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Nutrigenomics: Using Genetic Clues to Personalize Nutrition NYSAND Annual Meeting & Expo May 21, 2016 Janet Zarowitz, MS, RD, CDN Nutrigenomics! The study of the effects of foods and food constituents on gene expression 2016 © Janet Zarowitz, MS, RD, CDN Nutrigenomics Building Upon What We Already Know Dovetailing With Established Science Well Accepted • Diet and lifestyle choices can significantly affect our health • Poor eating habits can prevent achieving genetic potential and optimal health • Certain nutrients needed to promote normal replication of DNA for normal growth and healing Evolving Evidence • Specific foods and supplements can support our own unique genetic predispositions 2016 © Janet Zarowitz, MS, RD, CDN Family History Building Upon What We Already Know Family History provides clues to Potential for health and disease, looking for genetic trends 2016 © Janet Zarowitz, MS, RD, CDN Family History Potential and Predisposition NOT DESTINY The same is true for Genetic Profile 2016 © Janet Zarowitz, MS, RD, CDN Role of Genetic Profile In the Patient Care Process Genetic profile “joins” the intake process, alongside: • Family History • Medications, Supplements • Signs and Symptoms • Diet, Cooking, Eating Environment • Medical History/Diagnoses • Lifestyle, Exercise, Self Care • Lab Values, Biomarkers • Social Network, Supports …to help figure out the patient puzzle 2016 © Janet Zarowitz, MS, RD, CDN Genetic Profile Mapping a Person’s DNA Individual’s genetic characteristics (DNA analysis) can: • Provide insight into potential for developing certain diseases • Offer clues to root causes of disease/symptoms • Help reduce guesswork in treating suboptimal health 2016 © Janet Zarowitz, MS, RD, CDN Gene Expression Epigenetics, or how genes are expressed is where Nutrition gets into the game. 2016 © Janet Zarowitz, MS, RD, CDN Nature Meets Nurture Epigenetics - Where Genes Meet the Environment Once nurture seemed clearly distinct from nature. Now it appears that our diets, lifestyles & other environmental factors can change the expression of our genes. 2016 © Janet Zarowitz, MS, RD, CDN Epigenetics - Beyond The Gene Environmental factors affect gene expression (without changing DNA) Environmental factors turn genes “on” or “off” • Food, nutritional deficiencies/excess, breast/bottle feeding, GI microbial mix • Exercise, lifestyle, stress, aging, diseases • Prenatal, childbirth, early life experiences • Chemicals, toxins, radiation, pathogens, drugs ….. they all affect gene expression ….. the genome adapts to environmental factors 2016 © Janet Zarowitz, MS, RD, CDN Intergenerational Transmission From Macmillan Publishers Ltd: : Qiu, J. Nature, 2006, 441, 143, copyright (2006) 2016 © Janet Zarowitz, MS, RD, CDN Are Nutrition Professionals Already Practicing Epigenetics? Dietary Polyphenols and Cancer Prevention Eat Rainbow of Foods More Plant-based Foods Tomatoes Apples Citrus Turmeric Garlic Cinnamon Broccoli Cashews Grapes Tea Biochem Pharmacol. 2010 Dec 15;80(12):1771-92. doi: 10.1016/j.bcp.2010.06.036. Epub 2010 Jun 26. Cancer chemoprevention by dietary polyphenols: promising role for epigenetics. Link A1, Balaguer F, Goel A. 2016 © Janet Zarowitz, MS, RD, CDN Isolating Compounds & Epigenetics Diet and Supplements • Dietary fiber - gut bacteria ferment dietary fiber, produce butyrate, which mediates epigenetic process in gut associated immune system - GALT • Phytochemicals - gut bacteria metabolize phytochemicals into products that have epigenetic effects • Minerals - associated with changes in epigenetic mechanisms regulating gene expression Dietary Manipulation of Histone Structure and Function, Barbara Delage and Roderick H. Dashwood Annu Rev Nutr. 2008; 28: 347–366. 2016 © Janet Zarowitz, MS, RD, CDN Epigenetics & Personalized Nutrition “From inflammaging to healthy aging by dietary lifestyle choices: is epigenetics the key to personalized nutrition?” Personalizing Nutrition • affect epigenetic mechanisms - methyl donors, phytochemicals, fatty acids, vitamins • modulate genes involved in inflammatory diseases • modulate genes encoding absorption, distribution, metabolism, & excretion proteins Clinical Epigenetics, 2015 Mar: 7(1):33, vel Szic, Vidakovic, and Berghe 2016 © Janet Zarowitz, MS, RD, CDN How To Put This Into Practice, Today? Epigenetic Nutrition Strategy Using new genetic info, RDs can …. design customized nutrition therapies and lifestyle changes for healing — above and beyond symptom management. 