Download Nutrigenomics in the Patient Care Process: Figuring Out the Puzzle

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