Health notes: For your genes only

You’re more than the sum of your genes. Op­ti­mal health lies in fash­ion­ing your en­vi­ron­ment, nu­tri­tion and lifestyle pre­cisely to suit them

Destiny - - Contents - BY Fiona Dav­ern

We’re on the cusp of a ma­jor med­i­cal rev­o­lu­tion, which was sparked by the cod­ing of the hu­man genome in 2003. Dr Jef­frey Bland, founder of the In­sti­tute for Func­tional Medicine (IFM) in the USA and author of The Dis­ease Delu­sion (Harper Wave), ad­mits in an es­say ti­tled The Age of Omics: Op­por­tu­ni­ties, Trans­for­ma­tions and Par­a­digm Shifts that he isn’t a “typ­i­cal ci­ti­zen sci­en­tist”. He’s had his DNA se­quenced three times in the past two years. He’s had quar­terly blood tests to track a panel of biomark­ers pro­vid­ing in­sight into how his lifestyle choices are af­fect­ing his bio­chem­istry. He’s vowed to keep his Fit­bit on at all times and stay ac­tive. His gut mi­cro­biome’s been an­a­lysed four times.

Sound like a chronic case of noso­pho­bia? Bland thinks oth­er­wise. “It’s ev­i­dence of a sea change in health­care that’s based on per­sonal em­pow­er­ment, ac­ces­si­ble dig­i­tal tech­nolo­gies and the democrati­sa­tion of data,” he says.

Just a decade ago, it would have been in­con­ceiv­able to send your own buc­cal swab to a DNA test­ing lab­o­ra­tory and re­ceive the re­sults your­self 14 days later. To­day, it’s avail­able at a click.

In the not-too-dis­tant fu­ture, Bland en­vis­ages a ground-break­ing time, akin to the per­sonal com­put­ing rev­o­lu­tion, when big data and ge­nomic test­ing merge with so­cial me­dia and wear­able de­vices. The in­sights and ad­van­tages will be vast. Rather than the cur­rent one­size-fits-all ap­proach, he says, the fu­ture is medicine that’s honed for the in­di­vid­ual.

TAK­ING CHARGE OF YOUR HEALTH

An early player in the per­sonal ge­nomics and biotech­nol­ogy sphere was Amer­i­can com­pany 23andMe, co-founded by Anne Wo­j­ci­cki, who had a vi­sion of “a world of con­sumer-driven, af­ford­able health­care”. To­day there are in­nu­mer­able com­pa­nies around the globe of­fer­ing an ar­ray of ge­netic tests, from ances­try and pa­ter­nity to health and fit­ness.

In SA, on­line com­pany JOINCIRCLES (www.joincircles.com) has an in­spir­ing per­sonal com­po­nent that’s in­formed its in­no­va­tive ap­proach. Co-founders Dr Heidi van Log­geren­berg and Margie Doig-Gan­der have been life­long friends. From par­ty­ing as stu­dents to start­ing fam­i­lies, they’ve been through all of life’s stages to­gether, in­clud­ing the shock of de­vel­op­ing a dread dis­ease in their mid-30s. “We both suf­fered from oe­stro­gen cancer and we both found a so­lu­tion. We wanted to take that so­lu­tion to peo­ple and share what we’d learnt on our jour­ney,” says Van Log­geren­berg, JOINCIRCLES’ Med­i­cal Di­rec­tor. Cur­rently com­plet­ing a Func­tional Medicine Prac­ti­tioner’s course at IFM, she holds a Mas­ter’s de­gree in home­opa­thy (MTech Hom) and prin­ci­ples of ge­netic coun­selling from the Univer­sity of Cape Town. “We didn’t just want to of­fer tests, as other web­sites do,” adds Doig-Gan­der. “We wanted to of­fer the sup­port and the ap­pli­ca­tion, be­cause that’s where the value lies; that’s when you take ac­tion on your re­sults.”

With over 15 years’ ex­pe­ri­ence in the man­aged health­care mar­ket fo­cus­ing on the preven­tion of lifestyle-re­lated chronic dis­eases, Doig-Gan­der says that af­ter look­ing at their biomark­ers, she and Van Log­geren­berg re­alised they could have pre­vented their own can­cers. “Our pas­sion re­ally lies in the fact that we’ve sat in the pa­tient’s chair. We could see a big gap in health­care for tak­ing own­er­ship of your own med­i­cal in­for­ma­tion and hav­ing ac­cess to it eas­ily on­line,” she says. “We thought it would be hugely em­pow­er­ing to be able to go on­line and see spe­cific tests that look at var­i­ous biomark­ers, ge­netic pre­dis­po­si­tions and bio­chem­istry mark­ers in real time, then pur­chase those tests your­self and drive your own health­care process, in con­junc­tion with con­sult­ing med­i­cal prac­ti­tion­ers.”