2016 © Janet Zarowitz, MS, RD, CDN How I Started Testing Options Reference integrativerd.org 2016 © Janet Zarowitz, MS, RD, CDN 23andMe Process • Order at-home saliva kit through http://23andme.com • Mail-in • NYS workaround • Results emailed within several weeks • Raw data 1000’s genes vs. few • Upload data file to third party websites for interpretive genetic reports, e.g., MTHFRSupport.com 2016 © Janet Zarowitz, MS, RD, CDN Reading Genetic Reports Understanding SNPs/Gene Variations • Single nucleotide polymorphisms - “snips” • Most variations “typos” - switching one letter in gene’s sequence to another (switching nucleotide) • We all have SNPs • A person’s genome (and their SNPs) do not change 2016 © Janet Zarowitz, MS, RD, CDN SNPs What’s Their Relevance? • Some SNPs change the gene’s “instruction manual” - encoding a protein with altered shape, activity, stability and/or abundance • Only certain SNPs are associated with difference in molecular function significant enough to effect clinical measurements or disease risk • Genes that encode different enzymes (e.g., MTHFR) prone to common mutations or SNPs • Innovative view: “What if DNA mutations are not always the markers of disease, but rather — under the right set of circumstances — markers for resilience?” - Eric Schadt, PhD and Stephen Friend, MD, PhD 2016 © Janet Zarowitz, MS, RD, CDN SNPs Affecting the Body’s Ability to Do Work • SNPs reflect the ability of the body to do work • Some SNPs reduce function, less often enhance function • More than half population has SNPs that reduce activity of one or more enzymes by up to 70% • Some SNPs directly affect nutrient assimilation and nutritional requirements • Effects of these SNPs can be substantially mitigated with targeted nutritional approach - diet and supplementation 2016 © Janet Zarowitz, MS, RD, CDN Homozygous | Heterozygous • for each gene pair, SNP may occur in none, one or both copies of gene • on genetic reports “+” represents SNP • homozygous SNP “+/+” can have more significant health implications compared to milder heterogeneous genotype -/- Homozygous “normal” no SNPs -/+ Heterozygous “variant” 1 SNP +/+ Homozygous “variant” 2 SNPs 2016 © Janet Zarowitz, MS, RD, CDN SNP ID rsID Number or SNP ID identifies chromosomal locations 2016 © Janet Zarowitz, MS, RD, CDN Nutritionally Relevant Genes Well Researched MTHFR C677T and A1298C folate and methylation COMT Val/Met 158 methylation, mood and estrogen metabolism 2016 © Janet Zarowitz, MS, RD, CDN What is Methylation? Chemically Speaking Methylation is a biochemical reaction in which a methyl group (CH3) is attached to a molecule, converting it to a different molecule 2016 © Janet Zarowitz, MS, RD, CDN What is Methylation? Clinically Speaking Methylation has vital roles in: • epigenetics and gene regulation (DNA methylation & histone acetylation) • neurotransmission • amino acid metabolism • DNA synthesis and repair • hormone detoxification • vitamin assimilation (including folate) • homocysteine clearance • cell membrane structure 2016 © Janet Zarowitz, MS, RD, CDN Methylation Pathway SNPs May Present As • loss of digestive integrity (rapid cell turnover), food intolerances • mood disorders, depression, anxiety, cognitive function deficits • neural tube defects • endocrine imbalance (estrogens), environmental toxin buildup (phase 2 liver) • cancer, e.g. colorectal, breast, lung (altered suppression of gene transcription) 2016 © Janet Zarowitz, MS, RD, CDN Methylation Pathway SNPs May Present As • cardiometabolic syndrome (with homocysteine buildup) • chronic inflammatory diseases (less glutathione production) • impaired thyroid function (less T4 to active T3 conversion) • impaired fertility (male and female) • fatigue (reduced CoQ10 and carnitine production) • general poor overall health and immunity 2016 © Janet Zarowitz, MS, RD, CDN So That’s Why We Had to Take Biochemistry! Methylation Pathways 2016 © Janet Zarowitz, MS, RD, CDN Cycles of Methylation Pathway Plus Krebs