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Remember the old saying you are what you eat? It turns out, it would be more appropriate to say you are what you digest and metabolize. Human digestion is outsourced to the community of microbes housed in our GI tract called the microbiome. These microbes determine your blood sugar levels with meals (glycemic response), calories you derive from food, and modulate your food cravings, making some people more prone to obesity, diabetes and other medical conditions.

Did you know you need the right bacteria to benefit from the anti-cancer effect of broccoli? Cruciferous vegetables like broccoli contain glucosinolates which are metabolized by gut bacteria into an anti-cancer metabolite called sulphoraphane - that is if you have the right bacteria. Since one person may benefit more than another based on the microbes present in the gut, the next time your child says I won’t eat my broccoli because I don’t have the right bacteria, science is on her side. However, replacing those missing bacteria isn’t so far away. Proof of concept is a lab in Singapore engineered bacteria that derived the anti-cancer benefits from broccoli and shrink tumors in mice

“Twenty years ago, sequencing the first human genome was a colossal event that took 13 years and $1 billion dollars, and now we can sequence DNA for under $100 in less than a day”

There are various examples of how we digest and metabolize our food differently. Is red meat good or bad for you? It partly depends on your gut microbes – some microbiomes will produce higher levels of a pro-inflammatory compound called TMAO that has been linked to heart disease. What happens to the fiber you eat? Again, it depends on if you have bacteria that ferment more butyric acid (the main fuel source for the cells lining your colon) or compounds like propionic acid which are pro-inflammatory.

So how close are we to precision nutrition – to dropping the one size fits all diet and replacing it with customized diets based on an individual's genetics, disease state, microbiome, metabolome, etc.? Humans, microbiomes, food, and food culture are complex, and in order to progress forward, advancing our understanding in all 4 arenas are essential. All types of technology, not just computers, obey Moore’s laws doubling power. Twenty years ago, sequencing the first human genome was a colossal event that took 13 years and $1 billion dollars, and now we can sequence DNA for under $100 in less than a day. In a few years it will be within minutes for a few dollars, and perhaps on a device the size of your phone. Ten years ago it was a challenge to know what organisms are in your microbiome, and today, we can determine which microbial genes are expressed and what metabolites are producing thanks to advances in sequencing technology, decreased costs, and improved machine learning for complex multi-omics.

Precision nutrition, in many ways parallels precision medicine but has some extra layers of complexity. For one, food is complex. We know less than 1% of the compounds in plants alone, making 99% of what we eat “dark nutrition,” and Brightseed, a start-up company in Germin8 Venture’s portfolio, is using machine learning to discover unknown health-promoting phytonutrients. Moreover, food culture is complex. It is one thing to ask a patient to be compliant with taking a few pills and quite another to get people to change their way of eating. Add into the mix food deserts, budget and time restraints, and cultural eating habits.

Precision nutrition will be used to combat disease or pre-disease states, food sensitivities, weight issues, and metabolic issues. It will also be a tool to improve healthspan. At this time, if you are healthy and have an optimally functioning microbiome, the best way to make sure your body is getting the nutrients it needs is by incorporating a wide variety of whole foods rich with naturally occurring vitamins and minerals. The ideal diet is whole foods – vegetables, fruits, whole grains, meats, healthy fats. Daily supplements should be used to fill the gaps in conjunction with a healthy diet, and never in place of it. Ingredients matter, as most chronic diseases are linked to highly processed foods. Democratization of healthy food should be as important as access to healthcare. The 21st century health company will be an amalgam of digital health, precision medicine, precision nutrition, and therapeutics all in one.