Omix profile

Michael Snyder – about how he discovered diabetes before doctors

Daria Shipacheva, Reminder

Professor at Stanford University Medical School Michael Snyder has set himself a grand experiment. For five years, he tracked 40,000 indicators of his own body: he called the data on the microbiome, genome, metabolome and other "omics" the "omix profile". As a result, he was able to diagnose type 2 diabetes and Lyme disease at very early stages. Now he is working to make such an approach to health mass. Reminder talked to Snyder about his experiment and the future of medicine.

– Tell us about your omix profiling project. What is its essence and how did you decide on such an experiment on yourself?

– Today the medical system is arranged incorrectly. People come to the doctors only when they are seriously ill with something. And it should be different: healthy people should come to polyclinics so that they can detect early symptoms of impending diseases – and then deal with the prevention of these diseases.

In order to test a system in which it would be possible to detect disorders in the body at very early stages, we launched this project. In simple terms, we decided to analyze the molecules in my blood at different levels: separately – proteins, separately – metabolic products, separately – DNA and RNA, and so on.

It is convenient to conduct an experiment on yourself. My colleagues always have quick access to me if you need to take some additional analysis, conduct a new examination. Plus, I have been collecting information about myself for a long time with the help of wearable gadgets and sensors – this became a help for data analysis: it was possible to identify certain correlations between, for example, pulse dynamics, changes in blood glucose levels and the work of genes. Finally, testing everything on me was as safe as possible from a legal point of view: it is clear that the method is experimental, and the conclusions we came to could not always be confirmed in accordance with the requirements of modern medicine.

– What kind of research was needed to make an omix profile?

– Initially, we allocated about 40,000 molecules and other parameters for analysis. Based on them, we analyzed eight "ohms".

• The genome is a complete sequencing of my DNA.
• Epigenome is the study of DNA modifications that regulate the work of genes, and, unlike the genome sequence itself, can change under the influence of the environment.
• Transcriptome – analysis of the work of RNA and how it affects gene expression.
• Proteome is the study of proteins that are in the blood.
• Cytokine – analysis of cytokines, which are markers of inflammation and are involved in the work of immunity.
• Metabolome – the study of metabolic products in the blood, in particular, nutrients, glucose, etc.
• Antibody analysis is an analysis of the work of antibodies that play a key role in the functioning of immunity.
• Microbiome is a study of microflora in the intestine, urine, nasopharynx and on the skin.

The initial experiment took almost 5 years – 57 months. We did analyses and measurements 91 times, at regular intervals. During this time, I had viral infections seven times – at these moments it was especially interesting to track changes in my "omah".

We don't stop – as soon as some new technologies appear, we use them to learn even more information about my body.

– What are your main conclusions?

– The first, perhaps the most significant – creating an "omix profile", I found myself prone to type 2 diabetes. We found changes related to DNA methylation. They affected how my body assimilates glucose. But the doctors did not believe that something was wrong with me: the usual tests were normal, I was not obese, and there was no history of diabetes in my family.

However, analyzing my metabolome for a long time, we noticed two significant jumps in glucose levels. And both times before that I just had a cold.

After the first such jump, I decided to change my lifestyle: I started cycling twice as much, started running, and reduced the amount of added sugar in the diet. My glucose profile returned to normal – and I relaxed a little, eventually gave up running.

Then, about a year later, I picked up a viral infection again – and glucose jumped again. Then the doctors had already diagnosed me with type 2 diabetes – but I already knew what to do. I started running again, adjusted my diet. This helped to reduce the blood sugar level at the moment – but over time, glucose gradually continued to grow.

So I had to turn to medications in the end. Here I again faced a difficulty – the usual drugs did not help me. It turned out that I had a problem not with the sensitivity of cells to insulin (as usually happens with type 2 diabetes), but with insufficient insulin production by the pancreas. And I also learned this thanks to the omix profile. With this information in mind, I decided to try a new drug – repaglinide, it just stimulates the secretion of insulin. And it helped. After about eight months, my glucose level dropped significantly, and now I have diabetes under control.

The second interesting finding is that I was able to diagnose Lyme disease at the initial stage of development, noticing that my pulse rate increased and the oxygen content in my blood dropped.

– How did you know it was Lyme disease?

– An increased pulse and at the same time a dropped oxygen level in the blood is a sure sign of an impending illness.

Next, you need to compare the facts. Two weeks before I had these symptoms, I was helping relatives install a fence in a yard in a rural area in Massachusetts. There are just ticks that carry the Borrelia bacterium – it causes Lyme disease, or tick-borne borreliosis.

When, following the changes in my pulse and blood oxygenation, I had a slight fever, I was almost sure that I had borreliosis. The incubation period for Lyme disease is just about two weeks – everything matches!

I was in Norway at the time I started having symptoms. The doctors there are not so familiar with Lyme disease, and they did not suspect it in me. They wanted to prescribe me penicillin – while another antibiotic, doxycycline, is needed to treat borreliosis. But I was very persistent, and I managed to convince them.

And in the end it turned out that I was right. When I returned to the USA, I passed the necessary tests, and I was found to have antibodies to borrelia – this means that I really had Lyme disease. My personalized approach to medicine turned out to be more accurate than the generally accepted one – he pointed out the disease as early as possible. Thanks to this, I recovered quickly.

– How to make such an approach to health mass?

– We are already doing this. We recruited a group of more than 100 volunteers, many of whom were diagnosed with signs of prediabetes. We did the same omix profiling to them that we did to me. And we found a lot of interesting things: in particular, we found 49 serious deviations that affect the state of health. The most significant of them are two cases of heart problems, one lymphoma, two cases of precancerous conditions and several blood diseases. We also learned about 12 genetic risks that the study participants have.

