Arivale

Update: As of April 24, 2019, Arivale ceased consumer operations because they couldn’t charge enough to be profitable. We decided to still share this review on our website in hopes that new companies emerge to provide similar outstanding personal health services.

Dr. Lee Hood is a biotech pioneer who helped create multiple inventions used in genetic sequencing and synthesis. He co-founded over a dozen biotech companies. Dr. Hood is a member of the National Academy of Sciences and the Institute of Medicine, holds 36 patents, and received the National Medal of Science in 2011. In pursuing his passion for  P4 medicine“, medicine that is “predictive, personalized, preventive, and participatory, he co-founded Arivale, a company focused on personalized health management. According to Crunchbase, they’ve raised over $50MM since their launch in 2014.

Arivale is not well known according to search data from Google Trends, however they have served over 10,000 customers and provide a compelling service to set your health baseline and receive coaching to improve upon it.

Arivale’s private friendly health coach uses your biology and lifestyle factors to help manage your health. Arivale collects advanced blood work, as well as some genetic markers and a sample of your microbiome diversity. They use this data and balance them with your lifestyle factors to help you build and adhere to a plan to keep your health.

Unlike 23andMe and Ancestry.com, with Arivale you still own your medical records and DNA. You can share those with your primary care physician if you choose. Arivale values your privacy. For those skeptical of having a health coach, you’ll be pleasantly surprised. The monthly coaching calls are typically thirty minutes with plenty of useful information. They encourage micro-changes which are easy to adopt and make it clear why they are important. Arivale’s personalized dashboard is an outstanding user interface for seeing and tracking your health.

Of note, Arivale is limited because of state laws which restrict direct to consumer healthcare. These particular state laws do not allow individuals to order their own blood work and require that to be done by their state-licensed primary care physicians (PCPs), As a result, Arivale has limitations in working with customers in New York, Massachusetts, Rhode Island, New Jersey, and Maryland. There are workarounds such as getting your blood work done in nearby states or sharing your PCP blood work with your Arivale coach.  

It is not uncommon to feel a bit nervous on trying out Arivale.

Will you:

• Be willing to change things in your diet that you enjoy?
• Discover any serious negative issues with your health?
• Regret consenting to regular blood draws (and possibly trips out-of-state)?
• Find the Arivale health coaches or their advice annoying?
• Get anything useful from using Arivale?

On the positive side, when playing sports, optimal performance is typically preceded by slight nervousness, so take comfort in that. This experience is a step toward optimal daily health.

Arivale cost $99/month for coaching and data for the duration of your membership. 

The reasonable registration process allowed you to choose whether to provide  “Authorization for Research”, a voluntary opt-in to allow your biosamples and de-identified data to be used in research projects. Arivale appropriately discusses the risks and benefits of allowing this.

Arivale’s service can be paused and resumed on a monthly basis. Blood tests are covered every six paid months. If you pause, you maintain access to your dashboard etc, but cannot engage with your coach or get updated reports when they have new insights. Competitor 23andMe charges a one-time-fee and your reports are updated continually as they learn new insights.

However, even after Arivale is paused, you can still chat with one of their personal nutritionists via their free Food Therapy App or sign up for coaching-only ($49 / month).

The Arivale post-registration user experience is efficient and helpful.

You are given the option to select a health coach from three friendly looking specialists, or to have one randomly assigned. Each coach is a licensed healthcare professional, registered dietitian and certified nutritionist. They’ve received an additional 200 hours of training in genetics and the science of behavior change and most have master’s degrees in science and public health. Arivale provides you with videos to get to know them a little better, making it easier to choose one who resonates with you. This makes the experience comfortable and approachable.

Once you’ve selected your coach, you work with the Arivale concierge service to schedule your blood draw. To set a proper baseline, blood draws must be done in the morning for biological rhythms. They request four days of no supplements and non-prescription medications prior to your initial blood draw and no rigorous exercise for 24 hours prior. There is a twelve hour fast prior, as well. *Also no non-prescription meds four days prior. If you have allergies, it can be a bit of a pain to abstain from sudafed/claritin in preparation. They draw nine vials of blood for your initial draw and then 3 vials for your second six-month follow-up. Blood analysis results come back in three weeks. Genetics results in six weeks.

You will be asked to complete nine personal assessments on diet, personality, digestive health, stress, exercise readiness, lifestyle, happiness, health and “journey”. These take about 1.5 hours and are a good exercise for self-reflection. We recommend not doing them all at once. It is easier to cover a few per day as your schedule permits.

The diet assessment questions could use a bit more clarity. For example, they ask how often you eat eggs, but don’t provide a way to note if you only eat egg whites. They ask how often you eat sweets or chocolate. It would be better if this was two questions since chocolate varies considerably if you eat only dark chocolate sweetened with stevia. Again, nuance matters and the questions don’t allow for it or provide a way to add notes with further explanation.

The diet assessment can be challenging to complete for those who do not have a normal diet, but it is a starting point for your discussion with your health coach. Your Arivale coach will offer to pass along feedback and sometimes they adjust their surveys as a result.

The personality test results come with some interesting commentary. Arivale notes that disagreeable people are good fits as scientists, critics and soldiers!

