Billionaire VC Tim Draper (via Draper Associates) has led a $6 million Series A in wellness tracking startup, Vivoo. Also participating in the funding round is ONCE Ventures, Revo Capital, 500 Startups (which backed its pre-seed), Global Ventures, and (the female-led consumer tech startup focused) Halogen Ventures.
The personalized nutrition and lifestyle startup sells subscription-based at-home urine test kits that work in conjunction with an app. Its machine learning technology remotely analyzes a user’s peed-on test strip to serve up custom ‘wellness’ insights, then and there, offering recommendations across a range of areas such as nutrition and biological function.
The startup’s founding team is led by CEO and co-founder Miray Tayfun, a serial founder and bioengineer by background who graduated from Stanford’s postgraduate programs. Other co-founders for the 2017-founded startup are George Radman, CFO; and Gozde Buyukacaroglu, COO.
Vivoo launched its subscription service in July 2020 and has amassed more than 50,000 users from over 100 different countries in a little over a year.
It’s says it’s expecting its revenue to grow 10x in 2021 — and points to predictions that the mobile health app market will be worth $236BN by 2026.
It does currently offer a one-time pack (of 4 “wellness” tests for $34.99) — but otherwise it’s selling a 3-month subscription offering ($15.99pm) or a 12-month subscription which works out to $7.99pm.
While Vivoo is shipping its kits around the world, its biggest markets are the US and Canada — followed by the UK and Australia. (The Anglo bias is down to content currently only being available for English, and “tailored for Western cuisine”, which puts some obvious limits on global appeal.)
Typical users to-date are “health conscious individuals” looking for “actionable insights to improve their diet, health, energy, sleep and overall longevity”, per Tayfun.
“The Keto diet audience were the early adopters for our product but we’re seeing interest from a wide age and geography at the moment,” she tells ProWellTech. “Our biggest audience is 25-45 year old women users followed by the same age group male users. “Around 80% of our users also use other trackers such as wearable devices and who did or would like to do tests like genetic and microbiome at-home tests.”
Vivoo says the Series A funding will mostly go on expanding its team to further scale the business — with a focus on the US, where it has already inked partnerships with retail outlets including Amazon and Walmart to distribute the product.
Funding will also go on expanding the product, with additional test kits planned and a new premium offering incoming that will expand what can be tracked and offer integration with wearable data from products like the Apple Watch to further boost utility.
The quantified health trend has been evolving for several years now, beyond basics like step counting and sleep tracking — and getting, well, a whole lot more interesting and intimate. But the challenge for this new wave of ‘personalized wellness/health’ startups is not just gathering accurate data and avoiding privacy pitfalls, it’s making good sense of the data they gather.
Whatever the chosen biomarker, such startups have to be able to extract genuinely useful signal from biological noise (remotely in Vivoo’s case); and, if applying AI (as it is; and most startups in this new wave are), they also need to begin with enough training data to build algorithms that can robustly identify patterns across a diverse user-base and transform a snapshot of individual data into genuinely beneficial lifestyle nudges for the individual in question. Aka: Eat this, drink that, exercise now — as one such startup (January AI) does it.
Startups in this space are targeting a variety of biomarkers to sell the promise of custom nutrition/lifestyle advice that claims to offer a superior spin on the basic tenets of eat fresh, exercise often.
Some — like Ultrahuman and Zoe — are tracking blood glucose and/or getting users to collect and send in stool samples for analysis of their microbiome. And here the focus may be on diet/tackling obesity or pro-fitness/elite sports (or both).
While, for a female fertility use case, the biomarker in question can involve tracking vaginal mucus or body temperature, as with Kegg and Natural Cycles respectively. Or using saliva to track hormones (Inne).
Certain approaches to personalized wellness/health require more invasive interventions than others to acquire the necessary biological data to perform the tracking. But it’s fair to say that all ask users to get pretty up close and personal with their own bodies.
Collecting stool samples is obviously a fairly messy business. And gathering real-time blood glucose measurements — at very least — means being okay with pricking your finger, for example.
One game-changing technology — continuous blood glucose monitors (CGMs) — yields a steady flow of pretty fascinating diet and lifestyle data but you’ll need to be comfortable wearing a sensor that contains a semi-invasive filament embedded in your interstitial fluid in order to play. (And putting that kind of ‘wearable’ in place typically means applying a spring-loaded hollow needle that fires the filament into your flesh… so it’s definitely not the Apple Watch and isn’t going to be for everyone. Although researchers are trying to come up with truly non-invasive CGMs — such as GraphWear’s years-long push to build a skin-surface-level wearable for glucose monitoring; so if they pull that off it will be a major breakthrough for scaling personalized health.)
Vivoo — by contrast — is using a fairly simple, low mess, non-invasive avenue to get snapshots of biological data: Pee sticks.
“We chose urine rather than saliva or blood to start because it’s easy to collect and analyze and can be used to measure a high number of the body’s performance variables. 4,000 metabolites can be seen in the urine,” says Tayfun, suggesting it plans to branch out in the future. She adds that the startup sees CGM as a “complementary technology” — envisaging a partnership with a device maker down the line (“since the data is complementary to Vivoo data sets, and our users are always seeking more information”).
