HN Explorer

Launch HN: Be Golden (YC S22) – Measure and manage your inflammation levels

223 points by Snehpatel1 ↗ HN
Hi HN! This is Sneh and Kimberly from Be Golden (https://www.begolden.online/). Be Golden helps you understand how your lifestyle impacts your health, particularly in terms of inflammation levels. I (Sneh) am a PharmD and the CEO; Kimberly has a PhD in biology and is the CTO.

We all make lifestyle choices daily - what we eat, how much we exercise, etc. No matter how good we are, we are all probably trying to get better but we don't have a great feedback mechanism on how our choices impact our health. We may go to the doctor once a year (if that) to get some blood work done but so much happens in between that it's hard to tell what made an impact. We wanted to change that so that you are better understanding how your lifestyle is impacting your health to help you make better decisions.

Be Golden focuses on helping you measure and manage inflammation levels because inflammation is impacted by all key lifestyle behaviors (nutrition, exercise, sleep, stress) [1] and impacts a variety of health outcomes—from energy levels, to IVF success rates and IBS symptoms to chronic diseases like heart disease and cancer [2]. This Nature Medicine article (https://www.nature.com/articles/s41591-019-0675-0) states "One of the most important medical discoveries of the past two decades has been that the immune system and inflammatory processes are involved in not just a few select disorders, but a wide variety of mental and physical health problems that dominate present-day morbidity and mortality worldwide."

I started tracking my inflammation scores (see my graph here! - https://www.begolden.online/post/our-ceo-s-hscrp-scores-over...) after I learned I was at high risk of breast cancer and had a bilateral lumpectomy. I learned that chronic inflammation can be a driver of tumor development [9], progression [10], and treatment responsiveness [11]... and can impact a surprising number of other things. It keeps us from functioning optimally. The good news is that it can be managed with healthy lifestyle choices (see [1]). I started making healthy changes (like exercising almost daily) and seeing an impact on my inflammation levels (although it seems like the “startup lifestyle” has me back on an upswing lately). I decided to start a startup to help manage inflammation because I wanted more tools, data and analytics to help me make healthy lifestyle choices. I recognize the (hopefully short term) irony :).

So how does it work? You start by measuring your baseline inflammation levels using an at-home, finger prick based, blood testing kit, that includes a shipping label to send the sample back to the lab. You then receive your lab results and we start layering in data-based insights like how your levels compare to other people like you. From there, you can try a new habit from our list of scientifically backed options (https://www.begolden.online/post/lifestyle-interventions-ass...) or something else you have been meaning to try.

Once you choose a habit (for example, adding ginger to your diet), we will help you track how often you do it. Our current digital platform design is to text you daily and ask you: Did you have ginger yesterday? (yes/no). Then you will re-measure and receive insights. For example, you may get an insight like - you have had ginger 15 of the last 30 days and your inflammation levels are down 10%. Based on the data from clinical studies, some interventions can change inflammation levels (as measured by hsCRP) within weeks and others show within months [3]. As such, ...

161 comments

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Snehpatel1
[1] https://www.nature.com/articles/s41591-019-0675-0, plus sources on this page: https://www.begolden.online/post/lifestyle-interventions-ass...

[2] See the Nature article in [1] plus sources on this page: https://www.begolden.online/post/scientific-articles-on-the-...).

[3] https://pubmed.ncbi.nlm.nih.gov/19223918/,https://academic.o..., https://pubmed.ncbi.nlm.nih.gov/17909397/

[4] https://www.sciencedirect.com/topics/neuroscience/c-reactive..., https://www.nejm.org/doi/full/10.1056/nejm200003233421202, https://www.clevelandheartlab.com/wp-content/uploads/2020/04...

[5] https://www.health.harvard.edu/staying-healthy/understanding...

[6] https://www.nature.com/articles/s41591-019-0675-0, https://www.clinicaltherapeutics.com/article/S0149-2918%2819...

