Nutrigenomics: Application to Dietary Approaches and Nutritional Supplements

good evening everyone and welcome to the first in a series of our nutrition proclick 'el webinars the board for certification of nutrition specialists in partnership with meta genex integrative therapeutics and the American nutrition Association is very pleased to present dr. Diana Minich on nutrigenomics dr. minute is a dynamic and internationally recognized health expert and author her well-rounded experience in the nutrition field includes private practice clinical research product development management marketing writing and education dr. Minnich received her PhD at the University of Groningen in the Netherlands where she focused on essential fatty acid absorption and metabolism and her Masters of Science at the University of Illinois at Chicago where she studied carotenoids and oxidative stress she is a fellow of the American College of nutrition a certified nutrition specialist and a certified nutritionist by the Washington State Department of Health she is the author of four books on health and over 15 scientific publications currently she is senior advisor to the personalized lifestyle Medicine Institute in Seattle Washington and is that junked faculty for the Institute for functional medicine the Maryland University of Integrative Health and the University of Western states her passion is teaching a whole self approach to nourishment and bridging the gaps between science spirituality and art in medicine welcome dr. Minich so I hope that after this talk that you'll be able to walk away with some general applications to clinical medicine I know that dr. stone has just gone through a whole laundry list of different snips and nutrients I think what I'd like to do as we go through these certain things does have a conversation with you about them what are the limitations what should we feel really comfortable with what is kind of shaky ground and still very wobbly and being that I've been in the dietary supplement industry for 10 years what I'd like to talk with you about too is is supplements and how to work with some of these genetic profiles that I've worked with clinically and and what the results might be so here's the overview I'm gonna start your very broad talking about nutrition and really introducing you to this this newer landscape that we're in in the 21st century will traverse through nutrigenomics a bit epigenomics even food omics that relatively new term that came out in the literature a little while back and then we'll go into the bulk of the talk is really on diet and nutrigenomics and I'll close with a case study so I think if I look back at my trajectory as a nutritionist there have been times in my career that I've been very embarrassed you know you're in the airport you're on a plane and people ask what you do and you tell them that you're a nutrition professional that you're a nutrition researcher and a clinician and then of course you get a lot of questions and then you get to hear all of the controversies and debates that are out there right do I eat butter what about margarine what about soy you know it's kind of this barrage of questions so there's some part of me that's a little bit embarrassed for the the nutrition research that's out there to some degree because I know that and various researchers have said this that if I want to support a case within nutrition I can go and find those studies if I want to support the contrary case I can go and find those studies so what's the problem with those studies I think one of the problems with those studies is that we didn't have genomics we didn't have the genetics of the subjects in those populations they are just random very heterozygous mixed groups of people with really no delineation or differentiation on certain lifestyle factors that we now know are increasingly important for example did you know that grief is is something that modulates one of the inflammatory snips you know that all of these emotional factors that tie into our eating experience also need to be accounted for so I don't think we nutrition has been such a solid science in the way of studies because we've missed this part the nutrigenomics part right this I see will start to get added into the nutrition research more and more so one of the things I did last year at about this time was I went with dr. bland to the personalized medicine conference it was the personalized medicine world conference and it was all about essentially finding out the direction of personalized medicine which is essentially that that left cover of Time magazine they're trying to figure out how we use personalized medicine and I would say it's challenging what I'm seeing in medicine just from surveys from conferences that I've been at and such is that really we see this the most in oncology right now is where it's being used in pharmacokinetics so there are those two where we see that being employed however that said I work a lot with people with cancer so whenever I'm talking with these cancer patients one of my first questions is have you had your genetics done has your position run these labs and I would say about eight out of ten times the answer is no so even then the permeation into oncology one of the bigger fields where we could see great potential here has not really truly manifest there was a very interesting article in the Journal of the American College of nutrition published in last last year September October that came out on the the ten different areas that are trending towards more development by 2020 and essentially if you look at this list and scan it what you find is that many of these topics are going to be covered even over the course of these few days but number three on this list was gene expression which I found to be very interesting and under this category of gene expression which I expected them just to dive into nutrients specifically nutrigenomics there was really a discussion of the human genome looking at the microflora you know there's another concurrent session here talking just about the microflora and the power of that that we are more of those cells more of those micro organisms than we ourselves of our own body but who's talking about the genomic profile of those systems and not just