It may not seem like it when you’re checking your stock prices on your iPhone halfway across the Nevada desert, but technology is almost always just one step, some steps larger than others, from what came from before. Hieroglyphics were a step up from cave paintings. Papyrus was a step up from stone. Printing was a step up from the work of the scribe. Your iPhone stock check is some definable number of steps up from smoke signals.
For nutrition professionals, most of the technology that is leading to better regimens and better outcomes is a far simpler set of steps up from what came before, but the effects could be profound for supplement makers in the practitioner channel.
Miriam Kalamian can see a few of those steps very clearly.
Kalamian, a Montana certified nutrition specialist, believes a ketogenic diet extended her son’s life by years after he was diagnosed with cancer. But the strict guidelines of living keto were far from easy. She can track and coach the clients who seek her out now using an app. It was different when she was navigating the poorly charted nutritional landscape for her son. She remembers it as a tedious and exacting, but not always exact, task. “I had a pocket guide, a calculator and a notebook,” she says.
It’s very different now. Now Kalamian points her clients to an app, Cronometer. The macronutrient tallies from that well-worn pocket guide are programmed in, the calculations run automatically. The record of every meal she scratched into that notebook are logged and weighted against every other meal.
“You just put in some data. You put in your vitals. Then you select from a menu of what kind of diet you are picking,” Kalmian explains. “It’s doing the calculations for you.”
Everything that Cronometer does could be accomplished before. It’s just easier in its execution, more precise, more reliable, repeatable and, in the end, practicable for more people. In terms of the technical, these were steps. In terms of the day-to-day practical, they were giant leaps.
Stepping up
The same links between the Kalamian’s pen-and-paper diligence and the ease of the app are true across much of the space where technology meets nutrition.
Blood tests are nothing new.
Patients ordering their own blood tests without visiting a lab or dropping into a lab without a doctor’s written order, getting the results and delivering them by email or online portal to their practitioner’s office as a digital file is certainly new, and made possible by a number of technologies coming together.
Molly Maloof, a San Francisco MD treating her patients in the most holistic way with the latest technology and following every startup and biometric gadget, calls the blood test an example of how something complex made simple by technology is transforming care. It’s not everywhere—“The big thing that keeps this stuff from being really wide spread is just the pain of going to the doctor to get your labs”—but it’s going to be. Though Theranos stumbled with its microvolume “nanotainer” finger prick blood tests, the march towards simplification seems inevitable. “A lot of people are expecting Walgreens and CVS to develop a kiosk where you can get your lab work done,” Maloof says.
When it reaches the mainstream, the personalization of medicine and nutrition will be shoved that huge leap forward by the incremental steps that came behind.
Data hungry
In many ways, the revolution is already here. It’s just not marching down the street as revolutions tend to do. It’s slipping quietly into integrative health professionals’ offices one data bit at a time. Patients might bring a blood panel they picked up at LabCorp. It might be a microbiome census from a company like uBiome. It could be snip-by-snip genetics from 23andMe. It could be any number of data points from the self quantification crowd, but it could also happen with any patient, any time. Corey Schuler, director of clinical affairs for practitioner-focused supplement maker Integrative Therapies and a practicing nutritionist, sees it every day. “I have a patient coming in this morning,” he said in a phone interview. “They are probably going to have labs that I didn’t order, or [that] none of my colleagues ordered,” Schuler says.
In many ways, Schuler says, such patients are dragging the practitioner disciplines into personalized nutrition era. It’s not something being sold to them. It’s something being demanded by them. Every practitioner interviewed for this story echoed the same line—patients come in more informed, with more data. It’s especially true at the digital edge of the early adoption demographic. “There is an assumption in Silicon Valley that there is data available about everything, and if people can find the data, they will,” Maloof says.
That doesn’t mean they all understand it. Data by the gigabyte can be interpreted by an algorithm, but people ambitious enough to chase those gigabytes don’t necessarily trust the algorithm every time. They shouldn’t. And that’s where practitioner stand to benefit from the avalanche of data, whether it be biomarkers or genomic sequences. People need interpreters for the data, guides to pick out the trail along the pathways of personalized nutrition. A program that quantifies “still isn’t going to let you see the actual change in the patient in front of you,” Maloof says
Tracked and targeted
The practitioner is there as the guide, but the data and the technology also give the client a perspective and access to information that Arizona naturopathic doctor Lise Alschuler says has “almost democratized medicine.”
Alschuler helped develop an iThrive program and app built around the cancer community that tracks and guides users on a nutritional plan. It provides a focused set of small steps that let users see how well they are doing in one area and where they might need to improve in another. But the feedback interface is just part of it. Communication is key. She knows what her patients are doing and how they are feeling. “I can get flagged and follow up with that patient,” she says. “Otherwise I wouldn’t know until the next visit, or not at all.”
Connected care
For Kalamian, the Cronometer app she uses with her clients has become an essential. The challenges she faces would be well known to any nutrition professional. “Two really big problems in my world are compliance and accountability,” she says. Cronometer gives her a tool to take on both. Tracking what you eat makes it easier to control what you eat, but the level of data seems to matter. The fact that she can see what her clients are consuming adds an element of accountability. Users who see they are hitting their goals are more likely to keep hitting those goals. “Once you see the feedback that you get, it’s stronger than anything I can tell you,” Kalamian says.
The “professional” version of Cronometer is fairly recent. Canadian developer Aaron Davidson began the Cronometer project as part of an interest in the caloric restriction model for longevity, and added features and inputs for nutrient detail along the way. Users can see where they would be on their nutrition targets with or without supplements. They can see how their exercise changes their nutritional requirements.
The professional version passes nutrient status reports from patients to practitioners. “They can see data in real time. They can set targets and get reports on all of their users.” The digital nudge is another feature. “If they’re not logging, they can give them a poke and say ‘Hey don’t forget.’”
Davidson has found Cronometer useful in his own life. “I was always finding I’m not getting enough zinc from what I am eating,’ he says. Kalamian has found it powerful with supplement skeptics. “They will say ‘I don’t believe in supplements.’ I’ll tell them to use Cronometer. Put in a full day and then look to see if everything is in the green zone. Then you’re good to go. You’re nutritionally complete.”
The information that apps like Cronometer, iThrive and My Fitness Pal compile and present were always trackable at some level. Calories and steps could be counted. The nutritional value of foods was known. Practitioners could tell their patients to eat less of one food and perhaps more of another. They could nag them to exercise. They could order blood tests and track biomarkers over time. All of that was possible.
None of it was practical, not at the level the new technology delivers, but every feature the new technology brings is another step in a series of steps.
And that’s how the world changes, a series of steps that only look like leaps.
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