Recently, a friend asked me if I practice “personalized medicine.” I knew what he was referring to. Precision medicine, or personalized medicine, is a new and exciting field that assesses the genetic biomarkers, microbiome composition and pharmacogenomics (the study of genetic predispositions for drug effectiveness, reactivity and/or absorption rates) to create individualized treatment plans for patients rather than defaulting to a general one-size-fits-all treatment plan for everyone with a particular diagnosis.
In the world of cancer in particular, it has been groundbreaking. Doctors can now create treatment strategies for cancer based specifically on tumor markers and an individual’s metabolism and drug tolerance. It has increased rates of cure, and minimalized side effects of potential toxic drugs. It has changed everything.
Precision medicine has also been useful in my field, cardiology. Although it has not yet been used to the extent as in cancer treatment, it has nevertheless become extremely helpful. We have used pharmacogenomics to assess how patients will react to medications for risk factors like high cholesterol and high blood pressure, and to help us to better-tailor our prescriptions to each patient’s metabolism and genetic tendencies. This is critically important, especially for those on multiple medications. It helps with efficacy, decreases side effects, and keeps patients safer from many potential undesirable health risks.
But what about prevention? Does precision medicine improve our approach to preventing heart disease?
The truth is, prevention comes down to the basics of diet, exercise and other lifestyle choices. All the information in the world about drug sensitivity or predispositions to certain diseases won’t help patients who refuse to exercise and follow a heart-healthy diet. We have always thought that getting the basics down is essential for success: A diet of natural foods focusing on vegetables, fruit, whole grains, and lean protein…and an exercise plan that includes about 150 minutes of cardiovascular exercise per week, along with some strength training and stress reduction. This is Heart Disease Prevention 101.
Although those recommendations work for most, some don’t have the success we would hope for. This is where there is a place for personalized medicine. I first began thinking about this as many patients were coming to me talking about their great success on various “fad” diets. While I have always worried about the way fad diets pop up and seduce my patients into obsessive dietary regimens, I also noticed that for some people, some so-called fads actually seem to work better than the old-school recommendations.
Fad diets become fads because for some people (not all people), they work when “no other diet they were ever on before helped.” As much as I tend to be skeptical about fad diets, I have to admit that some of my patients really are helped by them. It makes sense, upon closer examination. Patients tend not to stick to diets that don’t yield results, but success breeds success. If a diet works, the person on the diet is more likely to keep going.
But what makes a fad diet work for one person and not another? This is where I believe we can use the principles of precision medicine to create a personalized plan for heart disease prevention. It’s likely that success on a particular diet has at least something to do with genomic predisposition of metabolism as well as individual microbiome configuration. These elements—unique to each person—could make one diet style more effective for some people than another style. Actually, we already know this is true.
There are many tests out there right now. (Some are probably more informative and reliable than others.) You can test your DNA, you can test your microbiome, and you can run all those results through various programs to get recommendations. I would recommend waiting on getting this done as this is still in its infancy—and it is expensive and may not be covered by insurance, and is sometimes filled with data that’s hard to translate into everyday life.
However, we already know some interesting things about how different people react to different diets. These are some tried-and-true ways to use personalized medicine to help you prevent heart disease:
- Carbs: Some people find it challenging to metabolize carbohydrates. They are more likely to become insulin resistant and, eventually, diabetic. If you already have blood sugar issues, the solution is simple: Cut out simple carbohydrates, starch and sugar. These are not for you. You can probably tolerate nutrient-dense whole grains like oatmeal, but let the rest go. Your metabolism is not suited to a carb-centric diet. Instead, focus on lean proteins and lots of vegetables, and you will be much more likely to experience weight loss and improved blood sugar balance.
- Fats: For those who have a strong family history of heart disease, fat is more likely the problem. When these people try a fad like the ketogenic diet and get most of their calories from animal fat, they may find that “out of nowhere,” their cholesterol is in the 400’s, their doctors are threatening them with prescriptions for statin drugs, their inflammation is through the roof, and they have no idea how this happened. That’s because these people are likely to be genetically less able to metabolize fats. These are the people who are at risk for heart disease, stroke and Alzheimer’s disease. Which fats they eat really matter. This group should be on a mostly vegetarian diet, with very lean protein (fish!) sparingly, plenty of fiber, and only natural fats from plant foods.
- Gluten: Then there are the gluten-intolerant. If these people did not legitimately exist, the gluten-free food industry would not be booming the way it is. Some of these people have celiac disease, a serious condition that requires eliminating gluten entirely from their diets for life. There are also those who might not have celiac disease, but feel worse when they eat gluten. There are tests for celiac disease and non-celiac gluten sensitivity. For those who test positive to either, a diet free from gluten and full of nutrient-dense foods is essential for health, lowering inflammation and restoring likely nutrient deficiencies. Going gluten-free is certainly not necessary for everyone, but if you give up gluten and you definitely feel better, then it may be for you and it could even be life changing.
The bottom line is that public health recommendations are good for most everyone, if practiced in moderation, but they certainly are not right for everyone, and there may be more we can do to tailor dietary recommendations to individuals for better prevention.
Before you start beating yourself up for just not doing well on your diet or not being able to stick to your resolve, first make sure that you are telling yourself the truth: Are you being disciplined in your pursuit? If you are doing your best, then perhaps your genes are resisting an eating style that isn’t right for you. You can get a blood test to help guide you, or maybe look at your family tree. Do your relatives tend to be overweight and diabetic? Prone to heart disease or Alzheimer’s? Do you have a family history of GI problems and gluten intolerance? These answers can help you answer the question of whether carbs or fats is the way to go for you.
Precision and personalized medicine is here. Let’s use it to our advantage, even without expensive tests.
Click here to buy Dr. Suzanne Steinbaum’s book, Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life