities in life.

[00:49:50] Guru: Like, exercise and good sleep and stress reduction, all kinds of other things, People think that probiotics are a great thing and I think it's a weird myth.

[00:49:57] Erum: Mm-hmm. I don't know if it can be classified as a myth, but this, if carnivore diet is bothersome to me, I understand that some people have health issues that they cannot pinpoint, and when they try the carnivore diet, they clear up. And what that tells me is that they have.

[00:50:16] Momo: One or two reasons for their health issues. But that does not mean that they should deprive their entire body from all of these phenomenal plant-based nutrients, and antioxidants. unfortunately the science is not there yet where, there's a magic wand or a magic test that can pinpoint those specific issues.

[00:50:35] Momo: But I'm sure there are many examples where someone has gut issues because of a single ingredient like egg yolk or bell peppers or broccoli. And because of that, they switch to this extreme diet that I think in the long run is going to harm them very much, but it's not going to be instant. So, that's a myth, that carnivore diet is a long-term solution.

[00:50:58] Momo: but we will see how it develops.

[00:51:00] Momo: Wow. Yeah, that's a crazy one. Okay, one, last quick fire question. If IAM could decode one mystery of human biology next, what would you want it to be?

[00:51:10] Guru: in my case, we hear that, and we've seen that inflammation is the root cause of most chronic diseases, if not all of it. And I would like to establish that and be able to measure and, provide the right interventions for people to reduce that chronic inflammation.

[00:51:30] Guru: I think that's the biggest, mystery of human biology

[00:51:34] Erum: Good.

[00:51:34] Guru: help us address chronic diseases like, we want to environ.

[00:51:37] Erum: Good one. All right. Momo your turn.

[00:51:40] Momo: I would like to prioritize the eradication of depression. I think depression is a disease that has so many downstream problems for the person, for the family, for the society. most other diseases affect only the person, but this one affects really many, many different layers. it affects the person in many, many ways in terms of their social life, their professional life, their enjoyment of life.

[00:52:06] Momo: there's some really good progress in our understanding of how neurotransmitters are made in the gut. stimulated by the gut microbiome and how they're transmitted to the brain via the vagus nerve, and we're trying to make those strides and we have some good preliminary results.

[00:52:21] Momo: So I'm hoping that we can accelerate that and really make good progress on depression and eradicate it.

[00:52:27] Erum: Yeah. What another beautiful thought. This is a great thought to end on. Thank you so much, both Gu Omo. Thank you so much for being on the podcast. We had a little technical difficulties that the audience will not notice because we do a great job editing, but you are very patient and graceful and I really appreciate you coming on the podcast.

[00:52:46] Momo: Of course,

[00:52:47] Guru: Thank you so much.

[00:52:47] Momo: grateful for.

[00:52:49] Guru: That was fun. Thank you so much.

[00:52:50] Erum: Yay.