the gut but what about the other mucous membranes even saliva so we need to look at that interface and how does that impact nutrient needs that's a whole other field in and of itself the area that I'm most interested in is phytochemicals so I'm going to be talking about not just what a human needs but what kind of food provide based on its genetics what are the phytochemical messengers that we are signaling to the cell and then of course dr. stone talked very eloquently about transgenerational effects that gene expression is not just an N of one an individual but it's generations that we have that potential through nutrients to impact three or more generations ahead of us so how did we get to gene expression being so popular in nutrition what happened well there was the Human Genome Project which was completed early in 2003 and that really if you think about it you know this is 2015 so we're looking at just 12 years ago that we cracked the human genome that's not a lot of time so we can't expect that we would have all of the solutions and all of the answers to what we need to do in in health care you know I'm sure that you've heard of the old adage that it takes roughly 50 years to take a scientific finding and to translate it into something clinical I don't think that we need to wait that long but I think that you have to realize too that all of this information is so new it's just bubbling up in 2007 this this article from LaSalle Co talked about how the different genes from different systems were interconnected so now not only are we seeing individual genes individual snips or variants what we're also seeing is how all of these different organ systems are interrelated that's really what we want to know – is the crosstalk so while this looks like a piece of art pointillism or something pixelated what you see here is that these little dots represent certain health conditions so you can see that the gray lines show the interconnection of different health conditions so if you look at the the aquamarine the bluish bubbles to the low left you can see all of the interconnections even to type 2 diabetes to obesity and so forth cardiomyopathy even right so we can start to connect the dots all throughout and of course I think that we intuitively know this this is systems biology after all it's functional medicine its integrative medicine but now we're seeing at at the genetic level so this is a very interesting portrayal of knowledge just where we're at so if you look at this schematic looking at the human genome project to the far left so 2003 and kind of that heat bubble right in the middle shows where a lot of the activity took place and how that that more or less extended outward so what we see then is to actually put that information into the understanding of the biology of genomes that's going to take a lot of time just to understand basic human physiology and then to understand disease to take it one step further right into medicine and finally into healthcare so you can see that this is going to be a long endeavor I think you can walk out of this this session with some general understanding about what you can do but I don't think that we can feel very firm that there are definitive guidelines that are currently available so what are the challenges there are challenges potentially with measurements with the different tests that are available with sorting out the data dr. stone mentioned a lot of the emotional issues that happen when you asked Michael about who gave this as gifts I did but only half my family did it and this is a family that's very very tuned in to health and healing but yet there's a lot of fear there's a lot of stigma how many of you have seen that with your patients a lot of fear so not okay not very many of you so and then also there's the whole issue of safety or discrimination with employers so what are the opportunities well I'm going to show you a study that showed that when patients know about their genetics they might actually be more compliant so we might see better efficacy we might see more targeted approaches people might feel like you're giving them a regimen that really suits them to their biochemical uniqueness so as we've been talking about there are many different tests that are out there and what's very interesting is that as the genome was being sequenced we saw a very high price to actually get get ones genome sequenced right it wasn't something that was in demand it wasn't something that had the the sense of rapidity in in measurements and there were a lot of questions about measurements but now we can get a 23andme test for 99 dollars and get lots of information the problem is is that most people don't know what to do with that and thereby we see a lot of the fear because people don't know how to put that all together so dr. stone talked about genetic Jeannie I think that this is an excellent one taking the 23andme data bringing it into some type of data mined like genetic Jeannie is a good one I do have a number of patients that use this people that are especially interested in methylation and detoxification there's also you know there's there are always so many questions about how to eat and do I go paleo do I go vegan and a lot of these communities around genomes are forming so essentially looking at one of the important things that 23andme can give you is ancestry so many times I'll sit down with the patient and start talking with them about what is their ethnic background what is it that their ancestors ate so when we say paleo to me that really doesn't mean anything from an anthropological point of view because throughout the planet at that time Paleolithic times we saw lots of different ways of eating even eating grains so I think that this whole term paleo has really taking on more of a it's taken on a very trended and in defined way and even Loren Cordain who is considered to be the father of the Paleo diet said it's been completely changed you know now there's paleo brownies and that would never be the case right so that that's kind of an anomaly in the in the whole system so I think that bringing in the ancestry piece is something that I like to bring in I like to have patience even do a little bit of research on what did your ancestors eat from Ireland or from