[7] https://www.nature.com/articles/s41591-019-0675-0, https://www.health.harvard.edu/staying-healthy/understanding...

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369762/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831096/ ,https://www.mdpi.com/1422-0067/22/11/5421/htm, https://www.nature.com/articles/s41591-019-0675-0, https://www.cell.com/fulltext/S0092-8674(10)00060-7

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debarshri
I'm sitting in doctors office waiting for my appointment for an inflammation on my hand and I read this. What are the chances.
Etheryte
This is a very appealing prospect and I'm sure you'll have no problem finding paying customers. The main question I can't help but ask is, how do I, or any potential customer for that matter, know that this isn't simply Theranos 2.0?
StayTrue
It's one conventional blood marker, widely used in medicine. Not suspicious IMO.
Snehpatel1
Great question! Theranos was designing its own testing machines. Be Golden is using existing validated testing methods.
IMTDb
Theranos promised to build a machine that would reduce the cost of blood samples by multiple order of magnitudes. They were unsuccessful in building it, and they lied about the progress of it all ton investors, journalists etc.

This is using existing - proven - testing methods and process. The claims are much less extraordinary; they are not claiming to completely transform an industry, but "merely" to give you additional insights on your health based on what's already known to be working.

Maybe it won't be successful or maybe the insights won't be as interesting as they claim, but it's nowhere near what Theranos was doing.

samatman
The chilling effect Theranos created was the worst outcome by far.

Most biomedicine companies aren't doing things which can lead to a Theranos result, and 99% of the companies which are building devices with an eye toward FDA approval are doing so honestly.

[dead] pipeline_peak
dboreham
Actually the people with this sort of condition tend to have a sense for what foods may be causing them trouble. So they're already thinking "hmm...did I eat onion" earlier?? Automating this process they're already going through seems reasonable. Obviously this requires that the questions are tailored -- it wouldn't make sense to ask about a randomly selected food from the gamut of all foods.
FounderBurr
You can get a CRP level from any lab without a doctors order for about $30. The correct test, drawn and handled correctly, unlike this method.
Snehpatel1
Great point - our pricing is a function of the added costs of packaging, shipping, etc. We believe at home testing will offer consumers more convenience than going into the doctors office. However, if we learn that in person testing is preferred, we would definitely explore that as an offering!
dboreham
Not very practical to do every day.
Snehpatel1
Wanted to check - are you referring to the testing? If so, you are right! We actually recommend testing every 1-2 months to likely provide adequate time for change to your levels. Each person’s needs and time to impact will vary, so you can adjust this frequency up or down, depending on what works best for you.
kite_and_code
Can you ship to and from Europe?
Snehpatel1
Not yet but we hope to expand globally in the future!
edf13
European here too and very interested in this too. Be worth you having a email signup form for notifications of rollout to other countries!
Snehpatel1
Good to know! As a short term hack - would you mind just noting you are from Europe in the "learn more" form under the open "other" field here: https://www.begolden.online/
edf13
I would but your site is jumping and scrolling back to the top whenever I try to fill the form in (on safari iOS)
benkoller
Interesting approach, thanks for the good reads. Would love to support, no strings attached, if you see an opportunity. Reached out on LI, feel free to dump the request if this feels off to you.
KMnO4
Cool! A couple suggestions:

1 - the CSS is all over the place on mobile, it looks pretty bad.

2 - maybe adjust the pricing of the bulk a bit. I assume you want to sell the bulk packs more, so incentivize them more.

Instead of $74 for 1 / $69 for 2, make it like $79 for 1 and $64 for 2, and make sure you say that’s “saving $30”. Right now it feels like it’s only $5 off which doesn’t convince me (yes I know it’s $10 actually).

