Dr. Larry Smarr details his personal journey as a pioneer in self-tracking to reverse pre-diabetes through nutrition and exercise, while he tracks over 100 blood biomarkers and monitors his inflammatory conditions. He discusses his analyses of Crohn's disease using advanced imaging and genomic insights, demonstrating a connection between gut microbiome composition and disease. The document highlights the importance of detailed, individualized health monitoring and the emerging role of genomic data in understanding chronic illnesses.

1. My N=1 Experience
Pioneer Session: "N=1: Pioneers of Self-Tracking“
Panel at the Genomes, Environment, and Traits Conference
Harvard Medical School
Cambridge, MA
April 25, 2012
Dr. Larry Smarr
Director, California Institute for Telecommunications and
Information Technology
Harry E. Gruber Professor,
Dept. of Computer Science and Engineering
Jacobs School of Engineering, UCSD
Follow me at http://lsmarr.calit2.net

2. I am the Digitally-Enabled “Patient of the Future”:
Measuring the State of Your Body and “Tuning” It
1999 2010
2000
Age Age
51 61
I Arrived in La Jolla in 2000 After 20 Years in the Midwest
and Discovered I was Pre-Diabetic.
I Reversed My Body’s Decline By
Altering Nutrition and Exercise

3. From Measuring Macro-Variables
to Measuring Your Internal Variables
www.technologyreview.com/biomedicine/39636

4. My Quarterly Blood Tests In Addition to Lipids:
Only One Was Far Beyond Normal Limits
• Electrolytes • Liver
– Sodium, Potassium, Calcium, – GGTP, SGOT, SGPT, LDH, Total
Magnesium, Phosphorus, Boron, Direct Bilirubin,
Chlorine, CO2 Alkaline Phosphatase
• Micronutrients • Thyroid
– Arsenic, Chromium, Cobalt, – T3 Uptake, T4, Free Thyroxine
Copper, Iron, Manganese, Index, FT4, 2nd Gen TSH
Molybdenum, Selenium, Zinc • Blood Cells
• Blood Sugar Cycle – Complete Blood Cell Count
– Glucose, Insulin, A1C Hemoglobin – Red Blood Cell Subtypes
• Cardio Risk – White Blood Cell Subtypes
– Complex Reactive Protein • Cancer Screen
– Homocysteine – CEA, Total PSA, % Free PSA
• Kidneys – CA-19-9
– Bun, Creatinine, Uric Acid • Vitamins & Antioxidant Screen
• Protein – Vit D, E; Selenium, ALA, coQ10,
– Total Protein, Albumin, Globulin Glutathione, Total Antioxidant Fn.
I Track Over 100 Blood Variables Over Time

5. Natural Anti-Inflammation Can Be Much Larger Effect
Than Antibiotic-Induced Inflammation Remission
27x
Much of the Inflammation Drop
Is Spontaneous
15x
Antibiotics
Antibiotics
Normal Range CRP < 1
Demonstrates Value of Fine-Grained Time Series

6. Frequent Stool Analysis Reveals Lactoferrin Spike
to Active Crohn’s Disease (CD) Level
Colonoscopy
Typical May 2011
Normal Lactoferrin Level < 7 Lactoferrin
Value for
Active
Crohn’s
Colonoscopy
May 2006 Colonoscopy
Jan 2012
Colonoscopy
December 2010
Colonoscopy and Biopsies
Support CD Diagnosis

7. Confirming the Crohn’s Hypothesis:
Finding the “Smoking Gun” with MRI Imaging
Liver I Obtained the MRI Slices
Transverse Colon
From UCSD Medical Services
and Converted to Interactive 3D
Working With
Small Intestine Calit2 Staff & DeskVOX Software
Descending Colon
Diseased Sigmoid Colon
Major Kink
Sigmoid Colon
Threading Iliac Arteries

8. LS Sigmoid Colon Cross Sections
Showing Inflamed Wall
Jan 2012 MRI Enterography report: “long segment wall thickening
in the proximal and mid portions of the sigmoid colon,
extending over a segment of approximately 16 cm,
with suggestion of intramural sinus tracts.
Ulcerative
Colitis is
Restricted to
the Mucosa,
while
Crohn's
Disease Note
Affects the Thickness
Whole of Wall -
Bowel Wall Normal
is 3mm
(like a
Balloon)
Source: L Smarr Using Calit2’s Jurgen Schultz Software

9. I Wondered if Crohn’s is an Autoimmune Disease,
Did I Have a Personal Genomic Polymorphism?
From www.23andme.com Polymorphism in
Interleukin-23 Receptor Gene
— 80% Higher Risk
ATG16L1
of Pro-inflammatory
Immune Response
IRGM
NOD2 SNPs Associated with CD

10. Crohn’s Disease Patients Have Number of Firmicute
Gut Microbe Species Reduced by Over 2/3!
Healthy Gut Microbes
Actinobacteria
7 Bacteroidetes Proteobacteria Firmicutes
33 5 43
IBD Gut Microbes
Actinobacteria
7 Bacteroidetes Proteobacteria Firmicutes
33 5 13
The Missing Firmicutes Inhibit Pro-Inflammation
Manichanh, et al, Gut 2006;55:205–211

11. Microbial Metagenomics
Can Diagnose Disease States
From www.23andme.com
Mutation in Interleukin-23
Receptor Gene—80% Higher
Risk of Pro-inflammatory
Immune Response
IBD Patients Harbored,
on Average,
25% Fewer
SNPs Associated with CD
Microbial Genes
than the Individuals
Not Suffering from IBD.
2009

12. First Stage of Metagenomic Sequencing of
My Gut Microbiome at J. Craig Venter Institute
I Received
a Disk Drive Last Week
With 35 GB FASTQ Files
Weizhong Li, UCSD
NGS Pipeline:
230M Reads
Only 0.2% Human
Next: 10-100,000 cpu-hrs
Gel Image of Extract from Smarr Sample-Next is Library Construction
Manny Torralba, Project Lead - Human Genomic Medicine
J Craig Venter Institute
January 25, 2012