I did the Viome test, with its net score of 60 pathways in six domains. Based on the results I am adding three supplements and increasing the dose of a few of the spices in my spice mixture. If I add Trulacta to my Tributyrin and a mild antibiotic for my Small Intestinal Bacterial Overgrowth – which I discovered I have thanks to this forum – I will test again in six months.
Viome and Trulacta are not tailored to each other, but inspired by Paul´s journey I connected each pathway to what Trulacta possibly could impact, with the aid of perplexity.ai. I share it here if it can be of interest to anyone.
“Viome’s core lab method (stool metatranscriptomics) appears technically robust and reasonably reliable for identifying active microbes and their functions, but the clinical reliability of its broad “health scores” and supplement recommendations is only partially validated so far. It is more credible as an advanced research‑grade microbiome profiling tool than as a fully proven diagnostic or treatment‑guiding test for most conditions”.
If – a speculative if - the preclinical results from Trulacta hold up for humans, most improvements in the Viome tested pathways appear to be modest, with a small number potentially being large. The immunity and gut health domains hold the most potential.
As for humans, there are some scattered pieces of evidence. For me the most impressive is the article referenced by Paul – based on clinical trials focused on longevity interventions – indicating Trulacta decreasing epigenetic age in some Gen2 reliable clocks, with effects on kidney, immune, inflammation and lung showing the most impact. As for direct tests on humans, my AI, which I don´t think knows I am on the Rapa forum, found ONE human doing it – up came Paul!
I see a planned trial, dated 2022, to evaluate the effect of 90 days of supplementation with a human breast milk supplement on sleep quality, low-grade chronic inflammation, immuno-modulation, metabolic health, and epigenetic aging. I can´t find any results and I hope this doesn´t mean it´s one of those studies that gets buried because of poor results. I have written the contact person for the trial. Will decide on Trulacta after that.
From AI, summary: How Trulacta fits with what you’re already doing
Your systemic inflammation is already excellent, so Trulacta is not needed to “fix” CRP/IL‑6; its role would be to fine‑tune microbiome‑driven pathways (LPS, biofilm, some uremic/toxin pathways, maybe microbiome‑heart and oral pathogen scores).
Tributyrin 300 mg already supports butyrate exposure, gut lining, and some anti‑inflammatory effects; Trulacta would act more via HMOs/HMBs (microbiome composition, immune modulation, decoy glycans) rather than overlapping fully with tributyrin).
1 Immunity domain:
Out of ten pathway scores, four are in my case in need of improvement according to Viome. Of those four , Trulacta could improve Uremic toxin production, Immune System Clearing and Immune System Activation Pathways and, indirectly and more speculatively, Serotonin Promoting Microbes.
If Trulacta works, the pathway for Uremic toxins (e.g. p‑cresol, indoxyl sulfate) may be the single pathway most likely to improve. These originate from microbial metabolism of protein and aromatic amino acids and burden kidneys and vessels. HMOs and human‑milk components shift adult microbiota toward more saccharolytic, bifido‑dominant communities and away from proteolytic/pathobiont profiles. A more “infant‑like” composition in adults (more bifidobacteria, fewer proteolytic taxa) plausibly reduces uremic toxin production.
For the two immune system indicators Perplexity.ai wrote:
- So despite Viome flagging “Immune System Activation,” your classical blood markers such as CRP <0.20 show low‑grade, well‑controlled inflammation and immune activation, which fits your diet and lifestyle rather than the pessimistic Viome score. If you see these numbers stay in this range over time, I’d treat the Viome immune‑activation warning as “still room to fine‑tune microbiome pathways,” not as evidence of a dangerous global over‑activation. The low “Immune System Activation” score probably reflects some combination of: residual pro‑inflammatory microbial pathways, local gut/oral immune signals, and maybe subtle gene‑expression patterns on the day of sampling.
- Your dietary pattern, polyphenol intake, and exercise are strong counterweights and may mean your actual systemic activation (if we measured CRP, IL‑6, TNF‑alpha directly) is better than Viome implies.