Snehpatel1
Great feedback! Yes, our mobile experience (and frankly, web) definitely needs work!
shagymoe
I've noticed that my C Reactive Protein were always high when I was taking creatine and doing strength training and wasn't sure which was the culprit. Likely both. Is there a way to account or correct for high hsCRP related to exercise or is the recommendation to do less intense exercise?
Snehpatel1
This hits perfectly on an FAQ we have:

Are there any times I should avoid testing?

Experts recommend avoiding testing when you might be experiencing an acute (short term) elevation in hsCRP. Some instances that cause short term elevation include bacterial or viral infections and strenuous exercise (like running a marathon). These cause short term elevations in hsCRP because acute inflammation (short term spikes in inflammation) can help the body clear pathogens and heal tissues.

Here is some related scientific literature you may enjoy: https://www.sciencedirect.com/science/article/pii/S073510970...

aaraujo002
This is very interesting. However, our lifestyle is not very linear, meaning that we can have some period more stressful than over. In this context, how do you deal with confounding variables ? For example, if my inflammation levels decrease in the next few weeks, it might be because I took some ginger everyday but it might also be because I had a less work and therefore more sleep.
Snehpatel1
Love this question. We can track as many additional variables as you like. For example - I track my lifestyle intervention (meditation) + 4 key dimensions of health (sleep, stress, nutrition, exercise) on a scale of 1-5 (1=bad, 5 = good). This gives me the added context you are talking about. In the future, we also plan to add the ability to connect to your wearables.
thomasfedb
This is basically just facilitating people data dredging their own health. If you measure one outcome variable and enough "candidate" inputs you'll eventually find something that looks like a pattern.

As a doctor I measure CRP when I'm specifically looking for something - but that's in the context of having formed a differential diagnosis, then having considered the pre-test probably of each differential, and forming a view that the test result with alter the overall likely outcome. The last thing I would even want to do (for me or my patients) is to start randomly measuring CRP when generally well.

Why not just eat the ginger?

tucosan
They don't even test for CRP but hsCRP (info is buried somewhere in the marketing babble). Also see my other comment below OP
somberi
Useful service, and tried adding two tests, but decided to not order when I saw:

Recurring subtotal $268.00 every 12 months

Do not know if it is useful enough to renew, and I as a customer do not like services that presumptively charge me on and on and moves the onus to the customer to get out of the charging cycle.

Thanks, useful service, but not for me.

Snehpatel1
Good news - once you order, you will get an email that lets you manage your subscription at which point you can cancel the renewal right away. Let me know if you have any issues with that!
somberi
What would work better for me, as an individual, is to not lock me in, let me try the goods that I have paid for, and evaluate if it satisfies my need, and drive the value (through messaging) of leaving my credit card on your file for future charges.

That would still not be good news, but just a normal expected behavior from a lab testing service.

Again, I am cognizant of the business realities that makes you do this, and just reaffirming why I will not pay for your services.

O__________O
Confused. Is it accurate that you are logging self-reported data daily, but only running diagnostic tests few times a year at roughly $100 a test depending on how many tests the end user commits to upfront? If so, with that combination of data, how is there any hope of meaningful analysis based individual specific observations?
doix
Congratulations on your launch! I apologize in advance for my ignorant questions, but here they go.

How can we be certain that inflammation is causing problems rather than just being an indicator that something is wrong? As in, if we start directly lowering inflammation with some drug or whatever, how do we know that it's helping rather than just masking the problem? So if someone is obese and inactive, but they start eating ginger to reduce their inflammation markers, would that improve quality of life?

I guess the best example(as someone that is completely ignorant on the topic) I can come up with is heart rate and exercise. We know that an elevated heart rate when exercising is good and provides benefits. But increasing the heart rate with caffeine does not provide the same benefits.

Coming from software where I can use a debugger to examine "exactly" what is going on in a program and an ex hardware engineer where we had simulators/models that were "pretty accurate", medicine/healthcare looks insane. We cannot model the human body accurately nor can we observe in great detail the processes that go on. I'm pretty amazed medicine is as good as it is with those limitations.

