Pendulum swings are nothing new in the realm of medical opinion. Whether they’re focused on the best treatments for pain, dementia, cancer or heart disease, new “definitive” guidelines often contradict previous ones, and old clinical debates seem to go on forever.
What is no longer in dispute is that nutrition is a central pillar of health, and that diet can be helpful in all these arenas. Just take heart disease as an example. It has become clear that incorporation of the Mediterranean diet could reduce cardiovascular events including heart attack, stroke and death by one-third.
If widely implemented, the Mediterranean diet could save up to $30 billion per year in healthcare costs.
Unfortunately, even though poor diet is the leading cause of death in the US and kills more people than smoking, there are significant disparities in the level of nutrition counselling offered during medical visits. This is a missed opportunity to fulfill the promise of nutrition.
The challenge for us as physicians, is how best to connect available evidence to the individual needs of each patient.
Enter personalized nutrition…
Although there are several definitions for personalized nutrition as reviewed in a recent BMJ article, it is currently viewed as “an approach that uses information on individual characteristics to develop targeted nutritional advice, products, or services…[that] assists individuals in achieving a lasting dietary behaviour change that is beneficial for health.”
DayTwo: Game-Changer for Diabetes
Personalized nutritional guidelines can be a game changer for a host of chronic medical conditions that may not shift with a one-size-fits-all approach. There is probably no better example of this than the work of Prof. Eran Segal of the Computer Science and Applied Mathematics Department and Dr. Eran Elinav of the Immunology Department of Weizmann Institute of Science.
Their study, Personalized Nutrition by Prediction of Glycemic Response, as published in Cell (Nov.19,2015), tested the glucose response of 800 subjects over 40,000 meals and found that subjects consuming identical diets had large variability in glucose elevation over time - sometimes to foods that were supposed to be “low-glycemic.”
They then created an algorithm that integrated individual factors such as physical activity and microbiome differences that could accurately predict these glucose fluctuations in response to specific foods.
Today, the work Segal and Elinav has been translated into a practical algorithm called the DayTwo Platform, which enables patients to improve their foods choices--and their glycemic control—in a tailored, individualized way.
Earlier this year, researchers at the Mayo Clinic corroborated Segal and Elinav’s original findings in a cohort of 327 non-diabetic individuals. The participants’ measured glycemic responses to a wide range of foods correlated strongly with the responses predicted by the Day Two algorithm (Mendes-Soares H, et al. JAMA Network Open. 2019; 2 (2)).
The Mayo authors write that, “A model predicting each individual’s responses to foods that considers several individual factors in addition to food features had better overall performance than current standard-of-care approaches using nutritional content alone, to control postprandial glycemic levels.”
Two additional clinical trials looking at the DayTwo system are currently underway—one at the Joslin Diabetes Center, Boston, and the other at the Diabetes Medical Center at Wolfson Medical Center in Holon, Israel.
Simply put, DayTwo provides patients with personalized guidance about which foods to avoid and which to eat more of, based on their microbiome profiles and a host of individual biometrics. The system is smartphone based, user-friendly and easy to implement.
Taming Post-Prandial Spikes
It enables patients to avoid the specific foods most likely to cause glucose spikes, while allowing them to continue enjoying foods that—for them—are not problematic. This is a great improvement over drastic, broad-stroke dietary changes that often feel to patients like deprivation, and cause them to get overly fixated on calorie counts.
The clinical studies so far indicate that when patients adhere to their individualized “algo” (algorithm) diets as guided by DayTwo, they can markedly reduce both the size and the frequency of post-prandial glucose spikes—and quickly. Along with that comes reduced hemoglobin A1C levels, greater amounts of time in healthy blood glucose ranges, and in many cases substantial weight loss.
Obviously, this has profound implications for patients with diabetes, pre-diabetes, and metabolic syndrome.
Personalized medicine will be the core theme of the 17th Scripps Natural Supplements Conference, coming up on Jan 23-26, 2020, at the Hyatt Regency La Jolla, in San Diego.
Scripps Conference Preview
Among the featured speakers is Dr. Darius Mozaffarian, Dean of the Tufts Friedman School of Nutrition Science and Policy, and co-author of the recent New York Times op-ed piece, Our Food Is Killing Too Many of Us. Dr. Mozaffarian will review the mountain of evidence showing that poor diet is the leading cause of mortality in the US. It is the main driver of the top most deadly diseases, and it carries a staggering cost burden. Mozaffarian estimates that obesity alone costs the nation $1.72 trillion per year. That’s 9.3% of our GDP.
He will also spotlight the research on how to personalize nutrition in the setting of diabetes and pre-diabetes. Dr. Mozaffarian will be joined by a panel of experts on personalized nutrition including.
- Dawn Lemanne, MD, MPH Co-Author of the book N of 1, speaking on the topic of Personalized Nutrition for Cancer Care
- Dale Bredesen, MD author of The End of Alzheimer's who will discuss Personalized Nutrition for Cognitive Decline.
- Jeff Bland, PhD, founder of the Personalized Lifestyle Medicine Institute, who has been at the forefront of the functional medicine and personalized healthcare waves for decades.
In addition to the focus on personalized nutrition, the conference will feature other topics highlighting nutrition and innovation in clinical care, beginning with pre-conference seminars on:
- The Clinical Application of Herbal & Botanical Medicine Herbal medicine
- Advanced Functional Approaches in Cardiology
- Bringing Integrative Medicine to Your Practice & Health Care System
- Integrating Genomics into your Clinical Practice
The main conference program includes presentations on important topics including:
- Integrative Cancer Survivorship by David Leopold, MD
- Nutrition for Fall & Sacropenia Prevention by Roger Mignosa, DO
- Keto, Paleo & Intermittent Fasting: A Taste of The Evidence for Emerging Dietary Trends by Chris D’Adamo, PhD
- Teaching Kitchens: A Patient-Centered Approach to Improving Nutrition
- Cardiovascular Health by Mimi Guarneri, MD, FACC, ABIHM and
- Why Psychedelics Will Transform Mental Health Care by Scott Shannon, MD, ABIHM
The conference has been approved for prescribed credit by the AAFP and AOA and will also feature a poster research competition with additional information at: www.Scripps.org/NaturalSupplements
Robert Bonakdar MD FAAFP FACN is director of pain management at the Scripps Center for Integrative Medicine and co-director of the 17th annual Scripps Natural Supplements Conference where he will be speaking on Personalized Nutrition Approaches for Pain and Headache. He can be found on twitter @DrB_Well