“Our biggest criteria when we’re looking for other tests or tracking devices is it should be at-home, not sending to a lab and waiting for your results for weeks. We believe that the process is frustrating and old-fashioned for ‘at-home’ lab tests,” she adds.
Vivoo’s approach is simple: It ships a pack of individual urine test strips to subscribers. (And for anyone who’s used an at-home pregnancy test the basic process will be familiar.)
Each Vivoo test strip contains a series of colored boxes. After the user has peed on these they just have to wait a couple of minutes and then take a scan of the strip using the camera in the app — which uploads the image data for analysis. (So the app is examining the pre- and post-pee colors to compare changes — and using that to determine urine test results.)
Vivoo says it’s using machine learning technology to perform this remote urine analysis — including what it bills as “advanced image and color processes for calibration, validation, and verification” (i.e. given how much variation there is across smartphone camera hardware). Once the user’s data has been crunched, the app then returns them custom wellness advice based on the machine learning tech’s remote read of their urine test.
Advice dished out may include suggestions on how to could tweak your diet to boost a certain nutrient if the urine analysis suggests it’s low (e.g. calcium or vitamin C) — such as ‘eat more calcium-rich arugula’ or ‘have a bowl of vitamin C-boosting strawberries for breakfast’ — or it might give an alert about a possible infection.
Hydration is another tracked measure. And, here again, Vivoo’s tech is using a color change analysis to determine whether a user is getting enough to drink — and, if it thinks not, the app will nudge users to drink more (by, say, recommending they drink 10 glasses of water per day).
While it’s making recommendations it says are evidence-based and associated with a healthier lifestyle, the startup’s website is careful to specify the product is for “wellness” purposes only — and that the app is not a medical diagnostic device.
Vivoo says its product offers a range of wellness “parameters” that health-conscious users can track — including overall hydration; menstruation; whether they have an infection (e.g. UTI) or bodily inflammation (tracked by analysis of white blood cells); their urine’s acidity and alkalinity level (used as a dietary indicator); ketones (mainly for those on a ketogenic diet); and the function of their liver and kidney.
“Users can access data on 15 health factors, including hydration, pH balance, ketones, calcium, magnesium, Vitamin C, free radicals, kidney function, liver function, UTI risk, activity levels, stress levels, menstruation, and overall wellness,” it writes in a press release.
There’s a lot of tracking going on here so it’s clearly not the simplest personalized health message. But Tayfun said the team was frustrated with the limitations of other health/wellness trackers and at-home test kits — wanting something more comprehensive as well as the gratification of instant results. Hence setting out to build Vivoo.
“This was definitely personal for me,” she tells ProWellTech. “I’m a bioengineer, and I wanted to know everything I could about my own health. Prior to creating Vivoo, I had tried every kind of tracker and test — wearables, tests like 23 and Me, blood tests like Everlywell — I wanted to know it all. But it was costly, and the results were rarely real time. Sometimes it could take 1-2 months to get specific metrics.
“As a bioengineer, I knew there had to be a better way. So we created a wellness tracker based on at-home urine tests that gives instant results and engaging, personalized recommendations to help people improve and manage their health on their own.”
Per Tayfun the “key data points” the app currently reads are: hydration, pH, Ketones, UTIs, kidney and liver scores.
“With the premium experience, we extended the tests and our customers will be able to track their Magnesium like minerals, Vitamin C, Free Radicals, and salt consumption,” she adds.
What scientific research is Vivoo drawing on to make recommendations based on its (remote) analysis of users’ urine samples?
“Our approach is to suggest evidence-based recommendations created by dieticians and reviewed by doctors,” she responds on that, further specifying: “The research mainly uses higher-quality scientific research such as meta-analysis, systematic reviews, and nutritional guidelines. Additionally, the impact factor and scientific journal ranking is also taken into account when selecting a reference.”
Some of the information on Vivoo’s website talks about the importance of ‘balancing’ the pH of urine. Asked about this she says urinary pH has a “close association with the dietary acid load”.
“Diet composition has long been known to influence acid-base balance by providing acid or base precursors. In general, foods rich in protein, such as meat, cheese, eggs, and others, increase the production of acid in the body, whereas fruit and vegetables increase alkalis,” she says.
“The capacity of acid or base production of any food is called potential renal acid load (PRAL). While human urine can range from 4.5 to 8, The optimal urine should be around 6-7. Having too acidic or too alkaline urine has some health risks.”
So this means that the app might flag that a user’s urine is ‘too acidity’ — and say that’s linked with eating more High-PRAL (aka “High acidic”) foods — which Tayfun suggests causes “metabolic acidosis” that she says has been associated with the development of a number of chronic diseases, such as diabetes, insulin resistance, hypertension, chronic kidney disease, renal lithiasis and non-alcoholic fatty liver, “among others”.