CIR­CLES OF SUP­PORT

A ma­jor mo­ti­va­tion for start­ing the com­pany was help­ing pa­tients who felt vul­ner­a­ble and alone in the med­i­cal sys­tem. An on­line plat­form, JOINCIRCLES guides and sup­ports each client through a jour­ney to well­ness. You or­der one of five DNA tests (diet, health, oe­stro­gen, sport and skin) or bun­dles of tests (far less ex­pen­sive) and the DNA swab kit’s de­liv­ered to your door. The courier de­liv­ers your sealed tube to DNAl­y­sis Mi­cro­bi­ol­ogy, a world-renowned, ISO-ac­cred­ited lab­o­ra­tory at the fore­front of DNA test­ing in SA.

All the tests the lab car­ries out are based on solid sci­en­tific re­search. “Our aim is to get this re­search into the pub­lic do­main, so that peo­ple can make more in­formed de­ci­sions and prac­ti­tion­ers can work with a pa­tient’s DNA, in­stead of against it,” says DNAl­y­sis Biotech­nol­ogy founder Dr Danny Mey­ers­feld, who holds a PhD in molec­u­lar bi­ol­ogy from the Univer­sity of the Wit­wa­ter­srand. “What made us a suc­cess was the science back­ing us. There are no wild claims or as­sump­tions here.”

Af­ter two to three weeks you re­ceive your re­sults and book your one-on-one ses­sion with JOINCIRCLES. They will un­pack your re­sults in de­tail, pro­vide their rec­om­men­da­tions re­gard­ing bio­chem­istry tests and re­fer you to a ge­netic coun­sel­lor or mem­ber of their Prac­ti­tion­ers Cir­cle, where nec­es­sary.

Doig-Gan­der, who has com­pleted a Func­tional Medicine Well­ness Coach­ing course at IFM and is cur­rently sit­ting her Ge­netic and Ge­nomics Cer­tifi­cate Pro­gram at Stan­ford Univer­sity, is avail­able to guide clients through their well­ness jour­ney, which can of­ten be over­whelm­ing. An­other layer of sup­port is pro­vided through the on­line store, which is di­vided into neat cat­e­gories so that you can shop for knowl­edge, tests, nu­tri­tion, en­vi­ron­ment and lifestyle. You can also shop by gene or brand, or even hit the “in­te­grated shop” but­ton and browse cat­e­gories like stress, gut or oe­stro­gen, that are aligned with your DNA re­sults.

THE ROLE OF EPIGENETICS

Far from the fear­ful Gat­taca-es­que no­tion that our DNA is our pre-pro­grammed des­tiny, sci­en­tists have dis­cov­ered that epigenetics (the study of the bi­o­log­i­cal mech­a­nisms which can switch genes on and off) places us in a bet­ter po­si­tion to shape our own health. Our genome is our en­tire ge­netic code, found in ev­ery sin­gle cell, and our epigenome is made up of mol­e­cules which at­tach like tags to the out­side of the genome and change the sig­nals or mes­sages it re­ceives from the out­side world.

Learn.Ge­net­ics at the Univer­sity of Utah, USA, ex­plains this con­cept clearly: “Iden­ti­cal twins are ge­netic car­bon copies. The ge­netic se­quences are ex­actly the same. Yet phys­i­cally, iden­ti­cal twins be­come in­creas­ingly dif­fer­ent over time.” Their epigenomes are sim­i­lar at birth and through the early years of life be­cause they share the same en­vi­ron­ment. But their nu­tri­tion, en­vi­ron­ment and lifestyle choices may change as they age, so while one may smoke, eat pro­cessed foods and lead a seden­tary lifestyle, the other may be a non-smok­ing vege­tar­ian who ex­er­cises reg­u­larly. In this way, our lifestyle choices and en­vi­ron­ment can al­ter our gene ex­pres­sion pat­terns, po­ten­tially lead­ing to pre­ma­ture age­ing, weight gain or chronic ill­nesses such as di­a­betes and heart dis­ease.

DNA TEST RE­SULTS UN­PACKED

JOINCIRCLES rec­om­mends that I do a bun­dle of DNA tests, in­clud­ing health, oe­stro­gen and diet. Each re­port shows the

“WE COULD SEE A BIG GAP IN HEALTH­CARE FOR TAK­ING OWN­ER­SHIP OF YOUR OWN MED­I­CAL IN­FOR­MA­TION AND HAV­ING AC­CESS TO IT EAS­ILY ON­LINE.”