Sweden or from Germany or from Africa or from Asia what did those proof those profiles look like so I think that these these hubs these sites are nice because they get people talking they get people on community and you can also find family members and in so doing doctor bland I didn't hear you mentioned the Institute for systems biology but as some of us know dr. Leroy hood is putting together a very long study a 30 to 40 year study looking at the collection of numerous types of data related to one's genetics and symptoms and also nutrition and lifestyle and following people for many many years so that when things come up from a health perspective that they can be coached back into wellness or even coached into optimal health so you can imagine that eventually we end up with lots and lots of data at our fingertips we're walking around with our jump drive with pockets of data all these different buckets on the different owns so I'm looking forward to the Institute for systems biology in terms of giving us the information on on what we can do real-time because I think that this is one of those Sciences where we're going to get a lot of information from the clinical side and that's going to inform the science that will move it forward so nutrigenomics very simply is this idea that gene expression or DNA can be modified by the action of nutrients and bioactive food components and this can happen indirectly and directly this is important for any of us that are dealing with chronic disease patients that have chronic disease or if we have symptoms ourselves because we are seeing that a lot of these chronic diseases are lifestyle induced of course so that's where our involvement comes into this so this idea that and I would even say the process of how we eat when we eat with whom we eat are all informing our genome in a variety of different ways and we get this the cell signaling cascade that happens so we take in this information and it's passed on through the cell and this is just a great teaching tool for patients just to talk with them about what are you communicating to your DNA you know I have a Facebook page and I notice that every time I post this post I get the most amount of likes and it's your DNA is not your destiny people still are really getting their minds around that that their health is under their control it feels liberating and at the same time it feels very overwhelming like okay now that I know that what do I do with that information so nutrigenomics very simply and you know when I started studying nutrition back in the early 1990s with dr. Phyllis Bowen dr. Claire Hassler gosh we just started getting into functional foods right trying to put things in food to create certain health benefits but now you can imagine that we can create personalized products I know that some supplement companies are looking at more of a personalized approach where you plug in your your health factors and then essentially what you get at the end is a packet delivered just for you right and so perhaps that's that's even more important for the patient to to consider that this can be a personalized process that they can own one of the things that I like about what we're seeing in nutrigenomics is that it allows us to question nutritional dogma that has held very solid for a number of years and many of these I've talked about with dr. bland just over the years but right so food is more than calories a calorie is a calorie and had bad foods give you disease unless you have genes to intervene and protect you so here are the new concepts that would replace those old ones the first one is that food is really full of informational signals and keep in mind it's not just the food it really is the whole process of eating secondly is that a calorie is to be judged about from the context it comes from so back to dr. Stone's point about the context dr. Houston and I just wrote a commentary for the journal of clinical hypertension talking about a study in which they used fructose while fructose may be a poison it may be of benefit depending on the context in which it was delivered and also on the genetics and also on the physical activity in the predisposition of that patient so we really have to look broader at these different dietary signals and the context now the piece that makes everything very unstable when we start talking about nutrigenomics outside of the fact of the fact that we have so many of these different things interacting is epigenomics and with epigenomics what we have is essentially not changes in the genes themselves like we would think of with single nucleotide polymorphisms or gene variants that we've been talking about but really the the conformational changes that happen with the DNA and so these are the things that when we think nutrigenomics it's nice to just plug nutrients into snips but it's harder to figure out how we're actually going to see these conformational translational changes you know we've been talking a lot about methylation methylation is very hot right now patients have a lot of questions but there's also a lot of debate around methylation you've got two different school you've got more than two different schools that are talking about methylation protocols and they're not even science-based they are clinically oriented and these clinicians are talking about their approaches to methylation so we still don't even have really the full breadth of how do we deal with epigenetics on top of everything else and even phosphorylation which drives most of the processes within the cell and the transfer of of those signals from outside in what about that what do we do with phosphorylation so I think that there are a lot of questions here I told you that I would be devil's advocate in terms of raising the challenges and I see a lot of them so with foods of course we know that there are various constituents in foods that do funnel in and change methylation they change phosphorylation but I don't think that we still have the Grinnell granularity that we need to go deeper into recommendations you know I think that there are some general things that everybody can can go with but I still think that we need a lot more research on these different constituents so there's a dynamic here right there is the I like how