There are additional options to order cortisol tests ($79) for stress and microbiome tests ($99). The microbiome test analyzes things like your TMAO level heart disease / microbiome interaction. It is not as sophisticated as other 3rd party microbiome analytics companies. The Arivale microbiome kit packaging comes in a designer box and is much nicer than something to collect a fecal sample!

Keep Health asked several people to try Arivale and provide their thoughts on the experience using the following questions:

Who are you? (quick bio)
Why did you want to try Arivale?
What services did they provide? Who was your coach?
How was the experience?
What did you learn and change from trying Arivale?
Do they use science backed and evidence-based practices?
Did it improve your blood work?
What would you like to see Arivale improve?
Would you recommend Arivale to others?

Here’s what they said:

As a scientist and an athlete, the prospect of engaging in a “wellness study” on myself simultaneously piqued my interest and activated the critical skeptic in me. My first exposure to Arivale was at a talk at Harvard Medical School just after the company had launched. Lee Hood was sharing the pilot data of the first 100 people who they profiled. I was impressed by the robust data and the fact that even people who thought they were healthy found some nuances to their health they could improve. I followed their progress over the years and finally embarked on my own Arivale journey.

Overall, as a (moderately) young and healthy individual, my goal was to do a “wellness checkup,” and to dial in my nutrition and lifestyle behaviors in a way that optimized for cognitive and physical performance. When the data came back, I did not have any major findings or lifestyle changes that I needed to engage in. However, there were several interesting aspects of my health and physiology that I learned, as well as a few micro-adjustments to my diet and lifestyle, that I’ve made since going through my data with my coach.

I worked with Heather Riviera as my coach, who was fantastic and able to cater her responses to my level of expertise. She quickly dove into the nitty gritty, often pausing to make sure we were both on the same page. Having a background in molecular biology & genetics made it extra fun to learn about the variants that were tested and how the biochemistry came into play. I found Heather to be extremely knowledgeable, and admired her ability to dig into the details with me.

As for the data, I was interested to find several genetic indicators that linked to issues I’ve dealt with. For example, I have an increased genetic predisposition to tendon and ligament injury. Having had 2 ACL reconstructions and 3 knee surgeries, this made a lot of sense. Heather suggested that my collagen matrix may not be as strong as it should, making engagement in dynamic weight-bearing activities an important way to engage in injury prevention. Knowing that my genetics predisposes me to this type of injury, I can focus my training regimen to better support my tendon and ligament health.

On the nutrition side, what I found interesting was that my Vitamin D levels were at the low end of normal, which was alarming given I’d done my bloodwork after a week-long vacation with plenty of sun. Given that I live in Boston, MA, Heather and I discussed how important it would be for me to take a Vitamin D supplement — especially during the winter months when it’s harder to metabolize. As a scientist I’ve long felt averse to the range of supplements that nutritionists and “wellness experts” are always hawking, especially given the lack of transparency or clinical studies to back up efficacy, so I asked Heather about how to navigate that space. She told me that the burden of proof lies with supplement companies since there is no FDA oversight, but that Arivale does vetting through a third-party verification company and that they don’t get paid for the supplements they recommend. This was comforting to me, especially in an industry rife with conflicts of interest.

As a fifty year old athletic male who thought he was healthy and following a healthy lifestyle, Arivale was a pleasant surprise. They helped me adjust my diet to protect my cardiovascular health. As a result, I dropped 10 lbs and 10% body fat going from 22.6% to 11.6%.

I heard about Arivale during David Ewing Duncan’s Arc Fusion Radical Wellness Summit in Boston. David’s experience inspired me to give it a try to set my health baseline and see if I could improve upon it. To start, I signed up for all the services including coaching, blood work, genomics, microbiome and cortisol testing.

I selected coach Katie from Florida and she was fabulous. She worked well with my personality type, providing answers to my questions and helpful advice such as establishing a consistent sleeping pattern and encouraging me to go see a physical therapist for my hamstring injury.

Based on my diet, blood work and genetics, she recommended increasing consumption of Omega 3 fatty acids and some high quality brands such as Nordic Naturals and Carlson. (I checked ConsumerLab to confirm and Carlson has their top rating.). The Arivale nutrition surveys and blood work results also helped me realize that even though I thought I was eating fish at least once per week, in reality, I was only eating fish about twice a month.

Given my family history of cardiovascular issues, she pointed me to the American Heart Association dietary guidelines for saturated fat intake of 12-16g / day based on body weight. I’m a visual learner and she let me know to limit my intake of red meat to the size of a deck of cards per day and my dairy to half the size of a deck of cards. This imagery has been effective and has had the side benefit of weight loss and reduced body fat even though I was injured and less active. Also, I did not have to give up eating foods I enjoy. I just learned to eat smaller portions of them and eat them less frequently.

After six months, I had my blood work retested at my primary care facility and the results were much improved.  

The lower cholesterol numbers are in spite of genetics which increase LDL. I feel like Arivale has given me at least another year of healthy life, so has been well worth the cost and effort.

Arivale’s genetic testing was useful as well.