cycle Nitrogen removal Krebs cycle Neurotransmitters Activates folate SAMe, Gluathione generation; phospholipids fumarate aspartate 2016 © Janet Zarowitz, MS, RD, CDN Genes Code for Enzymes Gene Locations Genes 2016 © Janet Zarowitz, MS, RD, CDN Enzymes Need Cofactors Like Mg, Zn, Riboflavin, B12, B6 Genes Cofactors 2016 © Janet Zarowitz, MS, RD, CDN Nutrients Can Bypass SNPs Genes Cofactors Nutrient bypass support Nutrient bypass support includes 5-MTHF (folate), B12, methionine, SAMe, choline, DHA, phosphatidyl serine 2016 © Janet Zarowitz, MS, RD, CDN MTHFR Gene C677T & A1298C SNPs Key Regulators of Methylation Methylene Tetrahydrofolate Reductase Gene function: encodes Methylene Tetrahydrofolate Reductase enzyme Enzyme function: converts folic acid and 5,10methylene THF to active form of folate (5-MTHF) 2016 © Janet Zarowitz, MS, RD, CDN MTHFR Gene C677T & A1298C SNPs Methylene Tetrahydrofolate Reductase Potential impact of reduced enzyme function of these SNPs: • Reduced conversion of Folate to ACTIVE form, needed for methylation and as coenzyme or cosubstrate in synthesis of DNA, RNA & amino acids • C677T - associated with cardiovascular problems reduced conversion of homocysteine to methionine; also associated with increased male infertility and sperm DNA alteration • A1298C - associated with neurological/cognitive problems reduced production of tetrahydrobiopterin (BH4), integral cofactor in nitric oxide & neurotransmitter synthesis; does not affect homocysteine levels 2016 © Janet Zarowitz, MS, RD, CDN Making the Assessment Will Nutrition Strategy Help? YOUR DNA IS NOT YOUR DESTINY… it’s one factor 2016 © Janet Zarowitz, MS, RD, CDN Making the Assessment Look at Clues Holistically Treat the Person, Not the SNP Medical History/Diagnoses Interfering Meds, Supplements Signs and Symptoms Environmental Toxins Biomarkers Cigarette Smoking, Alcohol Dietary Intake Stressors - Emotional, Physical Special Requirements AND Genetic Profile - SNPs 2016 © Janet Zarowitz, MS, RD, CDN Symptom/Diagnosis Clues Of Undermethylation Digestive issues, bloating, IBS, constipation/diarrhea, poor nutrient absorption, food intolerances Brain fog, sleep difficulties, neurological problems, anxiety, mood disorders, autism Excessive histamine response, itchiness, stomach pain, histamine intolerance Getting sick often, lowered immunity, cancer Cardiometabolic syndrome Peripheral neuropathy, dementia Weight changes, impaired thyroid Fatigue, joint pain, inflammation 2016 © Janet Zarowitz, MS, RD, CDN Biomarker Clues Of Undermethylation Low Folate -Elevated Homocysteine -Low RBC Folate Levels -High FIGLU in Urine Low B12 -Elevated Methylmalonic Acid -Elevated Homocysteine -Anti-parietal/Anti-intrinsic Factor Antibodies May Indicate Methylation Issues -Urinary estrogen metabolites panel - high hydroxyestrones, low methoxyestrones and ratios -Elevated Histamine -Anemias - megaloblastic or macrocytic 2016 © Janet Zarowitz, MS, RD, CDN Nutrient Requirement Clues Drugs Interfere with Folate – Absorption/Availability -antacids, H2 blockers, proton pump inhibitors -bile acid sequestrants/cholesterol-binding drugs -NSAIDS -anti-seizure drugs* -sulfa drugs - antibiotics -estrogen drugs - birth control, menopause meds -methotrexate* - chemotherapy *folate may negate effect of drug; work with MD Ref: Dr. Suzy Cohen, R Ph, www.suzycohen.com 2016 © Janet Zarowitz, MS, RD, CDN Nutrient Requirement Clues Drugs Interfere with B12 – Absorption/Availability -metformin -colchicine (gout) -antacids, H2 blockers, proton pump inhibitors -bile acid sequestrants/cholesterol-binding drugs -anti-seizure drugs -sulfa drugs - antibiotics -estrogen drugs - birth control, menopause meds -methotrexate - chemotherapy Ref: Dr. Suzy Cohen, R Ph, www.suzycohen.com 2016 © Janet Zarowitz, MS, RD, CDN Environmental Stressor Clues May Not Satisfy Methylation Requirements Diet -Low in leafy green vegetables and other folate-rich foods -High in processed foods, many enriched with competing folic acid -High alcohol intake Environmental toxins -Cigarette smoking -Working or living near/with chemicals including household Emotional or physical stress -Injury, surgery, infection, pregnancy, aging 2016 © Janet Zarowitz, MS, RD, CDN Genetic Clues - SNPs Clues suggest