Well: Direct-to-Consumer Lab Tests, No Doctor Visit Required


Credit Jon Krause

Two years ago, Kristi Wood was tired and achy and could not think clearly, and she had no idea why.

“I was in a fog and feeling awful,” said Ms. Wood, 49, who lives in Seattle and is an owner of a hiking supply company.

Ms. Wood had her blood tested by a consumer service called InsideTracker, which analyzes 30 hormones and biomarkers, such as vitamin levels, cholesterol and inflammation. After the service told Ms. Wood she had excessive levels of vitamin D, she cut back on a supplement she had been using and said she almost immediately felt better.

Now she has her blood drawn and tested by InsideTracker every four months to check everything from her blood sugar to her B12 levels which, she said, “allows me to be proactive” about her health. The services typically send their customers to a nearby clinic where they can have a vial of their blood drawn and sent for analyses. But InsideTracker also offers customers the option to have nurses show up at their home and draw blood. (Such services are different from another blood testing company that has been much in the news, Theranos, which aims to provide laboratory test results from a single finger prick.)

Home testing services like InsideTracker say they are empowering consumers, allowing them to spot metabolic red flags before they progress to disease. But critics say the services often lack proper medical oversight and convince healthy people that they’re sick, leading to unnecessary testing and treatment.

Those concerns have not stopped people from seeking home testing. The market for direct-to-consumer laboratory tests was valued at $131 million last year, up from $15 million in 2010,according to Kalorama Information, a pharmaceutical-industry research firm.

In December, the New York State attorney general, Eric T. Schneiderman, accused two companies, DirectLabs and LabCorp, of violating a state law that requires laboratory tests to be carried out at the request of licensed medical practitioners.

DirectLabs had sold hundreds of health tests to consumers, ranging from checks for heavy metals and vitamins to screening for parasites and disease. But Mr. Schneiderman said the person fulfilling the medical practitioner role was actually a chiropractor who had never met, spoken to or followed up with any patients.

DirectLabs did not respond to a request for comment. DirectLabs and LabCorp agreed to pay fines, and DirectLabs ceased operating in New York. In a statement, Mr. Schneiderman said that allowing consumers to be tested for serious medical conditions without consulting a physician put “their health in jeopardy.”

Advocates of home testing, however, say such cases do not reflect industry practices. InsideTracker and another leading company, WellnessFX, said they worked with doctors who reviewed all test results.

Paul Jacobson, the chief executive of WellnessFX, based in San Francisco, said the company complied with all regulations and offered customers the option of consulting with a doctor, nutritionist or registered dietitian to discuss their results.

WellnessFX sells packages ranging from $78 to $988, offering analyses of 25 to 88 blood biomarkers, including vitamins, lipids, cardiovascular markers and thyroid and reproductive hormones. Depending on the results, the company also suggests supplements, foods and exercise.

“You need to offer solutions to people; otherwise, you’re just giving them meaningless information,” Mr. Jacobson said.

Tara Boening, the dietitian for the Houston Rockets of the National Basketball Association, said the team started using InsideTracker this season. The players look at their reports (deficiencies are highlighted in red), which include suggested corrective actions such as eating more red meat and leafy greens if they are low in iron. The players “have been really receptive” to the information, Ms. Boening said.

But some doctors say that there is no evidence that such monitoring makes a meaningful improvement in health. Dr. Pieter Cohen, an assistant professor at Harvard Medical School and an internist at Cambridge Health Alliance, cautioned that the levels of vitamin D and other biomarkers that were optimal for one person might be very different from what is optimal for another person. He said InsideTracker’s lab reports, for example, classified vitamin D levels below 30 nanograms per milliliter as “low” — even though a level above 20 is perfectly normal and adequate for most people.

Dr. Cohen said his major concern with direct-to-consumer blood tests was that they screened for so many biomarkers and created seemingly arbitrary ranges for what is considered normal. Then they give people advice that they already know they should be following.

