Nobody ever said the march from nucleotides to nutrition was going to be short. Or steady. Or in a path that could be described as even remotely straight.
For the practitioner, that path to nutrigenomics and detailed nutrition plans based on genetics may get more twisted, narrow, and more difficult to follow before it ever gets mapped out in actionable detail.
Jessica Pizano, a certified nutrition specialist (CNS) teaching other nutrition professionals about the basics of nutrigenomics, says that, at least for now, the maps that do exist are so scribbled over in updates that anybody who hasn’t watched the scribbling accumulate will have a hard time finding the starting point, much less the destination. Keeping up with the science can be almost a full-time job. “People ask me all the time ‘What book should I buy?’ and I sort of chuckle,” Pizano says.
Even nutrition-focused MDs like Dr. Fred Pescatore in New York City shy away from such a roughly sketched schematic. “I don’t like to operate on the micro level of epigenetics,” Pescatore says. “I am not going to go in there and say ‘This is going to change your genetic expression.’ On the micro level, we’re not there yet.”
Jim Olin, vice president of marketing at Emerson Ecologics, hears the same thing from practitioners. The conversations all end with cautions, he says. “I don’t think it has hit show time yet, even in the practitioner space,” Olin says. Pizano does analyze her client’s DNA sequence and does build nutritional action plans based on what she sees. She describes nutrigenomics as “a really specific area that you have to study pretty intensely at this point,” but, for her, the payoff for that intensity of attention is already here. “I’m overbooked. I am beyond capacity at this point.”
Christie Williamson, a CNS studying at the Maryland University of Integrative Health, works with Pizano on a series of webinars to bring practitioners up to speed and has her own practice focused on nutrigenomics. She’s busy too. She attributes it to the kinds of clients she sees. “Three to five years ago it was mostly the chronically ill, the undiagnosable, the long lost and forgotten. They felt horrible every day, but no doctor could ever tell them why,” Williams says. “Now we’re more diverse, we have a lot of people who are looking for the preventative medicine, the precision nutrition.” Early findings in a large-scale study funded by the European Union suggest people who get advice based on their genetic makeup are more likely to adhere to the nutrition health regimen than people who get more generic advice about eating and exercise.
The now and the next
What practitioners like Pizano and Williams can do is look at the latest scribbles on the map that mark the basic landmarks and work from that. Certain genes affect how the body uptakes a certain nutrient. Those nutrients affect how a gene is expressed, toggling switches in the control center of epigenetics. Even in the “early baby steps” stage of nutrigenomic understanding, Williams says she is able to help clients achieve better health through calculated combinations of diet and supplement. “I write nutrition prescriptions based on people’s genes,” she says, putting it simply.
The understanding is very basic, at this point, but actionable, Pizano explains. They don’t know everything yet, but neither do mainstream medicine doctors, she says, pointing to the sometimes hit and miss manner of the medical establishment. Speaking specifically to psychiatry and anti-depressants, she asks “How many SSRIs will a person go through and still not get there?”
The knowledge is growing, she says, faster than ever. Consumer awareness of nutrigenomics seems to be keeping pace, if not growing faster. “It seems like the clients or patients have changed faster than most of the practitioners have.”
Ideally, as the consumer base grows, the knowledge base grows with it. Adding more genetic sequences paired with the individual’s medical history builds the big data that will drive the connections between DNA and diet. Analyzing that data and pulling out treatments and protocols is yet another “next frontier” for the field, but that part of the map is being drawn too, driven by machine learning algorithms and the emerging field of artificial intelligence.
Practitioners caution that programs can’t replace the face-to-face efficacy of a consultation. No algorithm, says Williamson, “is going to let you see the actual change in the patient in front of you.”
While a number of interactions between specific genes and specific nutrients are well characterized, additional complexities might only come out in the relationship between patient and practitioner, influences that can’t be factored into a snip-and-paste software program. “You’re not supposed to be able to hook your DNA up to an Apple app and it will spit out a diet,” Williamson says.
Beyond pharma
What the algorithms and AI can do is sketch out the contours on the map and highlight the landmarks. Getting to the destination still requires the guidance of a professional.
Services like PureGenomics, a genetics-based web program offered exclusively to practitioners through Pure Encapsulations, are the tools those professionals will use. The PureGenomics program analyzes results from a patient’s 23andMe test to find specific variations where science supports interventions, primarily involving methylation pathways that affect everything from cognition to cardiovascular health.
What makes PureGenomics different from a startup that might provide gene-based nutrition recommendations, with only the nominal counseling by phone, is that PureGenomics restricts access to qualified clinicians. That level of personal and professional involvement could be critical to keeping the promise of personal nutrition from getting dragged into doubt.
Knowing the patient’s history and experience, and then comparing that against the nutrigenomic readouts and AI-driven associations, will give practitioners a powerful reach into nutrition and epigenetics.
Personalized nutrition, says Metagenics CEO Brent Eck, has the potential to help practitioners steer their clients away from the “genetic determinism.” Eck talks about a “My grandfather died from liver failure; the grim reaper’s going to get me for liver failure too” mindset that personalized nutrition could tear down. Genetics could be seen as a collection of doors, Eck says. Some of them have monsters like heart disease behind them. “If there is a door that might open, make sure that you are doing whatever it may be from a lifestyle and diet perspective to keep it closed,” he says.
That capacity for prevention, coupled with the precision of nutrigenomics, could one day give nutrition an advantage over pharma, says Michael Stroka, a CNS and president of the American Nutrition Association. Stroka describes the pharma model as “one diagnosis for one huge swath of people and you have one drug for that disease.” The promise of precision nutrition in the hands of a studied practitioner reaches far beyond that. “You can then do an intervention that’s specifically targeted to the individual,” Stroka explains. “We’re not talking about molecular compounds. We’re talking about foods.”
Some of that work has already begun at places like Leroy Hood’s Institute for Systems Biology in Seattle. In ISB’s 100 Person Wellness study, the genetic profiles for 100 subjects were matched against blood-draw biomarkers and microbiome sequencing and resulted in actionable nutrition interventions for every one of them. That effort evolved into the 100K Wellness Project and has since spun off Arivale, a service that takes genetics, bloodwork, microbiome testing and fitness trackers and pairs it with personal coaching at $3,499 a year.
Still, even at the cutting edge of the science, the map is barely inked in at all.
Stroka calls it “a tenth of the way there.” Pizano and Williamson call for more education for more practitioners. “Let’s get some quality information out, specifically designed for the practitioner to start to really learn what goes into nutritional genomics and how to start to incorporate that into their practice,” Pizano says. She and Williamson have prepared webinars on the DHFR gene, histamine intolerance, and mitochondrial diseases related to genetics. Future webinars will include neurotransmitters and gastrointestinal issues.
So the map is getting clearer but will probably always have scribbles in the margins, and the truth, of course, is that there will be no single map anyway. Every map will be individual, personalized, with its own sets of schematics and scribbles, each map making the next map easier to read. The only thing that’s clear is that a map so complicated and so covered in scribbles will be difficult for the average person to read.
They will need a guide, somebody who studied the science and kept studying it. That guide will undoubtedly be a practitioner.
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