Smart Toilets Are Revealing the Health Data That Wearables Can’t

More than heart rate and exercise, smart toilets may soon track disease, sleep patterns, and drug use

A photo of a smart toilet in a bathroom within a high-rise building overlooking the city.
Photo: TrueLoo

TThere’s no well-worn career path to becoming a stool analyst, says Vikram Kashyap. To become the founder and CEO of San Francisco–based human waste analysis company Toi Labs, Kashyap had to break his own ground — by analyzing his own poop.

Kashyap has ulcerative colitis, an inflammatory bowel disease that causes sores in his colon, abdominal cramps and pain, rectal bleeding, and bloody diarrhea. The disease is, so far, incurable, though its debilitating effects can be curbed to some degree. Kashyap tried experimental treatments on himself, analyzing samples of his own stool in the process with the help of researchers at the University of California, San Francisco. Results of the four-year study were published in Science in 2010 and kicked off an earnest effort to develop a “smart toilet” that could help people monitor their personal health.

“I think more than anything, what [the study] did for me is it solidified my own interest in increasingly what became an obsession,” Kashyap says.

“I think the trend is that people are going to become their own managers of their health.”

Manufacturer Toto pioneered the “smart toilet” in the 1980s with devices that could warm or wash your tush at the press of the button. Entrepreneurs like Kashyap think smart toilets can revolutionize personal health by making precision medicine more accessible and affordable for consumers.

“I think the trend is that people are going to become their own managers of their health,” Kashyap says.

Toi Labs developed the TrueLoo, a smart toilet seat that the company claims can be installed in minutes, like a bidet. The TrueLoo uses sensor technology to analyze human waste and help aging users and their caregivers monitor a variety of urinary and digestive disorders. By taking optics-based measurements of waste and analyzing the data for signs of disease and disorder, the company says the TrueLoo has the potential to detect dehydration, infection with viruses, and urinary tract infections, one of the most common infections seniors experience. The company is testing the product this year in senior-living facilities in the San Francisco Bay Area, with plans to market it to general consumers as soon as 2021.

Kashyap and Toi Labs aren’t the only ones thinking about mining stool and urine for health data. At the University of Wisconsin, Madison, Joshua Coon and Ian Miller collected more than 100 samples of their own urine over 10 days to see what it could show about their various lifestyle factors, including nutrition, over-the-counter drug metabolism, exercise, and sleep patterns. Some of the urine metabolites they analyzed included furoyl glycine and quinic acid, known markers of habitual coffee consumption, and hypoxanthine, which showed how much they were exercising. They published their study in the journal NPJ Digital Medicine last November. “We just wanted to see what would happen when we collected as many urine samples as we could tolerate,” Miller says.

In the study, Coon and Miller used a gas chromatograph, used in labs to separate and analyze various compounds in a sample, and a mass spectrometer, used to analyze individual molecules in a sample, to investigate the contents of their urine. These powerful tools can monitor glucose levels, distinguish between viral and bacterial infections, and identify markers of inflammation and metabolic disorders and signs of kidney disease and cancer. Coon and Miller measured some of the compounds correlated with these health conditions but note that they were healthy at the time of the study.

During the study, they also wore Apple Watches to compare the accuracy and amount of data they could get from both sources. The urine samples provided data that consumer-grade wearables already do — like sleep and exercise tracking — but also data that wearables don’t, like how much caffeine, alcohol, or even plastic we ingest.

Consumer-grade wearables like the Apple Watch are powerful because so many people are using them, Miller says, but, he adds, “They don’t tell you everything.”

Of course, gas chromatographs and mass spectrometers are less portable, much larger, and more expensive than wearables. You can get the latest model of the Apple Watch for less than $500; a gas chromatograph and a mass spectrometer will put you back thousands and tens of thousands of dollars, respectively.

How do you engineer laboratory-grade equipment to be small enough to fit in someone’s toilet and cheap enough to buy? That’s the million-dollar question, Miller says. “People have had this idea before of looking at toilets to tell you about your health, but you’re not going to put a $300,000 instrument in everyone’s bathrooms,” he says.

“Nobody wants to think about their stool. They just want to do their business and go about their day.”

A few biometrics-measuring smart toilets have made it to market, including Toto’s Intelligent Toilet, but the several-thousand-dollar toilet was discontinued and barely used outside of Japan. Because of the cost, smart toilets are used by only a handful of private individuals who can afford to buy them and in medical institutions, like hospitals or senior-living facilities. There isn’t a consumer-grade smart toilet on the market that can gather and analyze biometric data, though Kashyap hopes to change that. Google, for one, was granted a patent in 2018 for a smart toilet that measures blood pressure. A group from the Rochester Institute of Technology has developed a smart toilet seat that can monitor users’ heart rates. BiomeSense, a startup founded by a group from of the University of Chicago, is developing a smart toilet seat to collect gut microbiome data.

“What we want to do is get a much deeper understanding of the microbiome and its changing nature of time,” says Kevin Honaker, BiomeSense co-founder and CEO. This year, BiomeSense is running clinical trials in which stool samples from participants will be examined for cancer progression, immunotherapy response, surgical recovery, and even athletic performance.

One of the obstacles in getting people to adopt this technology, Honaker says, is trying to make the technology “invisible.” “Patients really dislike giving stool samples,” he says. “Nobody wants to think about their stool. They just want to do their business and go about their day.”

Because bringing a laboratory into the home isn’t the most economically or technically practical idea, Kashyap’s Toi Labs is focusing on sensor technology, which isn’t as powerful as laboratory-grade equipment but can still provide enough data to monitor what’s going on in a person’s digestive system. He’s hoping to release the results of the TrueLoo trial in senior-living facilities this year.

With multiple companies nearly ready to push smart toilets to market and even more scientists researching the potential benefits of using the technology, people will soon have even more information in their hands to help guide their personal health decisions.

“I think at the end of the day, we’re increasingly moving towards a world where people are going to be making their own health care choices themselves and having the data that can be generated from themselves,” Kashyap says. “I think it’s going to just completely shift the power in health care and the way consumers engage with the health care system.”

Drew Costley is a Staff Writer at FutureHuman covering the environment, health, science and tech. Previously @ SFGate, East Bay Express, USA Today, etc.

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