dr. stone closed his talk talking about well we see these snips we see what your genotypes are and and what you're presenting with in terms of just the variability but you're doing okay so we always have to look at that gene environment interface so dr. stone and dr. bland have already talked about PKU and hemochromatosis there are some other gene environment interactions that I think are important to acknowledge and I'm going to talk about those a little bit more one of which which I'm sure dr. Houston will refer to is this whole idea of sodium restriction and hypertension so this is something that has been out there and and we hear about hypertensives needing to avoid salt right but this is just a generic recommendation and we do know that there are different degrees of salt sensitivity that exist so is it really beneficial to be of avoiding salt for everybody so there are some specific gene variants that have been identified and I do think that we need to see a little bit more interaction of the different lifestyle factors and how these tie in dietary cholesterol I'm sure that dr. Houston will cover this as well looking at hypercholesterolemia what have been the long-standing recommendation from the American Heart Association 300 milligrams of cholesterol daily for Americans and not to exceed that however if we start looking at the data a little bit more we don't necessarily find that there's very strong evidence for everybody for all different populations in fact only about a quarter of the halation is sensitive to dietary cholesterol and what you can see is a rise in LDL cholesterol and a compensatory increase in HDL dr. Maria Fernandes at the University of Connecticut has even shown some of that in her research eggs you know just even what do I do with eggs and cholesterol I get that question all the time I'm surprised I didn't come up for you Michael and all of those questions but it's a common one and there is some newer research to suggest that for patients with cardiovascular disease that may be okay but for certain genetic propensity towards diabetes Plus having cardiometabolic risk or even cardiovascular disease that that would be contraindicated on a daily basis so for my diabetic patients I have to really look at their egg consumption and also what is their genetic variability really looking at things like a bowi a powful a bowi for so food omics i know that everybody left this one to me since i'm the nutrition professional here so with food omics we have to think about the foods and what we're bringing in at that level so I can imagine in the future eventually what could happen is that we start having our own personally designed foods for our genetics and where we live the soil the air everything that the whole quality of that I've already worked in large food companies where I saw that that those initiated discussions were happening very early on even before we had results of the human genome project so essentially what we really need to look at is how do the constituents of foods match our physiology but beyond the basics beyond protein carbohydrate in fact I think we need to go deeper into those phytonutrients in fact this article in 2013 was talking about this idea of phyto profiling that we would have people that we would have metabolism types for that we would then draw essentially recommendations in the way of different phytochemicals and then how those phytochemicals could help with health so I do think that the future of nutrition requires us looking at non-nutritive compounds that will impact the genome so looking at these phytonutrients because we know that they play a role in epigenetic effects also genomic affects a lot of the detoxification effects that doctor stone was talking about we see this more and more and it's not about the calories I think that one of the issues with the nutrition field is that we've created a lot of buzz around the calorie and it's kind of like a mirage you know the calorie is just one thing but we have to look at those other messengers and the phytochemicals are big the phytochemicals if you start to look deeper are only as good as what our gut microflora is doing to them so what we really need to see is human genomics for the patient we need to see the food omics for the food and through that the phytochemicals and then we also really need to look more at the gut microflora in that genome and look at that interaction to see how we couldn't benefit you know there are certain things that i see in the literature and I just start recommending to patients because I feel like there's no harm done for example blueberries with blueberry polyphenols what we know is that the best utilization will come from a gut microflora that has a lot of bifida bacteria so taking probiotics that contain bifida bacteria together with blueberries may not be a bad idea and it's also not going to hurt anybody so again I think as we get more information around that these different factors will have more definitive recommendations for patients so let's just look back again 2003 the human genome project was completed where are we with clinical translation let's just see where some of the opinion leaders that are out there speaking to nutrition guidelines are what they're saying so we have the USDA in the US Department of Health and Human Services what they talk about are some general things about preventing overweight and obesity control calorie intake increased physical activity that's great not very specific and in terms of the food what we see is just this really generic one size fits all eating right so reduce sodium intake reduce calories for saturated fat and me doing my PhD on essential fatty acids and really looking at the family of fat it always really gets me when I see that we just really we malign fat just dietary fat on the whole we don't even look at the complexity of the different dietary fats the dietary saturated fats and those interactions with different genes that we have we just say stop consuming you know we don't even say from which sources keeping trans fat low keeping calories from solid fats as you can see a lot of these are very generic I mean even the last one well what is moderation for alcohol right I have some patients with genes for cancer particularly breast