possibility nutrition recommendation for each genetic SNP -/- no SNPs -/+ one SNP +/+ two SNPs 2016 © Janet Zarowitz, MS, RD, CDN How Does it Add Up? Clues Related to Possible Undermethylation + Methylation SNPs = Case for Nutrition Intervention • Woman trying to get pregnant, long-time on oral contraceptives * • Type 2 Diabetic on metformin, vegetarian • Patient with IBS, abdominal bloating, food intolerances/limited diet, elevated histamine • Postmenopausal woman on PPIs, borderline osteopenia *Testing for Methylation SNPs - all young women prior to pregnancy 2016 © Janet Zarowitz, MS, RD, CDN How Does it Add Up? Clues Related to Possible Undermethylation + Methylation SNPs = Case for Nutrition Intervention • Family hx cardiovascular disease, blood clots, elevated homocysteine, low folate • Patient on cholesterol-binding med, brain fog, sleep difficulties, elevated methylmalonic acid • Teenager with anxiety, mood disorder, diet high in processed foods • Premenopausal woman, family hx breast cancer, imbalanced urinary estrogen metabolites (high hydroxyestrones, low methoxyestrones) 2016 © Janet Zarowitz, MS, RD, CDN Nutrition Intervention for MTHFR SNPs Integrating Diet and Supplements 2016 © Janet Zarowitz, MS, RD, CDN Targeted Nutrition Support for MTHFR C677T and A1298C SNPs STRATEGY: BYPASS GENE BY ADDING ACTIVATED NUTRIENTS • Supplement - First support pathways with minerals and B vitamins except folate and B12 • Then, bypass MTHFR gene — greater need for folate, active form • • Diet - More folate-rich foods: liver, spinach, kale, other green leafy vegetables, asparagus, cauliflower, Brussels sprouts, broccoli, beets, lentils, legumes, papaya • Supplement – Transition to supplement with 5-MTHF/Metafolin, active, universally metabolized folate Increase vitamins and cofactors needed by folate • Diet - More foods rich in B12, riboflavin, B6, Mg, Zn, Cysteine • Supplement - Multivitamin containing vitamins and cofactors 2016 © Janet Zarowitz, MS, RD, CDN Targeted Nutrition Support for MTHFR C677T and A1298C SNPs • Limit synthetic folic acid which may compete with active form of folate • Diet - Limit processed foods enriched with folic acid • • • 1998 - folic acid fortification required in grain products - breads, cereals, flours, corn meals, pastas, rice, etc. Supplement - Do not take folic acid supplements or multivitamins with it (most have it) Diet - More foods good methyl donors, e.g. beets, quinoa, lamb 2016 © Janet Zarowitz, MS, RD, CDN Using Supplements Why Diet May Not Be Enough • Inability to convert vitamin form in food to bioactive form body requires; active form of nutrient can bypass affected gene • Assimilation is compromised requiring greater amount of specific nutrients than the “average” person • Nutritional deficiencies of folate, B12 and zinc may alter epigenetic methylation and reduce genomic stability 2016 © Janet Zarowitz, MS, RD, CDN Using Supplements Best Practices Addressing Methylation • Begin with supplement with minerals & B vitamins except B12 & folate • Transition to multivitamin for foundational support of methylation path • With cofactors, vitamins, minerals of methylation cycle, highly bioavailable, active forms e.g., Puregenomics • Start slowly, one new supplement/dose at a time • Check B12 levels before giving folate • Concurrently address other issues - e.g. inflammation, GI problems • Work with the MD regarding certain medications, diagnoses 2016 © Janet Zarowitz, MS, RD, CDN Monitoring Nutrition Support • Follow-up - how pathways are “pushed” or driven; feelings of detoxification • Monitor dietary and lifestyle changes, supplement compliance, symptom changes (digestive, mood, sleep, pain), side effects • 3-6 months revisit physiological biomarkers 2016 © Janet Zarowitz, MS, RD, CDN Assessing Nutrition Intervention for COMT Neurotransmitters 2016 © Janet Zarowitz, MS, RD, CDN COMT Gene Val/Met158 SNP Another SNP with Nutritional Relevance in methylation pathway Catechol-O-methyltransferase Gene function: encodes catechol-O-methyltransferase enzyme Enzyme function: metabolizes and detoxifies dopamine, norepinephrine, epinephrine and estrogens through methylation process 2016 © Janet Zarowitz, MS, RD, CDN COMT Gene Val/Met158 SNP Catechol-O-methyltransferase • Potential