RATHER THAN THE CUR­RENT ONE-SIZE-FIT­SALL AP­PROACH, THE FU­TURE IS MEDICINE THAT’S HONED FOR THE IN­DI­VID­UAL.

gene name and de­scrip­tion, fol­lowed by my spe­cific re­sult, an ex­pla­na­tion of it and the as­so­ci­ated risks, as well as di­etary and lifestyle rec­om­men­da­tions. It also iden­ti­fies low, mod­er­ate and high pri­or­i­ties in each bi­o­log­i­cal area. For the pur­poses of this ar­ti­cle, we’re tak­ing a closer look at the DNA health test.

This tests the fol­low­ing bi­o­log­i­cal ar­eas: lipid me­tab­o­lism, methy­la­tion, detox­i­fi­ca­tion, in­flam­ma­tion, ox­ida­tive stress, bone health and in­sulin sen­si­tiv­ity. Based on my fam­ily his­tory (my late mother had arthri­tis and spent her last days in a wheel­chair), I’m cer­tain I’ll need to fo­cus on my bone health. A few years ago I had a C4/C5 cer­vi­cal her­ni­ated disc, which my mother had at ex­actly the same age, so I be­lieve that’s my fate. Bone health, how­ever, turns out to be a low pri­or­ity. Van Log­geren­berg points out that my mother could have had in­flam­ma­tion prob­lems which af­fected her bone health if she wasn’t mak­ing the right lifestyle choices.

She’s spot on: my geno­type com­bi­na­tions in­di­cate that high-pri­or­ity ar­eas to fo­cus on are in­flam­ma­tion and ox­ida­tive stress. These mark­ers are ap­par­ently in­volved in ev­ery chronic dis­ease. “If you ad­dress those two things, you stand a good chance of ‘switch­ing off’ these genes – but you’ve got to make a real ef­fort,” she cau­tions. “Ev­ery time you ex­ceed your ideal weight, you start pro­duc­ing ox­ida­tive stress and in­flam­ma­tion. That’s good mo­ti­va­tion for keep­ing your weight down.”

In­flam­ma­tion ad­vice: I need to man­age my weight through a Mediter­ranean diet, which is ben­e­fi­cial in im­prov­ing mark­ers of in­flam­ma­tion. I should take in cur­cumin (the most ac­tive com­po­nent of turmeric), gin­ger, omega 3 and oily fish. I should re­duce my in­take of omega 6 and avoid fast foods, cho­co­late, al­co­hol and red meat. Any­thing that’s a toxin drives up in­flam­ma­tion.

Rec­om­mended tests: the first is Hs-CRP – DBS. “It looks at in­flam­ma­tion in the body, par­tic­u­larly in­side the artery walls, and is good for women as we grow older, as we al­ways as­sume we’re not at risk of a heart at­tack,” says Van Log­geren­berg. The sec­ond is the Fatty Acids Test. “This in­volves a fin­ger prick and shows you your ra­tios of omega 3, 6 and 9. It’s not for ev­ery­one, but if you’re prone to high in­flam­ma­tion, it re­ally helps you ad­just your diet,” she ex­plains.

Ox­ida­tive stress ad­vice: Be­cause I’m at an in­creased risk of poor an­tiox­i­dant sta­tus, I need to “eat the rain­bow”. My plate should look very colour­ful. I need to con­sume more veg­eta­bles than fruit and eat phy­tonu­tri­ent-rich foods and Brazil nuts (se­le­nium is an an­tiox­i­dant) ev­ery day. If I smoke, I should stop im­me­di­ately (thank­fully, I quit two years ago). Rec­om­mended test: The Dutch Com­pre­hen­sive Uri­nary Hor­mone Test, which mea­sures pro­ges­terone, oe­stro­gen, testos­terone, cor­ti­sol, DHEA and their me­tab­o­lites, as well as mea­sur­ing DNA dam­age. “If you can fix your adrenals, you can fix the preser­va­tion of pro­ges­terone and pro­tect your thy­roid gland, which reg­u­lates your whole body and helps in­di­rectly with weight loss,” says Van Log­geren­berg. Sup­ple­men­ta­tion is ad­vised in the form of Foun­da­tion 5, which com­bines a mul­ti­vi­ta­min, mul­ti­min­eral, phy­to­mul­ti­vi­ta­min, vi­ta­min D, omega 3 and pro­bi­otics.

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