On Viome flagging Immune System clearing AI writes: So the most coherent interpretation is: Viome is picking up microbiome‑level irritants (LPS, virulence, some toxin pathways) that create signals of work to do, but your systemic markers suggest your immune system and detox/resolution machinery are coping quite well overall. Viome´s scores may be partly pulled down by specific microbiome signals rather than reflecting your whole-body state”.
So if Trulacta works, I might see improvements in those immune markers, but the clinical benefit for me would likely be more limited.
The remaining six pathway scores are better, getting the recommendation “Maintain”, but of course none comes close to the top score, 100, For five of the six, Trulacta will yield “Likely little added value. These markers are already good / Maintain and Trulacta isn’t a strong, specific lever for them”:
For the sixth, “For you, this pathway is already in “Maintain,” but if preclinical effects translate, Trulacta could still modestly improve Microbiome‑Induced Stress—just not from a bad baseline”.
2 Energy and Performance Domain
Out of seven pathways, two are included in the immunity domain. The other five are all in need of improvement according to Viome.
Trulacta might indirectly modestly improve the Cellular stress score via lower systemic oxidative stress (by reducing microbiome pathways for biofilm, invasion and infections, and by stimulating antioxidant defenses).
More speculatively and in theory, it could improve Cellular senescence, by improving gut-mediated immunity; clearing senescent cells depends on immune competence.
Trulacta will have no or little effect on Mitochondrial health, Mitochondrial biogenesis and Energy production pathways.
3 Gut and digestive health domain
Out of 24 pathways, seven are included in the Immunity domain. Of the remaining 17, 12 are in need of improvement according to Viome. Of those, Trulacta is most likely to help – as always, assuming preclinical effects hold for humans - the following four.
LPS Biosynthesis pathways (which had my worst scores of the domain), by reducing LPS/TLR4-driven inflammation and shifting microbiota away from invasive/biofilm/pathogenic profiles. This could lower functional LPS pressure.
Biofilm/chemotaxis/virulence pathways, by reducing microbial genes for biofilm formation, adhesion and invasion. A strong mechanistic match.
TMA production pathway. Less direct evidence, but the shift away fromprotelolytic/pathobiont taxa may reduce TMA/TMAO-related metabolites.
Digestive efficiency pathways. If it works in humans: better nutrient absorption and improved stool quality in users, which fits with a more “infant‑like” microbiome and improved mucosal/enzyme milieu.
Possibly a slight indirect effect on a fifth pathway, (Microbial) Uric Acid production pathway (distinct from the Uremic acid pathway).
Sulfide gas production, Methane gas production, Protein fermentation, Bile acid metabolism, Putrescine production and Salt stress pathways will not be addressed by Trulacta
Butyrate production will be addressed by my Tribyturin supplementation, not by Trulacta.
Of the remaining pathways that Viome gave the “Maintain” verdict to:
Trulacta might modestly tweak Metabolic fitness, Inflammatory activity, Gas production and GABA production pathways.
Tributyrin may address the Gut lining health pathway.
4 Oral health
Of 16 pathways, 14 have room for improvement. Of these, Trulacta could be of a “possible small benefit” to address Cavity Promoting Microbes, Cavity Promoting Pathways, Oral Pathogen Activity, Oral Disease Promoting Microbes, Oral Inflammatory Pathways, Oral Mucin Degradation Pathways, Breath odor and Dental Health
Trulacta is not likely to matter for Gut health, Oral Polyamine Production, Oral Ammonia Production, Oral butyrate Production (which may be addressed by Tributyrin), Oral Flagellar Assembly Production and Oral LPS Biosynthesis Pathways.
5 Mood, memory and focus domain
Four of nine pathways are included under other domains. The other five were given the status “Maintain”.
