We used to think there was little we could do about the genes we’d been given. They were carved in stone and we were at the mercy of their bidding. It was a fatalistic attitude often used as an excuse to avoid making changes to our lives. What was the point if our genes were immutable?
Well it turns out that we were wrong! Although it is true that we cannot change our genetic code, we can greatly influence the expression of many genes and control the effects they have on our body. By making small changes to our lifestyle, our diet, our supplements, we can not only optimize the genetic blueprint we have been given but we can actually alter the way genes work. We can turn them on or off, up or down to maximize their beneficial side, while minimizing their adverse effects. We can steer them in a specific direction that enhances our health today and we can modify them to prevent problems in the future. Genes, it would appear, are malleable and with the right tools we can shape them to create better health and longevity.
Starting around 2011, I noticed an increasing number of articles referencing individual areas of genetic variation called SNPs, pronounced “snips” and short for Single Nucleotide Polymorphisms. Individual differences in these SNPs are called “alleles” and these alleles provide the basis of your personal genetic coding results from DNA testing. Articles discussed the association of SNP alleles with metabolic function, weight management and the risk of disease, particularly diabetes. So, although SNPs had been recognized for many years as components of our genetic makeup, the emergence of numerous studies examining the correlation of SNP variants with disease risk made them relevant to my practice. The potential to improve diagnostic accuracy, more clearly define risk and hone my therapeutic regimens according to individual genetics was exciting and, in terms of naturopathic medicine, somewhat of a Holy Grail for personalized health.
As increasing numbers of patients both presented with their genetic analysis or elected to complete it having consulted with me, I recognized that this truly was the next exciting frontier of medicine. Patients were unique and did not fit into pre-designed boxes. As I went over their results, explaining why they felt a certain way after different foods, with varying types of exercise and when stressed or losing sleep, their eyes lit up with a recognition that I truly understood them and their individual issues. “Yes, that’s me” would be a common expression at the end of our discussion. I would receive emails a few weeks later from patients seeing improvements in their health, their energy, their sleep and their weight, problems they had struggled with for years without an answer. Patients for whom I had scratched my head trying to figure out why my protocols were not working were suddenly doing amazingly well with simple SNP-based tweaks to their treatment.
I currently use personal genetic testing in my clinical practice to individualize treatment protocols for my patients. The analysis incorporates numerous algorithms through my on-line program GeneRx.ca (see link on the Genetics tab) and looks at genes affecting diet, metabolism, exercise, vitamins/minerals, neurotransmitters, hormones, detoxification, immunity, inflammation, thyroid health and sleep.
Personal Genetic Testing
The number of people ordering commercially available DNA tests is going up exponentially. In 2014 there were approximately 1 million tests ordered worldwide. By 2019 this number was above 25 million and numbers are more than doubling each year. Ancestry and 23andMe comprise over 90% of these tests. Individuals submit a spit sample or cheek swab to the company, which runs the analysis and provides a report of varying content and complexity. Some are more focused on heritage and geographic origin, while others advise on different aspects of health including disease risk, nutrition and exercise. Platforms differ primarily in terms of the genes they test and the advice provided. The question is whether people are using these tests effectively to improve their health. From my experience, patients often present with their genetic data, confused by the report and uncertain how to address many of the health issues they are now aware of.
The five cornerstones of health in my practice are metabolism, diet, stress, inflammation and detoxification. Optimizing these is the foundation of good health and the reduction of disease risk. In this book we will be looking at genes and SNPs that impact your metabolism, diet and stress. These three factors are closely interlinked when it comes to your weight, energy levels and diet. Some of them are associated with the development of diseases such as type 2 diabetes but it is important to bear in mind that such diseases have multiple etiologies and contributing factors. So, while you may have a “risk allele” you may never develop the condition. Personal genetic analysis lets you identify your own personal strengths and weaknesses and allows you to make sensible lifestyle choices to potentially improve your overall health and well-being. It may also help you achieve your ideal weight. If it can help reduce your risk for certain diseases, then that is an added benefit.
Genetic Case Study
Anna is a 36-year-old professional woman who came to see me because of unwanted weight gain despite her strict diet and exercise regimen. Her weight had increased 18 pounds in 8 months. She felt hungry all the time, had low energy and had muscle and joint soreness.