“The best-case scenario here is you lose your money and then you’re reminded to get more sleep and to eat more fruits, vegetables and fish,” he said. “The worst-case scenario is that you end up getting alarmed by supposedly abnormal results that are actually completely normal for you.”

InsideTracker was founded by Gil Blander, a biochemist who did postgraduate research on aging at M.I.T. He said the idea behind InsideTracker was analogous to routine maintenance for cars.

“We decided, let’s try to do that for humans,” Dr. Blander said. “We can help you find a small issue today that might be a big problem in the future.”

Some, like Joseph Roberts, say the services are life-changing. Four years ago, Mr. Roberts, a former Army Ranger and a retired master sergeant, was plagued by fatigue, depression and weight gain despite frequent exercise. Mr. Roberts, then 39, said doctors told him his symptoms were a normal part of aging.

Eventually, he decided to have his blood tested with InsideTracker, and the results surprised him, he said. He was told he had low testosterone and vitamin D, as well as excessive levels of vitamin B12.

Mr. Roberts cut back on daily energy drinks, which are loaded with B12. He also saw a doctor to discuss his testosterone levels. He learned his low levels were linked to a brain injury he had sustained as a result of a roadside bomb explosion in Iraq in 2003. He began testosterone-replacement therapy and now regularly checks in with a doctor. He also has his blood tested with InsideTracker every four months.

“I’ve had a huge improvement in my quality of life,” he said. “It’s money well spent.”

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The Future Issue: You, Only Better

Asprey says he finally lost faith in Western medicine at 23, when a doctor told him that vitamin C could kill him. It turns out this isn’t true, but for Asprey it was the last straw. As a boy, he suffered from inexplicable rashes and alarming, recurring nosebleeds. He says he also felt a mental sluggishness that never seemed to recede. This frightened him, especially as he entered college. By the time he was 22, he weighed 300 pounds. He bought disability insurance when he was about 25 because he was worried that there would come a day when he wouldn’t have enough energy to work.

His poor health didn’t hold back his career. Asprey rose through a series of high-profile positions at several successful technology companies in the ’90s and ’00s. Still, he felt restless and unhappy. In 1995, determined to get his weight under control, he spent 18 months on a strict diet and exercised six days a week. He got stronger, but lost little fat. And the food restrictions made him even more miserable.


Asprey built on a personal obsession with tracking his own food intake and health data to create a multimillion-dollar company selling the Bulletproof Diet, which includes coffee spiked with butter and oil. Credit Jeff Minton for The New York Times

In the ’90s, Asprey studied a form of information management called a decision support system at California State University, Stanislaus. Such systems use artificial intelligence to analyze data and present it so users can more easily make difficult business decisions. Asprey decided to apply similar tactics to his health. He began closely tracking his food intake alongside his energy levels, mood, sleep and physical activity to create a data set so he could see what patterns emerged — which inputs correlated with positive outcomes and which didn’t.

After his failed low-calorie diet, he tried others: the Zone, Atkins, raw veganism, high-protein and intermittent fasting. At the same time, he went to extreme lengths to collect additional data on his body’s performance. He had adrenal testing done to better understand how his hormones worked; extensive blood work let him monitor his glucose and albumin levels. He got DNA tests to look for genes that might cause immuno­deficiency and sent out samples of his feces to learn about the microbes in his digestive tract. He bought an electroencepha­logram, or EEG machine, to monitor his brain waves. Once, in 2006, hoping to treat gut problems, he placed an order online for a shipment of parasites called porcine whipworm. The eggs arrived from Thailand a few days later in a saline solution. He drank the whole thing hoping they would trigger an anti-inflammatory reaction in his gut. They didn’t.

In all, Asprey says, he has spent more than $300,000 over 20 years on this self-funded research. He talks about himself almost as a lab rat, or as a monkey that was shot into space and returned intact, bearing data to share. But, with his background in computer science, he also fancies himself a hacker — someone who endlessly manipulates a complex system, troubleshooting and looking for vulnerabilities to exploit.