• For example, one test is for increased risk of periodontitis. Fortunately, my dentist had noticed the symptoms and put me on 3x / year cleanings many years ago. My genetic tests confirmed that she was right to do so.
• Another test discovered that I have an increased genetic predisposition for high blood pressure. This predisposition is even stronger if you consistently eat high-sodium (salt) foods. I’ve always felt badly after salty meals and avoid them, so this seemed accurate as well.

There are a couple areas where Arivale could improve. Their 6th month blood work retest was for a limited set and did not include two areas where I was initially deficient. It would have been nice to see if the fish oil supplement made a difference to my Omega 3 levels. Also, the recommendation of increased consumption of fatty fish, it would be helpful if Arivale added testing for heavy metals in their blood work given the risk of increased mercury levels. (Of note, Coach Katie did give guidance for eating low-mercury fish such as salmon).

Separately, see this article on the risks of eating sushi!

Arivale’s ability to give guidance on my non-mainstream dietary supplements was rather limited, but not surprising. They stick to the mainstream health practices and that is fine.

I have recommended Arivale to my friends and gave Arivale subscriptions to my family for the holidays. Their experiences have so far been positive as well.

My Arivale experience has been a pleasant surprise.

The contagious spirit of my son Erik’s enthusiasm for Keep.Health introduced me to Arivale with an initial 3 month’s subscription.  The benefit from participating in this program has exceeded my expectations.

I live in a 78 year old, well seasoned male body.  Over the last 10 years, I have been through knee replacement surgery, prostate cancer with prostate removal and then followup radiation when the cancer began to return, stomach hernia surgery, a couple of episodes of heart stenting and eventually triple bypass surgery.  My wonderful creative and loving first wife Helen struggled with living with breast cancer for eleven years before succumbing peacefully to the disease. Life does not always go as one would ideally hope for.

Fortunately, as of now, I am reasonably healthy and have a beautiful relationship of 5 years with my second wife Molly.  Both of us were married 50+ years and lost our spouses to cancer. We all knew each other 55 years ago as college undergraduates.  We enjoy caring and comforting each other and sharing all kinds of fun new experiences together.

My motivation to engage with Keep.Health is I would like to live another 15 years with wholesome health so I can see my grandchildren attain their mid twenties.  I want to be able to support Molly as we age together and to help with supporting my adult handicapped son. I enjoy the company of my adult children and being with their families.

At the point I started with Arivale, I was somewhat discouraged with the way my health was going.  Since my heart surgery, my ability to enjoy going for walks has diminished. I get heart related chest discomfort.  This restricts how much exercise I can get from walking. My weight and body mass indices are not optimum (at best!).

Here is the good news!  In three months of solid effort, I have seen much positive change.  I have lost 10 pounds and regained the ability to go for long walks.  I am not saying this is the result of working with Arivale. However, clearly the support I have gotten from my Arivale health coach Molly has been an important assist.  Molly has been a very helpful resource person as I have retooled my eating habits and pushed me in very constructive ways to engage in a healthier lifestyle. Using the app MyFitnessPal for logging everything going into my mouth has been useful.  While I am not a purist about how I record everything, the app enables one to see how food choices affect caloric intake, salt content, and carbohydrates. Earlier in life, I ate a modified “weeds and seeds” diet to reduce cholesterol. Re-engaging with a healthier eating plan is making a difference.  Having a health coach with weekly calls does help. My coach has provided realistic and individualized suggestions to food planning and attractive choices. As a result of the blood, genetic, and microbiome testing, I have added omega 3 and vitamin D supplements. I am now enjoying long walks and committed to more daily walking.  Golf again seems inviting.

My coach has listened to my unique personality and respected when I chose some suggestions but not others.  She has done a really good job offering information and being a consistently patient, motivational coach.

I am not a Fitbit person or rigorous about exercise and measurement.  Weighing each morning and how my belt fits do well enough for me.

All in all, my health life has significantly improved over the last 3 months.  Arivale has helped with this.

As a healthy eater and a hard core athlete, I was a bit skeptical as to whether or not I needed a health coach.  My brother gave me a 3 month subscription to try this so I figured why not test it out.

I worked with Coach Lydia  and focused primarily on lowering stress levels and improving digestion issues.  Based on some of my results and our conversations, she suggested a few supplements:  Omega 3 Nordic Naturals and Acacia Fiber. Since my study results show that I tend to be low in Omega 3’s, this seems to be an easy to implement a health win.  The acacia fiber was also an added bonus because as someone who follows a gluten-free, soy-free, dairy-free diet, it was tricky to find a fiber supplement that wouldn’t aggravate other issues.  

For the stress side of things, she had me focus on taking deep breaths before meals and meditating several times a week.  Although she helped me plan times into my schedule for these things, the conversation often seemed too scripted and I didn’t feel like I ever really connected with her on a personal level, but she was always very nice, friendly, and informative during our conversations.  

I think Arivale is a good fit for someone who is serious about improving their health, wants to get some baseline data points, and is ready to commit to taking some steps towards a healthier lifestyle.  If, however, you’re not at a point where you have extra time or energy to do this, consider holding off until the time is right.