cancer well for them moderation means zero you know not a good idea so what's very interesting is I did this exercise of looking at all these different dietary recommendations is that essentially the American Heart Association is saying the same thing American Cancer Society is saying the same as so as the American Diabetes Association all very different conditions yet none of them have really embraced taking on the Nutri genomic more of a personalized nutrition approach so we're not even seeing this in very large scale recommendations I think eventually what will we what we will see is something along the lines of what I call systems biology nutrition where we do start to look at the different organ systems and we start comparing phenotypes and genotypes so I think it's interesting even though there was a lot of emotion around people's DNA being tested this study which just came out very recently this was in Europe and again there's a little bit of a difference between North Americans and Europeans on this but it seems that there's a lot of receptivity to designing diets for DNA least in Europe there's a lot of momentum especially in the Netherlands University of Aachen again so there are some personalized nutrition approaches that are out there some internet delivered services I think some some grassroots companies are catching on there there are some companies that are really broaching and moving out more with personalized dietary advice I know pathway genomics does as dr. stone had showed some of the different panels and they go further into translation of those effects you know if you see these variants what do you do with that information and again what do we do with the epigenomics I think that remains the wild card so there are lots of different things that we can be looking at with nutrigenomics approaches some things that are a little bit higher up in terms of we can feel really comfortable with these things because they are safe we're not doing the patient any harm then there are other things that perhaps we have to dive deeper on this study came out last year and it was looking at gene variants for a Poe life of protein a 5 so essentially what they showed was that and if you look at these the bars so you have two different forms of the gene variability so you have the the TT and then the C allele so this is the variant so when they gave these two different groups to different diets particularly looking at carbohydrate what they found was that the change in April lipoprotein a5 and triglycerides which is one of the the biomarkers that really responds to a both a 5 was modified through the diet through dietary carbohydrates so with whole-grain we see an improved effect over refined rice this is a study what I was referring to before about compliance is that when patients know that something is tailored to them they seem to be a little bit more receptive so I find that this study is very interesting from really thinking about will nutrigenomics change medicine in terms of patient compliance so in this study they had patients about sample size was about 100 these were patients that had been followed over time didn't do well with losing weight so they put 50 of those subjects into a group that tailored the Mediterranean diet to their genetics then they had another group that they just gave the Mediterranean diet to so this study was done in in Greece so very easy to really make sure that that Mediterranean diet happened right so what they found over time and this effect strengthened the longer the study was done what they found was that at 300 plus days a follow up that there was an improvement relative to the the two groups together so the the group that had the nutria genetic the the prescription to follow this specific diet had actually done better in terms of weight loss and although I'm not showing it they actually did better in their blood glucose as well so it makes sense that those two parameters would go together so what about supplements and just clinical applications how do we again handle this I think dr. stone did an excellent job handling the MTHFR polymorphisms here so I don't want to go too deep into that because I think that he he did such an excellent job one thing that I see clinically that starts to complicate the picture is when we see all of these different pathways that really come off of this methylation cycle I had one patient earlier this year I'm sorry last year 2014 in which she was all keen to work on her methylation snips so that would be pretty easy right because I I'm pretty comfortable with the amount of 5-methyl tetrahydrofolate that you need in order to to help and we could monitor that with her physician do certain labs but then she was having difficulty she was having a lot of side effects and this is what we are hearing and seeing as some of those methylation forums and as we went further into her genetics we found out that she had a snip in sister thigh on beta synthase now CBS is one of the key you know essentially these enzymes that is going into the trans sulfation pathway so anything that she had that had sulfur in it made her SiC so I couldn't put her on a classic detoxification protocol loaded up with lots of protein loaded up with lots of sulphur she couldn't even have green vegetables without getting sick her vitamin b6 levels were high because she wasn't utilizing that for that's that part of the cycle one of the key B vitamins for that so I would say that there are still a lot of discussions about how to handle these cases where there are more things going on than just methylation I think you know again back to the adage of if you have a hammer everything looks like a nail if you only know about methylation then that will become your world but it's really much more than that it's very complicated actually but we do know that methylation ties into many different conditions as dr. stone talked about and I'm not going to go through this just because he did such a good job covering that and it would just be repetition I do want to make a comment though here about how not all gene variants are detrimental for example having this substitution that's MTHFR looking at 6 770 could actually be protective in in men against prostate cancer with adequate folate so it's