Anna had originally wanted to eat more healthily and planned to lose about 5 pounds. On the recommendation of a friend, she had radically changed her diet from a higher protein, moderate carbohydrate diet with “minimal fats” to more of a “ketogenic” diet incorporating high fat, low to moderate protein, and restricted carbohydrates with fewer vegetables and no fruits, whole grains or starches.
Within a couple of months of starting the diet she began to feel “puffy” and inflamed and then started to put on weight. To counteract this she increased her exercise, running 30 minutes to 1 hour, 4 times a week and became stricter with her diet. Despite this she reported increased feelings of hunger and craving and continued to gain weight. She felt progressively more fatigued, particularly during exercise.
Prior to our initial consultation, Anna had run herself through the 23andMe DNA test. Having signed up though the 23andMe website, Anna received a testing kit within 1 to 2 days, which included a specimen bottle for a saliva sample and instructions on how to fill it. She returned the specimen to 23andMe in a pre-paid envelope along with a signed form. 3 to 4 week later Anna received an email indicating that her genetic data was available. She was then able to log into her account and access both her raw data and a basic report. The raw data is a huge file containing gene and SNP codes for approximately 1500 genes and is not useful in any practical manner. However, I am able to process the file using my GeneRx.ca program to produce a report, which is both informative and practical in terms of providing a diet, lifestyle and supplement protocol. Anna sent me her raw data file and prior to our meeting I ran it through the program. Part of the report based on Anna’s genetic profile (details at the end of this chapter) indicated the following:
• Significantly increased weight-gain and hunger when consuming more than 22 grams of saturated fat per day.
• Moderate increase in desire for energy rich foods and increased weight gain with a low protein, high saturated fats diet.
• Higher risk of progressive weight gain and worse with a high saturated fat diet.
• Overall she handles carbohydrates well.
• Increased inflammation with endurance exercise.
By ignoring her genetics and following the latest “ketogenic” dietary trend, Anna not only failed to lose weight, she actually gained more. In addition, the diet had caused an imbalance in the systems in her body and brain controlling feelings of hunger. The diet had also resulted in higher levels of inflammation resulting in feelings of soreness, “puffiness” and fatigue.
By dropping her carbohydrates and increasing calories from saturated fat Anna’s genetic coding had led to increased fat accumulation, particularly around the abdomen, which posed a significant health risk. It also led to higher levels of her hunger hormone (ghrelin), which resulted in poor satiety and cravings for energy-dense foods. Restricting her carbohydrates was unnecessary as she actually coded well for these and by doing so she limited her energy supply leading to additional fatigue. Increased fatty weight contributed to increased inflammation.
Based on her genetics I recommended the following protocol:
• Reduce her daily lean protein intake calculated according to her body weight.
• Slightly increase whole grains to 2/3 the physical size of her protein portion.
• Vegetables and salads allowed in unlimited quantities.
• Reduce her saturated fat intake to less than 22 grams per day.
• Supplements (see Appendix 2)
o Resveratrol Extra
o Tri-Metabolic Control (TMC)
Anna lost 3 pounds in the first week, and 16 more over the next 8 weeks. The “puffiness” and inflammatory feeling were significantly reduced by day 10 and completely gone by 2 weeks. Energy levels, both day-to-day and with exercise, were back to normal by 4 weeks. At 2-year follow-up Anna continued with a moderate and balanced diet and had maintained a healthy weight.
This is a good example of why there is no one diet that suits everyone. Diet trends come and go and they work for some people but not others. In some cases, like Anna’s, they can be detrimental. Genetics provides insight into your individual metabolism and allows a highly personal, safe and effective program to be designed.
Anna’s Detailed Genetic SNP coding:
• APOA2: CC – significantly increased weight-gain and hunger when consuming more than 22 grams of saturated fat per day.
• FTO: TA – moderate increase in desire for energy rich foods and increased weight gain with a low protein high saturated fat diet.
• PPARG: GG – higher risk of progressive weight gain and worse with a high saturated fat diet.
• TCF7L2: CC – handles carbohydrates well.
• IRS1: TT – handles carbohydrates well.