
Launch HN: Caelum  Health (YC S17) – Digital Therapeutic for Stomach Problems - laurenkc
We’re Luke and Lauren, the founders of Caelum Health (<a href="http:&#x2F;&#x2F;caelumhealth.com" rel="nofollow">http:&#x2F;&#x2F;caelumhealth.com</a>). Caelum is a digital therapeutic for Irritable Bowel Syndrome. We optimize your diet and figure out which foods are driving your stomach problems.<p>Lauren is an MD from UPenn who saw how patients with stomach problems (IBS alone affects 15-20% of people) couldn’t get the care they need. The best treatments - diet and lifestyle changes -  work in clinical trials, but are extremely hard to execute in the real world without continuous expert guidance. Very few patients have the resources to afford this type of guidance.<p>Our app fixes this by providing 1-on-1 digital coaching (via messaging). We guide patients through the leading IBS diet (the Low-FODMAP Diet) with turn-by-turn directions and daily lessons&#x2F;exercises.<p>Currently, the diet requires several stages of eliminating food groups and then adding them back in to see whether symptoms change - forcing each patient to “start from scratch” even though many other patients have gone through the same process. We leverage user data to personalize each patient’s program based on their eating habits, past food trials, and demographics (age, gender, ethnicity, etc).<p>We’re launching our consumer-facing product and will be starting our clinical trial soon.<p>We’re a sibling team and have wanted to start a company together since we were kids. When Luke went into tech and then business school, and Lauren into healthcare investing and then medical school, we thought it probably wouldn’t happen. We were obviously wrong. We became pretty obsessed with bringing data to medicine and applying it to the treatments right in front of us: food, exercise, sleep, stress-reduction.
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trowway21
What they are offering is actually very simple, and systematic.

While the list of foods containing fodmaps has changed a lot lately, there are
several sources that are up to date. University of Michigan has a lot of
reliable resources.

The system is described in full here:
[http://www.myginutrition.com/diet.html](http://www.myginutrition.com/diet.html)
(U of M)

They also have a pinterest that has tons of ideas and specific brands they've
tested... Which is here:
[https://www.pinterest.com/UMGIdietitians/](https://www.pinterest.com/UMGIdietitians/)

Full list of foods here:
[http://www.myginutrition.com/downloads/Low_FODMAP_foods.pdf](http://www.myginutrition.com/downloads/Low_FODMAP_foods.pdf)

The warning my dietitian has given me, is that many of the websites out there
are using out of date information pertaining to foods; and that I should only
trust their lists.

~~~
welder
You just put this startup out of business. The Michigan Uni website and video
tutorials are more complete than Caelum's mvp. Couldn't figure out how to get
Caelum's website to work, it just dumped me into a food log todo-style app
with no info how to use it.

~~~
lukekc
Our core value currently is the 1-on-1 coaching, so the MVP app is meant to
support the coaching service (and currently working on building out the
content). Michigan has some great content, but it’s a different experience
than having a coach or dietitian. It could be supplemental to a dietitian -
sounds like this is the use case for trowway21. There are definitely people
out there who want to do the diet with content/info only, and our service
wouldn’t be a good fit for them.

Thanks for your feedback on finding the app disorienting - that’s helpful for
us to know as we improve it moving forwards.

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bvod
I feel like your pricing is off. $29/week is too expensive for consumers, yet
far too cheap if you plan to get reimbursed from insurers. Especially
considering you'll need a lot of people and show improvements for them if you
want insurers to pay - this pricepoint won't let that happen.

~~~
jpmw
If you compare that to paying for a dietitian, it's actually not TOO bad. BUT,
I think churn will be high due to price.

I could see a declining fee model. Just a thought.

We are trying a low FODMAP for my wife. I could see her paying for it for 2-3
months, then we would probably find that expensive at $29/w...but, if after 3
months, it went down to say $29 per month, then it would totally make sense as
we would use it a lot less, I think.

At least if we compare to when she stopped gluten, lactose and a few other
things 6 years ago...the worst was the first 2-3 months.

~~~
barbegal
A dietitian is a different service though. Registered dietitians are trained,
accredited professionals that can legally give you medical advice. This
service will not give you medical advice.

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fabiandesimone
As any new project that pops up in here, I wish you well and hope you guys
make it.

However, as a IBS sufferer, I'm not sure I get it.

Yes identifying the foods that make you ill is a top priority for IBS patients
like me, but I downloaded this app:

[https://www.monashfodmap.com/i-have-ibs/get-the-
app/](https://www.monashfodmap.com/i-have-ibs/get-the-app/)

And within a week or two I identified the culprits, took them out of my diet
and I'm back in business all for I think it was a one time payment of $6.99
and some willingness to make some changes. The app is fantastic.

I guess what you are really selling is the coaching and I'm sure some people
do need it. Good luck guys

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barbegal
Your terms state that "The services are not medical advice or treatment". If
that is the case then this service is operating in a legal grey area where
customers could be under the impression that medical advice is being given out
and could sue Caelum Health if the diet does have a negative impact on their
health. And if the customer knows it isn't medical advice, then they should
run the advice past a medical professional on a regular basis which kind of
defeats the purpose of the service.

~~~
lukekc
That language is intended to indicate that we’re not a physician, hospital,
drug company, etc. - pretty standard for companies in our space.

But you’re right that, similar to drugs, dieticians, or physical therapy,
we’re not a substitute for a doctor - in fact, one of the ways our users find
is through referrals from their doctor.