Snehpatel1
I will now apologize in advance if I am not answering the question :)

Overall, we recommend healthy lifestyle habits versus drugs to manage inflammation levels.

thomasfedb
The body is nuts. Fascinatingly and amazingly nuts.

I think an honest answer to your question is "we can't be certain". In fact we can probably be fairly confident that "inflammation" (as if that's one simple thing) is not going to be quite so straightforward.

A person who is obese and sedentary might get some benefit from a "magic drug" that prevents the effects of inflammation, but they'd be far better advised to adopt a more active lifestyle before they put their hopes on ginger.

ricokatayama
cool. I'm writing from another country. Is is possible to have an access to the tool, but doing the hscrp test from here?
Snehpatel1
I'd like to do some more research on this - for example, there may be some regulatory reasons we may not be able to. Can you email me at founders@begolden.io so I can follow up?
jjallen
This is like 10x the cost of other hsCRP tests you can take from home.

Pretty hard to justify the cost differential.

Also, going to a proper doctor and having a real blood test done once a year would cost way less than this.

mritchie712
> proper doctor and having a real blood test done once a year would cost way less than this.

how much is that?

muschellij2
Most insurance plans see this as preventative care to get bloodwork done when you're doing your wellness visit, so, if you have insurance, $0 out of pocket.
Snehpatel1
In my experience, some doctors won't order hsCRP (the marker we measure) for everyone. If they do, I think it would be rare for insurance to cover it multiple times per year.
metadat
Why do we need it multiple times per year? Maybe that's the part that needs to change, so as many people as possible have access to the data?
Snehpatel1
The idea is that by testing multiple times per year, you get more insight into what may be driving your levels and be able to intervene sooner
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Grimburger
Not sure about other countries but this is completely free in Australia. It's a general consult and bulk-billed onto medicare.

I get an annual blood test done, even if not in the country, have paid $30 in Europe and $20 in Asia as a foreigner, isn't even worth bothering to claim on overseas health insurance.

SyneRyder
That seems correct to me. I tried to look up the costs in Australia and I think this is the Medicare Benefits Schedule for it (ie C-reactive protein), though I'm happy to be corrected if I'm wrong:

http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=66...

If correct, it seems the cost to the taxpayer is $9.70 AUD (about $6.67 US). So even without bulk-billing making it free here, that's still a 10x markup.

Snehpatel1
Thanks for this info, particularly as we look to expand internationally :)

Our price includes lab costs but also the cost of the packaging, shipping, ordering physician, etc. which all starts to add up!

We decided to start with at home kits for the convenience but are planning to explore other methods of measuring levels (e.g., partnering with physical labs)

Edit: I should also add that costs/prices typically start higher with startups and we fully expect them to come down as we scale.

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Snehpatel1
I believe our prices are in line with other at home tests. Would you mind sharing any links you have that have pricing 10x lower? I'd love to look into it and see if we can bring our costs down for our customers!
lxe
I found this one https://www.ultalabtests.com/test/cardio-iq-hs-crp for $30 something.

Usually they are anywhere between $50 and $90 on everlywell and letsgetchecked I think.

You're right on the money at $74 I think but I will steer clear due to this $60/year digital platform subscription that kicks off after year 1.

Snehpatel1
We made it optional to auto-renew the subscription. Hope you give us a try!
unmole
I'm obviously not in the target market but apparently I can get the test for 450 INR or 5.65 USD. This is includes a trained phlebotomist coming to my house to take the sample: https://www.1mg.com/labs/test/High-Sensitive-CRP-2274
Snehpatel1
This is helpful to know as we look into international expansion.