- Assuming Trulacta’s human‑milk bionutrients work in adults roughly like HMOs do in current studies, it is plausible but unproven that they give a small supportive effect on these mood/memory/focus pathways, mainly via the gut–brain axis, SCFAs, and tryptophan handling—not a strong, direct lever. Trulacta is best thought of as a gentle gut–brain modulator: possibly small benefits on neurotransmitter‑related signalling and cognitive robustness, especially if it improves microbiome and sleep.
Trulacta could possibly be mildly supportive for a microbiome responder in the pathways for Neurotransmitter Production and Cognitive Health
Any effects for Anxiety & stress response, Anxiety Associated Pathways , Cortisol Pathways are speculative. .
In humans, there are only early hints that HMO‑based prebiotics might improve stress‑induced mood state; robust data on anxiety or cortisol regulation in adults are not available.
AI: Given your scores here are already “Maintain” and relatively high, Trulacta is unlikely to visibly move these Viome pathway scores; at best it may help preserve good status by supporting gut barrier and lowering low‑grade inflammation over time.
If you were to trial Trulacta with these pathways in mind, it would make sense to track very concrete things (sleep onset/quality, perceived stress, mental clarity on demanding days) for 4–8 weeks, rather than expecting big changes in Viome scores.
6 Heart and Metabolic health domain
Of the nine pathways, one is included under immunity and one under gut health (Uremic/TMA).
The remaining seven all have room for improvement, according to Viome.
Even if it works for humans, Trulacta will be weak in this domain. It is best viewed as a microbiome/inflammation modifier that might slightly support heart and metabolic profile.
The most likely/least unlikely is for Trulacta to improve Microbiome Heart Health; HMOs in adults increase bifidobacteria and shift the microbiome toward a more infant‑like, saccharolytic pattern, which in models reduces inflammatory and atherogenic signals.
Vascular defense, Cholesterol transport and Vascular Oxidative stress pathways come next in possibility.
For Vascular health, kidney-heart health, and Renin-Angioensin pathway any effect is extremely unlikely.
Note on Cholesterol transport score – an example of a probable contradiction between Viome and my heart/metabolic status
Your poor “Cholesterol Transport” score is not contradicting your excellent LDL and plaque status; it’s reflecting a modelled gene‑expression pattern that doesn’t currently look like Viome’s “ideal,” even though your actual cardiovascular risk markers look outstanding.
Why the Viome score and your labs diverge
- Viome’s cholesterol/LDL transport score is based on RNA expression of transport and efflux genes in blood cells, not your measured LDL‑C, HDL‑C, or plaque burden.
- They acknowledge (in a “Real Member Questions” article) that many people have low serum LDL but a “Not Optimal” LDL/transport score, because the score is about patterns of gene activity that can be associated with plaque biology, not about current cholesterol levels.
- Your situation—LDL 2.2 mmol/L and zero soft/hard plaque at 78—means your real‑world atherosclerotic risk expression is extremely low, regardless of what a pathway model predicts might theoretically happen if conditions were different.
In short: the Viome score is a risk‑flavoured molecular snapshot, not a measurement of plaque or LDL, and your conventional data trump it.
What the poor score might still be hinting at
- The model likely weighs transcripts related to: LDL uptake, efflux transporters (ABCA1/ABCG1), HDL remodeling, inflammation, etc.—pathways that, in other contexts, correlate with atherogenesis or efflux efficiency.
- A “poor” score could mean your expression pattern is closer to the cluster Viome sees in people with less favourable lipid handling, even if your current LDL and imaging say you are doing very well.
Given that you already have low LDL, no plaque, and a very anti‑inflammatory diet, these RNA nuances are more of an academic observation than a call to change anything major.
How much should you act on this?
- Your LDL and plaque imaging are hard outcomes; they carry far more weight than a derived transcriptomic risk score.
- Viome itself stresses that their pathway scores should be interpreted alongside conventional labs and clinical findings, not instead of them.
In your case, I’d:
- Use the cholesterol transport score as a gentle reminder to maintain what you already do well (omega‑3 intake, low inflammatory burden, good blood pressure, exercise),
But not as a reason to intensify lipid‑lowering beyond what your cardiologist or your existing imaging/LDL would justify