impact of reduced enzyme function of this SNP • Patient may feel excessive stimulation - alertness, wakefulness, sleeplessness, restlessness — norepinephrine, epinephrine are stimulants • Dopamine, norepinephrine, epinephrine & estrogens may build up • May have greater impulsivity in behavior choice • Cognitive performance may be affected 2016 © Janet Zarowitz, MS, RD, CDN Targeted Nutrition Support for COMT Val/Met 158 SNP STRATEGY: SUPPORT ALTERNATE METHYLATION PATHWAYS, SUPPORT LIVER, FOSTER RELAXATION & SLEEP • Support alternate pathways that bypass the COMT SNP • Diet – More foods rich in B12 • Supplement - Multivitamin with B vitamins (adenosyl/hydroxycobalamin) • Avoid COMT inhibitors - caffeine, green tea, quercetin • Support Liver (detoxification including estrogen detox) • Diet - More cruciferous vegetables, garlic, onion, fruits, vegetables, nuts, herbs, spices • Diet - Organic foods and animal protein without raised without hormones or antibiotics, as much as possible 2016 © Janet Zarowitz, MS, RD, CDN Targeted Nutrition Support for COMT Val/Met 158 SNP • Support Liver & Detox (con’t) • Supplement - DIM (diindolylmethane) • Lifestyle - Moderate alcohol, no smoking, less toxic household cleaners, beauty and hair products, reduce toxic load • Support Sleep & Relaxation - alternate pathways/bypass COMT SNP • Diet - Foods rich in magnesium • Supplement - Magnesium at bedtime • Lifestyle – Incorporate yoga, meditation, breathing exercises, etc., promote relaxed mood • Lifestyle - Follow sleep hygiene principles, support sleep quality/quantity * Work closely with MD if patient has mood disorder/cognitive diagnosis 2016 © Janet Zarowitz, MS, RD, CDN More Genes with Nutritional Relevance Potential Impact of SNPs • DAO & HNMT - potential for histamine intolerance • HLA-DQ - potential for celiac disease 95% with celiac disease have SNP in HLA-DQ2 gene; most remaining 5% have SNP in HLA-DQ8 gene • CYP1A2 - may be fast or slow metabolizer of caffeine • ACE - may have increased risk high BP when high Na intake 2016 © Janet Zarowitz, MS, RD, CDN More Genes with Nutritional Relevance Potential Impact of SNPs • MTRR - may have slower B12 regeneration • CBS - may have reduction of intermediates required for transsulfuration and detoxification • TCN2 - delivery of B12 to cells may be limited • FUT2 - intestinal microbial diversity and bifidobacteria levels may be low; may also be protective of B12 status 2016 © Janet Zarowitz, MS, RD, CDN More Genes with Nutritional Relevance Potential Impact of SNPs • GC - may have increased risk of suboptimal Vit D status • TCF7L2 - may have increased risk of type 2 diabetes • NOS3 - may have higher circulating levels of triglycerides • BCOM1- may have limited β-carotene to Vitamin A conversion THIS PARTIAL LIST WILL CONTINUE TO GROW! 2016 © Janet Zarowitz, MS, RD, CDN Nutrigenomics Best Practices • Focus on well-researched, evidence-based nutritionally relevant SNPs • SNPs represent potential for suboptimal functioning – their expression not predetermined • A homozygous SNP (+/+) can have more significant health implications compared to milder heterogeneous genotype • Understand the gene’s role, related biochemical pathways 2016 © Janet Zarowitz, MS, RD, CDN Keeping Nutrigenomics 2016 in Perspective Providing Clues and Potential, Not Certainty • Genetic research and relevance of SNPs in its infancy • If multiple SNPs in a particular gene, impact may be more significant • Nutrigenomics is complementary with medical nutrition therapy, integrative nutrition approaches • Look at all the clues … do they validate each other? Treat the patient not the SNP! 2016 © Janet Zarowitz, MS, RD, CDN No SNP is an Island • Genes don't work in isolation — work synergistically • Chronic diseases affected by multiple genes; impact of single SNP, even if relevant, usually small • Body designed with “backup systems” — biochemical pathways overlap • May be compensatory genes in closely related pathways that support the body’s performance • Mix of positive and negative environmental factors that impact genes (and SNPs) and their expression is infinite 2016 © Janet Zarowitz, MS, RD, CDN Plus Gut DNA! • Gut microbiome - second pool of person’s genetic material • 100 trillion bacteria in gut have their