not that all of these gene variants make our patient unhealthy it's about the right environment the right nutrients and really understanding the intersections of their physiology so one thing I do want to talk about because nobody has addressed it really here yet although I know this is a favorite of dr. Stone's is bitter taste receptor polymorphisms so I can imagine in the future five to ten years out your patient comes to you and you have them do a number of things that relate to their physical exam and one of them is you have them taste strips to see whether or not they're tasting bitter there is more and more science coming out about bitter bioactives and how important these these bitter foods are and how they connect to different receptors now these receptors also exhibit genetic variability and polymorphisms so this is probably the tastes that not many patients like to talk about they like to talk about sweet and about sugar not necessarily the bitter non pleasing compounds but we think about things like green tea you know why do all these things work to some degree in terms of helping with metabolism well as it turns out if we look at the science there are a number of these polymorphisms to be looking at and I would say that this still lives much more in the science but on the clinical side the way that we can start to assess this is by actually doing tasting and I can show you that there are strips available so you can get these just right on and you can just have your patient test and and try one of the strip's just to see if they're a super taster or a non taster and just to see where they're at most people tend to know but it's a it's a great experiment just to you know have something a little bit more concrete these bitter taste receptors and their different polymorphisms seem to be related to different health benefits so there's one now this is a gene variant so this is where we see an actual benefit of the variant and we see that with this bitter taste receptor which tas two one six RS and then this particular genotype AAA for people that have that they seem to have longevity so there might be something within that genotype that confers that so what I like to do is I definitely from a patient perspective I think that implementing bitters might be a good thing for most people unless it's toxic right so bringing in more of bitter greens I think can be good for most people if there are super tasters they may not need as much you look at children and how averse they are to tasting bitter they're very sensitive well perhaps they don't need as many bitters compared to people that are a little bit later in life so what we see is that these bitter taste ins have plio tropic effects in the gut so they help with gastro intestinal peptide release they change gut motility gallbladder contraction intestinal motility so the question might be do we have impaired digestion you hear so much about how poor our gut function is right is that just because we're not eating proper foods the proper bitter foods that are really tapping into those taste receptors do we have polymorphisms in those taste receptors that are changing our gut function this study came out in 2005 showing that bitter taste errs have lower body mass indices and not just that but also body fatness tricep fold thickness and even trending towards reduced waist circumference so I think it's a marker that eventually we want to continue to monitor and look at the polymorphisms in the taste receptors that coincide because this might eventually tie into somebody's compliance in eating more vegetables especially more bitter greens doctor stone brought up soy which I was very glad to see and referring to a specific polymorphism you know soy is another one of those very emotional charged topics and if you look at the research on dietary soy in cancer and I've had some time to really dive into this I think it's very broad I think we can say yes there are gene variants there are certain polymorphisms that even connect to glucuronidation processes in the liver and perhaps patients with impaired gluconate Asian have impaired activity with soy isoflavones but overall I would say that you know we have to look at again the multi facets I don't think that we should just ban soy for everybody right I think we need to be looking at the population if it's a woman where is she and her life cycle the type of soy that somebody is taking in is it fermented or not I think that that's an interesting question the isolated ISIF labonz you know one of the things that I learned doing research on some of the estrogen receptors is that when we take in soy isoflavones we can shift the receptors on cells to prime those cells more towards ER beta so soy isoflavones tend to be er beta-agonists and that's a good thing because ER beta balances the effect of ER alpha and of course we have different genetic expressions for the ER alpha y beta but you know I think it's always a complex question for many people and I think that really the reaction that people are having is more to perhaps the genetic modification but overall soy in a mixed diet I recommend to to several of my patients I think it also depends on the gut microflora perhaps we're not utilizing the iSuppli bones very well because we have a poor gut so taking that into consideration is important fish oil supplements how many of you have your patients on fish oil right now I do okay yeah it's pretty common and how many you of you are typing your patients genetically before you put them on fish oil anybody okay well it's an interesting question right because there was this study that came out in atherosclerosis in 2010 showing that a po e for carriers may experience an increase in total cholesterol and LDL cholesterol with DHA supplementation now there's not a plethora of evidence to suggest that this is problematic however there are some discussions happening in certain circles of practitioners seeing this a bit in their practice right so it's something that you know this shotgun approach of just give everybody everything I think in the future will change because we will have more information about this one of the things that I feel pretty passionate about is detoxification and detoxification pathways I've had the privilege to to have