He eventually developed his dietary guidelines, which emphasize that half the day’s calories should come from healthy fats like coconut oil and avocados. Asprey believes these provide more energy and satiation than carbohydrates. The rest is a mix of organic proteins and vegetables. It is both strict and decadent. Sugar (including fruit), grains, legumes and pasteurized dairy are to be avoided, as are many trendy health food items like raw kale and nut milks, which Asprey says contain toxins. The diet is ketogenic; it forces the body to burn fat, instead of carbohydrates and glucose, for energy.

The centerpiece of the Bulletproof Diet — and the business — is Bulletproof Coffee: a blend of freshly brewed coffee, the Brain Octane oil and grass-fed butter, consumed at the beginning of each day to boost energy and curb hunger. It comes with a remarkable patter. In 2004, as part of his campaign of self-improvement, Asprey went to Tibet to study meditation. On a trek in the Himalayas, he began to feel the effects of altitude sickness. At a local guesthouse, he was served a cup of tea mixed with yak butter, which he found to be revitalizing and energizing. After returning home, he tried to make his own version, and eventually landed on the recipe he sells today — almost.

Asprey and Bulletproof employees are fond of asking whether you’ve had ‘‘real’’ Bulletproof Coffee — meaning not made with store-bought butter and coconut oil in your kitchen, but with their branded products. Asprey insists that most American coffee is riddled with a fungus that causes a post-consumption crash. He is especially hung up on mold toxins, or mycotoxins, which he believes were responsible for the health conditions that afflicted him while growing up. The mold in American coffee, he says, leads to illnesses, inflammation and weight gain. Asprey sells his own specially treated mold-free coffee for as much as $18.95 a pound online and at the shop. Next month, he is releasing a Bulletproof cookbook.

Despite some superficial signs of age, Asprey’s face is unlined, and after a while his self-assuredness and unflinching confidence in his methodology becomes contagious. Listening to his story, I stopped questioning his logic. I found myself growing impatient as he described the benefits of his medicine cabinet of ‘‘brain nutrients,’’ and asked for some — ‘‘I feel like I need them,’’ I said. An assistant brought in freshly blended cups of Bulletproof Coffee in Bulletproof-branded stainless-steel travel mugs. The fattiness of the butter and oil lent the coffee a mouth feel similar to Guinness. After a few sips, I started to feel giddy, and almost high — as if I could run a marathon and deliver a keynote lecture and do my taxes, all at once.


Credit Photo illustration by Andrew B. Myers. Prop styling by Sonia Rentsch.

The next morning, I arrived at the Pasadena Convention Center for the first day of the Bulletproof Biohacking conference. Inside, the crowd was almost comically Southern Californian. The bodies were firm, the jawlines sharp. The women were no strangers to cosmetic enhancement, and most of the men wore aggressively sculpted updos or low-slung man buns. Five-toe Vibram shoes and neoprene yoga pants were the popular pan-gender wardrobe choices. This was the vanguard of the quantified-consumer class — health-conscious Angelenos, the same types who were early adopters of the Master Cleanse and green juices.

The event was billed as a cutting-edge biohacking event, but it was tame compared with what goes on at the fringes of this community. Seven months earlier and about two hours away, in Tehachapi, a much more extreme clique of biohackers gathered to share the recent discoveries from their world at a gathering called GrindFest. These are the real transhumanists, the kind of people who implant magnets under their skin and embed microchips in their bodies to replace key cards. Asprey’s ethos is not so dissimilar — he wants to push humanity past its biological limits — but his sell is a little more palatable: We need only think of our bodies as hardware in order to improve upon them.