own DNA! (10x more than 10 trillion human cells in body) • Foods we eat influence composition of individual’s gut biome • Gut bacteria (under their DNA instructions) respond to food just like human genes; their end products influence epigenetic expression Examples: gut bacteria’s response to dietary fiber and phytochemicals • RDs already address balance of gut ecology with diet, probiotics 2016 © Janet Zarowitz, MS, RD, CDN Nutrigenomics - A New Tool Using Genetic Clues to Personalize Nutrition Counseling Nutrigenomics provides an exciting new tool for Registered Dietitians to personalize nutrition care by matching diet and lifestyle with a client’s genotype and biochemical individuality…to optimize health. 2016 © Janet Zarowitz, MS, RD, CDN Nutrigenomics Part of Functional Medicine Model • Health now recognized as more than absence of disease • Nutritional imbalances characteristic of chronic disease • Concept of multiple diseases existing independently from one another is being replaced by understanding that origins of illness can often be traced to the same physiological disturbances and common underlying pathways - adapted from Jeffrey Bland, PhD 2016 © Janet Zarowitz, MS, RD, CDN Future of Nutrigenomics 2016 © Janet Zarowitz, MS, RD, CDN Present & Future Research More Precise Predictability, Disease Prevention, Early Intervention, Confirmation • More information about gene function, nutritionally relevant SNPs, clinical implications • More research on effects of foods & nutrition supplements on gene expression • More specific biomarkers (various stages of pre, early and full disease onset) that reflect gene expression/genetic differences • Growth of genetic profile databases, related health profiles • Understanding of multiple SNPs in multiple genes that collectively influence likelihood of developing common and complex diseases • Mechanisms of gene expression transfer between generations & health implications • New direct reporting to consumer 2016 © Janet Zarowitz, MS, RD, CDN Future of Nutrigenomics …will evolve from providing clues to underlying root causes to offering better predictive tools …will ready us for the earliest nutrition intervention to treat disease if it occurs, in a precise, targeted way …will evolve as a framework to design and prioritize personalized diet and lifestyle plans for optimal health and preventive strategies before disease presents 2016 © Janet Zarowitz, MS, RD, CDN Resources DIFM - integrativeRD.org • DIFM list serve - Q & A’s with fellow RDs • Links to testing, books and websites • International Society of Nutrigenetics and Nutrigenomics (ISSN) relationship 2016 © Janet Zarowitz, MS, RD, CDN Resources • Dr. Amy Yasko – knowyourgenetics.com neurological/autism • Dr. Ben Lynch: mthfr.net • mthfrsupport.com • Dr. Eric Balcavage – the methylationdoctor.com • SNPedia – snpedia.com 2016 © Janet Zarowitz, MS, RD, CDN Resources • NIH • National Center for Biotechnology Information ncbi.nlm.nih.gov/clinvar/ • National Human Genome Research Institute genome.gov • Genetics Home Reference, US National Library of Medicine ghr.nlm.nih.gov • Genome magazine – genomemag.com 2016 © Janet Zarowitz, MS, RD, CDN Definitions Genome - The sum total of all the genetic information in an organism; its instruction book—the blueprint that directs the development and functioning of human beings and other organisms. Genomics - The study of genes and their function. Nutrigenetics - Focuses on the impact the changes in our genes (also referred to as polymorphisms) have on our potential health path, which is strongly influenced by food, nutrition, stress, and toxins. Nutrigenomics - Concentrates on the impact of diet and lifestyle factors, such as food, nutrition, stress, and toxins on gene expression. Nutritional Epigenomics - Focuses on the changes in gene expression influenced by modifications to DNA and its associated proteins without changing the nucleotide sequence of DNA, where the genetic information is stored. These epigenomics changes affect gene expression and can also be inherited. 2016 © Janet Zarowitz, MS, RD, CDN Contact Me Janet Zarowitz, MS, RD, CDN Integrative and Functional Nutritionist [email protected] www.mysupplementRD.com 914-222-3919 2016 © Janet Zarowitz, MS, RD, CDN