“Nutrigenomics is surely part of the future for pro-active, personalised, predictive and preventative healthcare”, a snippet taken from a blog that we wrote back in April 2014 and now, two years on, the use of nutrigenomics as a tool in the health practice has only grown in stature.
Indeed, nutrigenomics – the study of the interaction between genetics and diet – is now gathering a large body of research and knowledge that has the potential to change the way we approach nutrition and medicine; moving away from ‘one size fits all’ to a more personalised approach.
In this week’s article we interview Anne Pemberton, a nutrigenomics expert who will be speaking at our Cytoplan Education Event ‘Implementing Nutrigenomics in your Health Practice’ in July.
Anne tells us about how she started using nutrigenomics in her practice, the benefits to her clients, the types of clients she uses nutrigenomics testing with, and the ethical considerations.
Anne, the term ‘nutrigenomics’ has been around for many years, but how and when did you first become aware of the potential for using nutrigenomics in your practice?
I worked with Dr Damien Downing as his head Nurse and Nutritionist in York for a few years. Dr Downing used nutrigenomics testing on our patients with cancer diagnoses. It was mainly to look at methylation defects but more importantly with a specialist laboratory that could tell us which chemotherapy would be the best for our patients.
At one point Dr Patricia Kane was quite excited about ’23andMe’ [please follow the link to find out more about ’23andMe’] and she said I should get my family to try it. At that time my mother had just passed away with lung cancer and my father had early dementia. I needed to know my risk factors so I could work on reducing them.
I know now that ’23andMe’ cannot possibly predict risk factors but back then any information was gratefully received. At the time I used ’23andMe’ they were allowed to give health advice so I got everything, which was great. Once I fixed my own genomics and felt the incredible difference I wanted to fix the world.
With ’23andMe’ testing now available in the UK have you had people come to you that have had the tests done themselves? What sort of help do they want with the test results?
I consult with 5-10 clients weekly who want help with their nutrigenomics data. They are mostly people who have tried to fix themselves but get into a muddle because they are listening to others on forums or trying to understand the biochemistry from poor or confusing sources.
They generally want help to understand as much as they can and receive guidance to put a specific individual protocol together. I see people with a myriad of conditions such as autism spectrum disorders, mental health conditions generally and chronic fatigue/myalgic encephalitis.
Can you tell us a bit about your own journey in implementing nutrigenomics in your practice?
My own journey commenced with fixing my son and myself. We both had methylation, trans-sulfuration, neurotransmitter and folate polymorphisms, so it all looked pretty bleak plus we each had spent a lifetime being vertically challenged.
We both have an amazing work ethic so we don’t have the time or the patience to be ill. As typical Type A’s we crashed and burned readily. I’m a ‘never give up’ and ‘always ask why’ person. It has never been enough for me to accept what is and so I set off with a group of tutor study buddies researching all the available training we could find.
I have undertaken several nutrigenomics courses and I follow some of the greatest teachers of our time. I have seen hundreds of nutrigenomics clients over the last 3 years with conditions I have already discussed. I have also been able to identify conditions that were a previous mystery. This work for me is the ultimate in detective work. I love the rewards of the emails when my clients make progress after years of trying.
What benefits have you seen for your clients? Can you give us an example of how nutrigenomics has provided you with a key piece in the puzzle of understanding what might be contributing to a client’s symptoms or health conditions?
I have seen more than 50 clients who have subsequently been identified as having pyroluria or elevated krypto-pyrroles and this can be life changing for those clients. They have spent their lives in a highly anxious state and now we can identify them and help them to become whole again. Pyrrole disorder isn’t the easiest condition to test for because pyrroles degrade under light and collection, testing and interpretation and reporting are inconsistent. I use pyrrole testing alongside ’23andMe’ and a thorough history.
The best single outcome was a young man studying at University with high functioning autism and epilepsy. He tried various anticonvulsants, but the side effects always outweighed the benefits. Epilim took him from an A* student to a D in one semester, Keppra made him violent to the point that when his mum asked for help she was told to sign the forms and have him sectioned.
We ran his ’23andMe’ alongside a ‘Genova NutrEval’ so that we could see the expression of his polymorphisms and more specifically how he was breaking down the drugs. His seizures were too frequent to allow him to be drug free and he wasn’t keen to follow neurolipid-keto diet, which would have been my choice.
I therefore plotted his polymorphisms onto a biochemical pathway and presented this with scientific papers on the specific metabolism of the drugs. We then found an alternative drug and approached the Neurologist with our findings. Call that a lucky break but the Neurologist was impressed and agreed to a trial of the new drug. It worked without side effects and the young man is now seizure free and leading a normal life. We are supporting methylation, biopterin and trans-sulfuration cycles to ensure he can metabolise the drug and lead as normal life as possible.