The study is still ongoing. But the results are already there. Many, for example, saw how their lifestyle affects the body at the molecular level – and decided to change it. This, of course, helped to improve the symptoms of prediabetes. Although nine participants in the experiment, unfortunately, still developed diabetes.

The participant in whom we suspected cardiomyopathy – this is a serious cardiovascular disease, it can lead to heart attacks and, consequently, premature death or disability - underwent additional examinations, and the diagnosis was confirmed. Now he is taking the necessary medications, and can also monitor his heart more closely to avoid trouble in the future.

In cases where we found early signs of cancer and precancerous – mainly by analyzing the proteome, that is, blood proteins – people were able to start treatment quickly and avoid the progression of the disease. It is likely that standard tests would not have "caught" these diseases at such an early stage.

And with the help of genome analysis, we also found out that one person was taking the wrong medicine – it turned out that it was not good for him.

– It sounds good, but when will ordinary people get real access to such technologies?

– Hopefully in the near future. We are currently developing an algorithm that will automatically detect that you are getting sick based on data from your wearable gadgets – as I did manually when I discovered Lyme disease.

Apple recently announced several studies: they will collect data from their smartwatches to study how different parameters affect health. It seems to me that the most significant of their initiatives is a project in which they analyze the relationship between physical activity and cardiovascular diseases. I think this is a big step towards preventive and personalized medicine.

Moreover, I have watched how ordinary people themselves begin to use gadgets for early diagnosis. Once there was a couple at my lecture – they were interested in how I track the onset of infection by the parameters of my body, and after the lecture they bought themselves a smartwatch. So they were able to notice signs of illness in his wife – it turned out to be a lung infection. It is unknown when doctors would have discovered her illness. So we can say that personalized medicine is already coming to the people.

– Do you think it makes sense for every person to do a genetic test today – or is it still more of a "toy" for biohackers? In Moscow, for example, full–genome DNA sequencing costs about the average monthly salary of a Russian, and full-genome sequencing is even more expensive. Is it worth it?

– Perhaps, if it's so expensive for you now, you can wait with this test for now.

However, in general, genetic tests work: we have data that 17% of people discover important information about themselves based on the results of DNA analysis. And in the future, gentests will become even more relevant – when there is more research on how genes affect the risks of various diseases.

Any technology inevitably becomes cheaper over time. If you can't afford such a test today, just wait a bit – soon genome sequencing will become even more affordable, and then you can take the test.

In the meantime, you can buy yourself a smartwatch – they are already available to most now, and you can use them to monitor your condition.

– What about microbiota analysis? Such tests have already appeared in Russia, but do they have practical benefits?

– To be honest, I don't think there are any current clinical recommendations related to the composition of the microbiota today.

Yes, the study of the microbiome is an extremely exciting direction in medical science. This will help to create tools for more effective glucose control – and hence the prevention and treatment of diabetes, metabolic syndrome and obesity. But I think this tool will become really useful after some time.

Now, for example, we have the results of microbiota studies in obese and non-obese people. Conclusion – in overweight people, the composition of the microbiome is less diverse. But what to do with this information? Scientists give only an obvious recommendation: overweight people need to lose weight. So today all these tests on the composition of the microbiota have more scientific than practical significance.

– Do you think there will be wearable devices in the near future that will help track the metabolome and microbiome?

– Of course, technology will develop, and new tools will appear to measure the parameters of the human body. We can see it already today – smart watches are getting smarter every year.

As for the metabolome, I think so. Take the same glucose – there are already sensors that can monitor blood sugar levels 24/7. They are intended for diabetics, but will become more and more popular among healthy people. Also, I think new gadgets will soon appear that will be able to measure other parameters of metabolism – cortisol, for example.

And I also see that many are ready to switch from wearable gadgets to implantable ones. There is a demand to install sensors directly under the skin so that they more accurately monitor various processes inside the body.

As for the microbiome, I don't think we will need to monitor it on an ongoing basis. The composition of the microbiota changes slowly, so it is enough to take an analysis from time to time. So gadgets that analyze the microbiome in real time are unlikely to appear in the foreseeable future.

– And what else do you plan to do besides omix profiling?

– We plan to study more closely the markers associated with the development of mental illness. Our goal is to find molecular changes by which it will be possible to predict the development of such problems.

Finally, we will try to make our developments more accessible. We have created an algorithm to diagnose an impending cold – but this is just the beginning. We have founded a company whose main task is to create a personalized dashboard containing basic information about human health. Artificial intelligence will calculate correlations and indicate potential threats. It will be similar to the analysis of the state of the body that I did as part of our experiment manually – only the iPhone version.

– By the way, about correlations. Correlation does not mean causation. Does this cast doubt on your conclusions?

– We try to be very careful in our conclusions. For example, those 49 discoveries about the health of the participants in our study – they are all reliable. They are well-reasoned and confirmed by the results of other tests.

Or the fact that I was eventually diagnosed with diabetes – now no one will argue with the fact that my glucose fluctuations are abnormal. However, the fact that my glucose metabolism was disrupted due to a viral disease remains a hypothesis – I don't have enough data yet to say this for sure.

– I have heard that you are called a "narcissist" in connection with the omix profiling project: they say that a person loves himself so much that he has studied himself from all sides at the molecular level! He's either a hypochondriac or a narcissist. Aren't you offended to hear that?

– I know the person who came up with it – it's just a joke. And no, I'm not offended – I don't care, I don't pay attention to it.

I myself became the first test subject for omix profiling only for reasons of convenience and legal security. It is important for me to change the medical system, which is not working now – and I decided to start with myself, as it should be.

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