~~~
barbegal
But unlike FDA approved drugs, registered dietitians and licensed physical
therapists your service is not accredited and can't legally give the advice
that it claims to give. As an example Ohio state law says that "only licensed
dietitians can practice dietetics".

Practising dietetics is defined as including "Nutritional assessment to
determine nutritional needs and to recommend appropriate nutritional intake"
and "Nutritional counseling or education as components of preventive,
curative, and restorative health care"

Either your service isn't doing those things (and outwardly it seems it is) or
the service must be provided by a licensed dietitian to customers in Ohio or
it is breaking Ohio state law.

[1] [http://codes.ohio.gov/orc/4759](http://codes.ohio.gov/orc/4759)

~~~
lukekc
We've worked with our lawyers on this topic and so far we're in good shape.
But it's definitely something we need to keep an eye on as we introduce new
functionality / try out different marketing.

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notlob
Can you speak a bit about how this is regulated? Are you working with the FDA
Digital Health group?

~~~
laurenkc
The FDA is currently selectively regulating mobile apps, primarily based on
risk categorization. We haven't been subject to regulation so far, but will of
course work with any regulatory bodies if/when that time comes (and, of
course, regulation of digital health products is continuously evolving).

~~~
notlob
I would suggest taking a more proactive approach in your relationship with the
FDA, perhaps hiring an experienced consultant to either help you work with the
FDA (the new "Pre-Cert" program might be worthwhile) or dial back your
marketing claims to a safer position.

Right here on this Show HN you've said "Caelum is a digital therapeutic for
Irritable Bowel Syndrome." This statement makes clear that you're intending
for this to be used in the treatment of a specific disease (so this is a
medical device and is subject to FD&C Act).

You're also said you're providing "1-on-1 digital coaching" and more
specifically you "personalize each patient’s program based on their eating
habits, past food trials, and demographics (age, gender, ethnicity, etc)" (so
specific treatment regimens). "Minimal risk" for the FDA generally excludes
individualized treatment regimens. There may be sufficient grounds to support
oversight.

~~~
laurenkc
Thanks, will bring up these points with our advisers in this area

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rzr999
I have a long lasting gastritis and would love to try you guys out. I am
wondering if I should wait for the lactose/fructose/sorbit tests or not.

Another question is I already have a huge list of things I tried, can I just
feed those in?

~~~
laurenkc
Getting started isn't dependent on any particular lab testing - the low-FODMAP
diet includes elimination of lactose/fructose/sorbitol, so as you follow your
plan you'll figure out if those are triggers for you.

For the things you've already done, you can tell your coach it'll be
incorporated into your plan.

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jpmw
Oh god, love it! This is not that expensive if you compare to having someone
helping you that you pay for, and need to get a meeting with.

On the business side, I would assume churn will be pretty high after a few
months.

~~~
lukekc
Yup, this is the comparison we see - alternative is going to a dietitian,
which is very expensive. Re: your other post on people potentially churning
after 2-3 months - we've actually seen strong retention, but leaving after 2-3
months is certainly a use case we've seen as well. Those users tend to have
gotten a lot of value from the product, and are also profitable for us -
overall not a bad outcome

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glitcher
Cool project and great idea! Unfortunately your website falls a bit short on
selling me though. And at $29/week after the free trial I don't even want to
find out if I love your app, because then I would know exactly what I was
missing out on after having to cancel based on price.

~~~
laurenkc
Glad you like the idea! Thanks for the feedback about the website. Would love
to learn more - is there a particular part that especially falls short (or
something that, if included, would have sold you)?

~~~
rzr999
One example which is as simple as possible as complicated as necessary would
be great.

~~~
laurenkc
Gotcha, that makes a lot of sense - appreciate it

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cm2012
When we get back from vacation my wife is absolutely subscribing. Its a step
up from dieticians (who guve worksheets and meet in person) since the app
looks like it will make everything much more streamlined.

~~~
lukekc
That's great! Look forward to having your wife on board

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hhw3h
Do you all have plans to support ulcerative colitis or the SCD diet?

~~~
laurenkc
We're building the platform so that it can support any diet, and UC/Crohn's
are on our short list. (Some folks with those conditions have benefited from
the Low-Fodmap diet too, although it wasn't designed for that purpose.)

~~~
hhw3h
thanks lauren. good luck with your company.

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pg_bot
Do you consider yourself a covered entity? If not, what kind of data are you
collecting about your users?

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rokhayakebe
Cost? It is not showing me the cost when I click on free trial. Could be a
bug, using Chrome.

~~~
lukekc
The cost ($29/month) should be displayed both on our homepage and when the
user gets to the payment screen in the sign up flow.

If this is a bug obviously want to track it down - where exactly did you
click?

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djstein
just sent to one of my best friends who has been suffering for years. I hope
it can help

~~~
laurenkc
Thanks for sending along! Hope we can help.