One of the concerns about nutrigenomics testing is the time it takes to analyse a client’s testing results. Is looking up the clinical significance of SNPs very time consuming? How can this be made more efficient?
I would say that it’s a matter of practice. Everything is time consuming when you first start out because you have to learn new skills and new information. It is also about being realistic. You get used to looking at patterns rather than individual SNP’s and that’s the best approach. No SNP is a single entity. Knowing the case inside out and back to front helps you to know what to look for.
What ethical considerations are important when considering testing?
Lots – the most important is how to deal with a client who attains a new diagnosis from either a subsequent functional test or referral. For my clients who have subsequently been found to have pyroluria there can often be a grieving process so understanding the grieving process and being able to refer for appropriate support is a must.
I guess I’m lucky because my psychology and nursing background helped me enormously but as a Nutritional Therapist you really do need to be part of a multidisciplinary team. If you look at the highly successful people in the industry they never work alone.
I have a team of people I trust and admire for their approaches and I’m not precious with my clients. If someone I trust can serve them better I refer them on. [See our previous blog for an explanation of pyroluria – Nutrigenomics and Autism].
I think also you have to be trained appropriately to work with nutrigenomics. There are too many areas where you can fall down and increase the negative symptoms in your patients. The biochemical cycles we are working with need to be addressed in a specific order and that can depend on biochemical individuality.
I am aware we have all tried approaches that have done this and we are all aware of Herxeimer reactions. I feel that now we know the person’s individual potential towards these reactions we should take more care and use the tools we have at our disposal. The Hippocratic oath says “First Do No Harm”. This is my first rule.
Are there any drawbacks / risks to testing?
In addition to the ethical considerations I also feel that it is necessary to have appropriate training in the application of nutritional support once you have the results. There is a specific method of addressing SNPs and if they are addressed in the wrong sequence the effects can sometimes be disastrous. This is why Angela Bailey and I set out to provide training in the UK.
Also there are many apps that interpret ’23andMe’ data which encourage ‘SNP treating’. This should not be done under any circumstance. Appropriate functional testing should always be undertaken and this is specific to the case but I often run the ONE test first. There are no specific risks to the patient when testing as this is a straight forward urine test.
What sort of clients benefit from testing?
Anyone who is motivated to run the test. It can work as a health protection plan or to help someone who is not managing to get well despite all endeavours. I believe we can really help those with complex enduring conditions and those we term “pathological detoxifiers”.
What proportion of your clients do you use testing with?
I use Nutrigenomics with about 60% of my clients but I very rarely ask them to test. Most clients come to me having already run a ’23andMe’ so the need is there to provide the service.
I am inundated with ’23andMe’ requests but I want to refer them to people who I have trained because the practitioner will then be supported until they become proficient and confident.
What would you say to practitioners that do not want to consider implementing nutrigenomics testing in their practice?
I think practitioners have to make their own minds up but this can be a fabulous tool to enhance clinical practice. It is not for the faint-hearted or those who feel it will make them a fast buck. It is however, for those who really want to help their clients and cannot accept that there is no answer.
What do you see as the future for Nutrigenomics testing in practice?
The NHS are busy training their doctors, nurses and dieticians in nutrigenomics (ie to undertake what we are best at). I think it is beginning to really personalise nutrition and medicine.
For chronically sick people nutrigenomics and epigenetics have to be considered. We have guessed this aspect of care since the days of Patrick Holford. Now we have tools to really do better for our clients.
Anne has a background of 26 years of intensive care cardiothoracic nursing and psychology, and is a recognised expert in the field of nutrigenomics. She trained at ION between 2003 and 2006 and later completed her MSc in Nutrition at NCA where she currently works part-time as Course Director for the MSc in Nutrition Science and practice.
Anne’s fascination with the area of nutrigenomics has led her to co-develop the first post graduate nutrigenomics CPD course. The course is delivered twice yearly in London and York.
A Cytoplan Education Event – Saturday 2nd July, 10.00am – 5.00pm.
Cavendish Conference Centre, 22 Duchess Mews, London, W1G 9DT
Anne will be speaking at our Cytoplan Seminar in July on how to implement nutrigenomics into your health practice. To find out more about this event, and to book your place, please follow this link.
With many thanks to Anne for this Q & A session, if you have any questions regarding the health topics that have been raised please don’t hesitate to get in touch with me via phone (01684 310099) or e-mail ([email protected]).
Amanda Williams and the Cytoplan Editorial Team: Clare Daley, Joseph Forsyth and Simon Holdcroft