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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS • Nutritional Genomics concerns the effect that changes in our genes have on our risk of disease and dysfunction that can be mitigated by nutritional intervention as well as the impact our food, nutrition, stress, and toxins have on the expression of our genes. It is the umbrella term that includes nutrigenetics, nutrigenomics, and nutritional epigenomics. However, the term is broadening to mean nutritional systems biology which includes all of the ‚omics‛ technologies; proteomics, transcriptomics, metabolomics, etc. • Nutrigenetics is focused on the impact that changes in our genes (also referred to as polymorphisms) have on our potential health trajectory, which is strongly influenced by food, nutrition, stress, and toxins. • Nutrigenomics is focused on the impact of diet and lifestyle factors, such as food, nutrition, stress, and toxins, on gene expression and the resulting effects on the human system that can be measured scientifically. • Nutritional Epigenomics concerns 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. • Allele – An alternate form of a gene. • Phenotype – The physical, biochemical, and physiological characteristics determined by genotype and environment. • Single Nucleotide Polymorphism (SNP) - The occurrence together in a population of two or more genetically determined alternative phenotypes, each with appreciable frequency (each occurs in >1% of the population). 24 • Homozygous – Two copies of the same nucleotide; CLOCK 3111 TT. • Heterozygous – One copy of each nucleotide; CLOCK 3111 CT. • Plasticity - The adaptability of an organism to changes in its environment or differences between its various habitats. 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS 3 Functional Diagnostics: Redefining Disease Mark Hyman, MD ‚Functional medicine is a disruptive technology that will overthrow the tyranny of the diagnosis.‛ Jeffrey Bland The history of medical diagnosis has a storied and embarrassing past. The taxonomy of disease morphed as we moved from symptoms, to anatomy, to molecular biology, to genomics and metabolomics. A penchant for naming is intrinsic to the human mind. Linnaeus, the 18 th century Swedish scientist known for the naming and classification of plant species, developed 11 categories of disease – painful disease, motor disease, blemishes and so on. Hippocrates categorized disease into the four humors: black bile, yellow bile, phlegm and blood. Tibetans distinguish 404 diseases divided into four causes: karmic disease originating in past lifetimes, disease resulting from influences in early life, disorders involving spirits, and superficial disorders resulting from diet and behavior. In late 19 th and early 20 th centuries, doctors and scientists shifted from a symptom based diagnostic model to an anatomical view of disease, which lead to the first international classification of disease in the 1850’s and segregated disease into 140 categories including ‚visitation from God‛. The 10 th edition of the ICD (International 25 Classification of Diseases) published by the World Health Organization in 1993 contains 12,000 categories of disease. With the advent of the genomic revolution and personalized medicine, the next edition, due in 2015, may need a radically new system of classification. Our current categorization of diseases has little to do with the meaning, myths and metaphors we associate with them. Before Robert Koch discovered the tubercle bacillus, medical textbooks unequivocally defined the cause of tuberculosis: hereditary disposition, unfavorable climate, sedentary indoor life, defective ventilation, deficiency of light and depressing emotions. The microscope changed all that. Disease is primarily defined in phenomenological, not etiological, terms. We describe what we see – histology under the microscope; or through more refined and sophisticated ways of seeing static pathology - the x-ray, ultrasound, CT scan, MRI; or other advanced imaging tools; or gross aberrations in physiology, such as elevated glucose or renal or liver function tests. We struggle to accommodate new scientific understanding by creating new categories of ‚predisease‛ – pre-diabetes, i pre-hypertension, ii predementia (MCI), iii pre-autoimmune disease. iv But 2012
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