Little of the technology on display at the Bulletproof convention was new. No one was being implanted or fused with anything. They preferred to upgrade the old-fashioned way, with a miracle drug or pill or elixir that would transform them from the inside out, and there was no shortage of products that promised to do so. The Bulletproof Coffee was abundant, as were the Bulletproof-branded collagen bars, grass-fed meat jerky and small paper cups of steaming, earthy bone broth. There were samples of Fat Water, a new Bulletproof sports drink infused with a certain fatty acid that Asprey believes the body processes into energy more efficiently than it does glucose. There were Bulletproof-branded supplements, like glutathione, an antioxidant that Asprey says helps detoxify the body. I narrowly missed the cricket brownies smeared with colostrum icing — the crowd descended on them as soon as they were set out. I watched a woman drip a tincture made from deer antlers on the eager tongue of a slim and handsome attendee. I rolled my eyes at a hypnotist putting a woman into a trance, and then, hours later, the same hypnotist talked me into taking an injection of vitamins labeled simply a ‘‘shine shot.’’ (He had taken one, too.)

There are more than a few nutritionists who are dubious of Asprey’s bold claims. It’s hard not to be — there’s little research outside his own that backs them up. Asprey’s diet advises against calorie counting. It is also high in fat. Marion Nestle, an author and professor of nutrition and public health at New York University, is among those skeptical of what Asprey is selling. ‘‘I don’t know any diet, exercise or healthful-living shortcuts,’’ she wrote in an emailed exchange. ‘‘We all want to live forever, and if changing one thing in our diets can do that, we can all hope. The success of the dietary-supplement industry is best explained by wish-fulfillment fantasies.’’

On the day before the conference began, I asked Asprey about his childhood. He quickly rattled off a few sentences about his parents. They worked at Sandia National Laboratories, which taught him the value of scientific inquiry. That wasn’t what I had meant. Were his parents particularly health-oriented? Or did he grow up eating takeout and frozen meals? He gave a dismissive shrug. ‘‘My parents gave me squeeze margarine and bran muffins because that’s what the magazines said,’’ he said. He paused for a moment, reconsidering. ‘‘They did their best.’’

During the ’80s, when Asprey was a kid, eating bran muffins was the fad diet of the day — that, and a little Jazzercise, and you’d be set. Eventually, people came to recognize that the benefits of the fiber were canceled out by the heavy ca­loric load and sugars. Margarine was also peaking in popularity around that time, seen then as a sensible alternative to butter. But since then, nutritionists have questioned the wisdom of the low-fat, high-carb diet that Americans have been steered toward for years. Asprey’s diet is, for all its technological fervor, a refutation of the last generation’s hollow wisdom. In its avoidance of complex carbohydrates and its pseudoscientific rhetoric, it’s not so dissimilar from the Paleo diet — along with a bunch of supplements that would befuddle a cave man, or even a New Yorker.

My own parents were trim and active; they were also Southern, which meant that butter-and-sugar sandwiches and cheese grits were staples of our diet. I was a heavy teenager, with more acne and eczema than I’d like to remember, and it wasn’t until my 20s that I understood the role dietary habits played in that. Since then, I’ve endlessly experimented with raw diets, green juices, Paleo-inspired meal plans and various cultish boutique fitness classes, trying to figure out what works best to maintain a healthy weight. I still don’t have a definitive answer. Fad diets persist because they are seductive, and offer the promise of unlocking a better you by following a few simple rules. And Asprey’s pitch couldn’t be more epistemologically fashionable: A/B testing, hacking and data analysis have already provided us with many novel insights and conveniences.

Asprey believes that nutrition should be as effortless as everything else in our technology-enhanced existence — why shouldn’t it be? His background is in information management, and that is what he is skilled at: distilling oceanic volumes of information for easy consumption and decision-making. The allure of the Bulletproof lifestyle is that you can outsource that work. ‘‘That fundamental laziness, where I want everything to be easier, is part of what drives me,’’ he told me that first day. ‘‘I don’t want to do more work than is necessary to do great things. I don’t see why anyone should do more work than is necessary to do great things.’’

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