“In this case, we show the possible health risks and suggest low-PRAL (Alkaline promoting) foods to balance the ‘acidic’ urine pH and lower the health risks,” she goes on, suggesting generally that checking their urine pH regularly will help Vivoo users to be “more proactive, learn more about their body and get help with choosing mindful food options to improve their wellbeing”.
On the website Vivoo recommends users do a weekly test of their urine — although it suggests that those tracking their hydration or ketones might feel nudged to test more often. (Although the current subscription packs don’t provide enough test kits for users to maintain daily testing without a break.)
Vivoo’s speedy remote analysis of users’ urine test strips hinges on machine learning models that Tayfun says were trained on “more than 1M data points to give precise results”.
Although she qualifies that by saying the database is growing “day by day” to add more info on “different light conditions, camera models, phone models and softwares of the mobile devices to be accurate in multiple platforms”.
And, well, as the app itself is not a medical device the analysis it performs is just a data operation, not a medical diagnosis — so performance/accuracy is obviously not akin to a medical-grade device.
Asked how it’s assessed the accuracy of the scanning component of the analysis, Tayfun says that for the Vivoo Lite product the image processing system has been tested in external laboratories and in its own labs.
“Measurements are carried out simultaneously in the tests and comparative analyzes are made. Phones with different operating systems and camera features are used in accuracy tests,” she says, adding: “Comparative analyzes in urine analysis devices are measured by looking at two percentiles, which are 100% accurate and +-1 level error of measurement values.”
She also specifies that a new Premium subscription tier of the product will also undergo a third party laboratory and analysis — with results slated to be published in a peer-reviewed journal (but that hasn’t happened yet).
“Our urine tests are registered with the FDA but the app is not as it’s not a diagnostic device but a data tracking tool,” she adds when asked whether Vivoo has plans to apply for the app to be regulated as a medical device in the future.
“We have plans to extend the capabilities of the application in the future, and we may consider adding metrics that can help chronic disease sufferers to track and share their data with their healthcare professionals. We will be following the FDA’s guidelines and recommendations as always if we choose that approach.”
In the nearer term, Vivoo will be beefing up the product proposition and looking to scale revenue with a premium tier.
“As we added more metrics into our urine tests, we realized wearable integration and even Genetic data integration can be a
huge benefit for our customers to better understand what is going inside their bodies,” Tayfun suggests, adding: “We will be making major updates from November to February on a monthly basis so stay tuned!”
“The main benefit of allowing our customers to integrate their wearable data is that now they will be able to crossmatch their sleep, activity, and heart data with Vivoo’s urine metrics. A simple example is seeing you had a bad night of sleep is ‘ok data’ but visualizing your sleep data with your hydration and magnesium data, will give you more actionable items about how you can improve your sleep via nutrition and simple daily activities. Same for period cramps, heart health, even mood swings, and mindfulness.”
While commercial momentum is clearly building to encourage the ‘worried well’ to quantify and track various bits of their biology, there are likely to be limits on how many of these wellness trackers/test kits/subscription services even a highly ‘health conscious’ individual is going to be prepared to shell out for.
Vivoo’s push to cover a wide range of trackable metrics — including by bolting on additional at home tests kits (presumably expanding out from urine analysis) — looks like a play to cover as many bases as possible so it can sell consumers on a single subscription service for all their wellness tracking needs.
Asked about the competitive landscape, Tayfun says its current perspective is that technologies that are using “different body data and science-base” are complementary to Vivoo’s approach — and she extends an invite to fellow founders for API integrations “if the customer consents”; (adding: “We believe together we can change bad habits to goods more easily! More data will allow our technologies to provide better insights and recommendations.”)
However she also agrees that consumers will have a finite budget for wellness tracking.
“We’d like to position Vivoo as a one-stop shop by covering a big area of wellness, nutrition, mindfulness, activity, and sleep on the line. But we don’t have expertise in all of these verticals so working with well-established partners such as Apple, Calm, Oura, Whoop and collaborations as such would benefit both the customers and companies to provide better insights to customers,” she says, adding: “Also, I believe more data will improve products as well. You might see you’re lactose intolerant in 23 and Me and dairy can be your superfood in Viome, anonymized data can guide us to be more precise, and improve the company’s science and technology.”
Research remains a priority for the startup — which says it will continue to spend a fifth of its budget on R&D.
Tayfun confirms that this includes doing research on what she describes as “anonymized data” from users — trailing “amazing findings” it plans to publish (“in late 2022”), such as the “most hydrated States and state water fountain regulations” and “ketones and personal income (rich cities starve themselves more!)”.
Commenting on the Series A in a supporting statement, Draper describes “personalized data driven health care” as a “major theme” for Draper Associates.
“Miray and her team at Vivoo are collecting personalized data frictionlessly through a simple at-home pee test with actionable advice that allows customers to be proactive about their health,” he said, adding: “Wellness has become such a high priority over the past year, with more people taking proactive control of their health. We’re excited to work with Vivoo as the company expands its footprint globally.”