Our current pricing is in the US market. Hopefully, costs decrease over here over time!

pirate787
The whole point is that the test is part of a system to put the results in context, more frequently that an annual visit. My doctor isn't very good and has never brought up or tested me for this.
sdwr
Not going to argue with the price, but monthly / biweekly / weekly testing is way different than once a year. Yearly is enough to get an overall sense of where you are at, biweekly lets you correlate w/ much more fine-grained signals. Plus it keeps the score in your head as a goal.
firasd
Very interesting. I remember seeing data in the early days of Covid that CRP was quite correlated with severity
Snehpatel1
We are excited to potentially use our platform to research more in this area - for example, do people with higher baseline hsCRP levels have higher likelihood of long COVID?
carlyballen
I preordered test kits. Looking forward to using it soon and seeing my results!
eikaramba
I recently also developed an App to help me figure out my IBS and digestion problems. Basically i looked at all the apps in the app store but did not found a simple to use app. Inserting your meals should really be as simple as it possibly can, otherwise you will end up not using it at all.

If anyone is interested, it is currently available in the google app store. Apple coming soon. Foodolyst: https://play.google.com/store/apps/details?id=studio.creatne...

Also available as a webapp: https://app.foodolyst.creatness.studio

The app works in German&English. I haven't proof read every English entry however, so feedback is very much welcomed. I can return lifetime premium access in return :)

Okay enough advertising, sorry but the topic is quite interesting and everyone with food problems can just benefit from this.

tucosan
Why do you test for hsCRP and not CRP?

What exactly can I learn from my hsCRP values? What can I learn from hsCRP that I can't learn from CRP?

hsCRP is a very sensitive marker. If I'd exercise the day before the test and my values would be elevated? What would I learn from my result in this case?

Will your provide explanations of what influences my individual hsCRP levels and what specific interventions I should take in case they are elevated?

What is your process if you detect abnormally high hsCRP values? How do you alert your customers of their possibly lethal condition?

How does your service provide value to me as a customer apart from me not needing to go to a lab/doctor to get tested?

Anyways, I don't see much value in getting just hsCRP tested standalone without any other meaningful context. What about my iron levels? Vitamins? Lipid profile? IgG, IgA? HBa1c. On and on it goes. There is a reason that medical doctors collect a host of lab data to make informed decisions about their patients health and which possible interventions induce postive change without interdicting harmful side effects.

Snehpatel1
Apologies for the delay. There were a lot of questions so wanted to answer all of them in one shot.

>Why do you test for hsCRP and not CRP? What exactly can I learn from my hsCRP values? What can I learn from hsCRP that I can't learn from CRP?

hsCRP stands for high-sensitivity C-Reactive Protein, while CRP stands for C-Reactive Protein. Both tests measure the same protein, but hsCRP tests are more sensitive to lower inflammation levels and can therefore let you measure these lower levels.

See the 'Defining hs-CRP' section in this link for additional details: https://www.uspharmacist.com/article/the-application-of-high...

>hsCRP is a very sensitive marker. If I'd exercise the day before the test and my values would be elevated? What would I learn from my result in this case?

Experts recommend avoiding testing when you might be experiencing an acute (short term) elevation in hsCRP. Some instances that cause short term elevation include bacterial or viral infections and strenuous exercise (like running a marathon). These cause short term elevations in hsCRP because acute inflammation (short term spikes in inflammation) can help the body clear pathogens and heal tissues. Here is some related scientific literature you may enjoy: https://www.sciencedirect.com/science/article/pii/S073510970...

>Will your provide explanations of what influences my individual hsCRP levels and what specific interventions I should take in case they are elevated?

Yes, we focus on lifestyle interventions that help lower inflammation levels. You can find more info here: https://www.begolden.online/post/lifestyle-interventions-ass...

We plan to continue to build on this list

>What is your process if you detect abnormally high hsCRP values? How do you alert your customers of their possibly lethal condition?

The lab results should indicate if your levels are above normal. If you have any questions regarding your health, we encourage you to always seek the advice of your physician or another licensed health care provider

>How does your service provide value to me as a customer apart from me not needing to go to a lab/doctor to get tested?