the father of nutritional detoxification as one of my mentors dr. bland so there are a number of things and this definitely ties in to cancer it ties in to really tailoring foods to helping the liver helping the gut so we look at food intolerances and especially being on the rise you know seeing the epigenetic effects of food and and noting that people are just not able to withstand certain foods anymore why is that is that their gut microflora is it enzymatic deficiency and is that in enzymatic deficiency because they had a snip that got turned on in a bad bad environment right so many times we replete with certain enzymes to help or we eliminate those foods but I think that there can be a genetic component there that we really do need to go into further so with in detoxification these are the classic liber pathways right of phase 1 and phase 2 and the the other part of detox that I think doesn't get talked about very much is the individual environmental exposures so overlaying not just liver pathways for the genetic variability but then also looking at the environment and the variability and what we're exposed to and how that's so individualized so we we have to be looking broader and that is to add to our list of ohms this is the expose ohm right where we have the chemical environment that forms on the inside as a result of things that we're experiencing in the environment on the outside so one of the things that I've been investing my time in over this past year is really looking deeper at foods that change these pathways I have felt that we haven't done a good solid sound scientific update of this information this has been out for a while in textbooks and but we really needed to go deeper so just this past year in 2014 I had the privilege really the it was quite a gift to have a student to help me to go into the literature to look at all the different cytochrome systems all the different phase 2 enzymes I also looked at antioxidant response element and gene expression there and then finally at metallo thining production so looking at upregulation of metallo thiamine which is one of the proteins that is responsible for heavy metal sequester ization and metabolism in the body so I'm not going to present all of that to you here because it's still under review for publication but essentially I walked away from looking at all of these foods and you know let's just take an example here so here we have the the green chart which lists the inducers of sip one enzymes and we broke them out we went much further we went into all the way to sip four so we really we have a lot of granularity here but the challenge is is that a lot of these seem to be healthy foods we may or may not want to induce certain things in certain patients if they already have normal or / activity which dr. stone had alluded to some of the detox and genomic profiles that you can order as a clinician so here's an example of inhibitors you know things like blueberry and some things exhibit bi-directional effects so then what do you do you know again I walk away from this and there are some clinical trials and then there are some more in vivo studies with animals there are differences in dosing sometimes there are things put together in studies where one negates the other so again back to the complex interaction in a mixed diet I think in nutrition what happens is we're so fixated on the one food the one bioactive the one nutrient and we have to remember that we don't eat that way unless we're just having supplements as our sustenance but we usually have a mixed diet together with supplements right so it's complicated is what I would say and we do have a number of clinical takeaways from this article and and that is again I think in the vein of what dr. stone said is to to use clinical experience to be really looking at the whole picture of the patient rather than just honing in and saying just eat this one thing it's difficult because you know thinking of detoxification the first thing you want to say to people is have more cruciferous vegetables get more sulfur green colored vegetables but not everybody reacts well and I've actually had some patients that have elevated two hydroxy estrogen and so that might tie into cruciferous vegetable consumption I get a lot of people that are very the eaters already so maybe we have to actually work in a reverse direction with their their genetic variability and how they're metabolizing based on their foods so if we just look at Phase two just very simply and this is from dr. marrows book I just put it out there very simply but again our article takes this much deeper into these four areas and now looking at the current research it's it's a lot right in terms of really tailoring a patient's regimen to this but I think it gets us a little bit closer to where we need to go and then I'll just close on personalized estrogen metabolism this is also very closely connected to detoxification very much an interest of mine and it applies not just to two men and women or not just to women but also to men it applies to to everybody really so methylation as you can see here is a key process for detoxification of estrogen in fact the body treats estrogen as a toxin so if we have snips if we have genetic variability and what we are able to do in relationship to our MTHFR or comt then we're going to have an issue with getting estrogen out of the body


  1. The nutrigenomics market is remarkably driven by the increasing advancement in the field of metabolomics, computational biology, proteomics, genomics and bioinformatics.

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    Nutrigenomics involves the determination of genetic sequence to help design a diet according to the assumed reaction by the genetic build-up.

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  2. If you cant manage a presentation, how can you be trusted to manage health?

  3. I could not hear with or without ear phones.  Could not get the sound up and the subtitles were less than optimal…very sad.  Logged in several times.  Could slightly hear but not enough to really be helpful. Could hear the introduction person but as soon as Dr. Minich came on, all went soft.  Have no idea why or what.

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