We provide you the information to take action once you receive your lab results

>Anyways, I don't see much value in getting just hsCRP tested standalone without any other meaningful context. What about my iron levels? Vitamins? Lipid profile? IgG, IgA? HBa1c. On and on it goes. There is a reason that medical doctors collect a host of lab data to make informed decisions about their patients health and which possible interventions induce postive change without interdicting harmful side effects.

We plan to expand our list of biomarkers in the future, as we learn more about our customers

curmudgeon22
Really interesting chart on your lifestyle interventions link. Curcumin has both a very strong performance and pretty good range. Interesting to see that it is much more so than exercise or sleep improvements.
NavinF
Relevant: “curcumin is a PAIN (pan-assay interference compound, ie a substance with weird chemical properties that make every test seem positive, so if you do chemical tests to see whether it activates eg coronavirus-fighting immune cells, it will always say yes). This means people are always publishing exciting papers about it and alternative medicine people are always getting really enthusiastic about it and suggesting it as the cure for everything (eg depression).”

From https://astralcodexten.substack.com/p/pascalian-medicine

n8henrie
Do you provide any context on the normally expected day-to-day variability in CRP levels? I imagine that getting spot checks once a month would require a few years (or perhaps decades) if data before signal could be reliability differentiated from noise in a given individual.

Have you established anything like this in pre-production testing? At least something as simple as "make no intentional changes to your lifestyle and test monthly for a year," and then institute your recommended lifestyle changes and test for another year? If so, it would be helpful data to make available (in a loud way -- I admit I read your post but haven't perused the website yet).

Are there interventions that lower CRP but have no effect (or negative effects) on health? I agree with other commenters regarding the problems of surrogate markers...

Snehpatel1
I'm sharing my personal results here, where you can see changes over time: https://www.begolden.online/post/our-ceo-s-hscrp-scores-over....
n8henrie
Thanks for sharing -- it's a little short on details though! Is there somewhere that you share what interventions you implemented when? And did you establish a baseline first?

I ask because if your initial level were omitted as a single outlier, the remainder of the chart would look a bit different.

masters3d
I love all the new health monitoring startups.

I recently tried documenting my glucose using one of the many startups using electronic patches that measure glucose every few minutes.

What is the likelihood that a similar electronic patch would become available for inflammation in the industry?

Snehpatel1
We believe it will be possible to start doing a more "continuous" monitor for inflammation in the future and are looking forward to that day! If it is possible, we plan to offer it as part of Be Golden
nonameiguess
This sounds like you're doing research. You're trying to gather data on daily habits and interventions taken by subjects and then looking at the impact on their blood marker levels. That is normally something that would happen in a randomized controlled trial or possibly epidemiological retrospective if you're doing pure data mining, and the research subjects would at worst be volunteers, but might even be paid. This feels like you're asking research subjects to pay to be research subjects so they can take your treatments that you don't yet have evidence for.

I don't mean to sound like I'm impugning your ethics, but why are you doing this as a startup and not a research proposal? Is it normal for YCombinator to fund medical research?

ahstilde
Congratulations on your launch! We've had a lot of inquiries about inflammation when we see our patients at Wyndly (https://www.wyndly.com), so it's good to know someone is thinking about making this process easy!
imdsm
This is a great idea, but the website could be so much better. I felt like I wanted to be taken on a journey, of what is this? why does it matter to me? how does it work? how can I get involved? what's the projects future?

I love the idea, and so do many others, hence why Theranos was able to raise what it did, the idea of having insight into our own health is exciting, intriguing, and important.

I wish you the best of luck on your journey, but I would definitely improve on the site, if you have the resources to do so.

anchochilis
Did you actually read the copy on the website?

> Measure your baseline inflammation levels and see how they fluctuate with lifestyle choices (nutrition, exercise, sleep, stress) so that you can make the right choices for you

> Be Golden works by using an at home finger prick based blood testing kit and a digital platform

I'm not sure what "story" is left to be told here. It's pretty self-explanatory.