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COVER STORY
NUTRIGENOMICS
DAVID VINTINER
14 OPTIMUM NUTRITION
PROMOTING INTERACTION
Put simply, nutrigenomics (short for
nutritional genomics) is the study of
how food and genes interact with one
another. This interaction is two way.
OPTIMUM NUTRITION 15
COVER STORY
GLOBAL RESEARCH
The completion of the Human Genome
Project in 2000 offered researchers a
global perspective, and new tools with
which to investigate genes and gene
function.13 The Project also led to the
development of spin-off areas, known
collectively as the omics, which extend
our understanding of the biochemistry
and physiology of the cell and the
whole organism (see box on page 19).
Pharmacogenomics, the study of
how individual genotypes respond to
drugs, opens up the possibility of a
more personalised approach to the
prescription of medication. Many fail
to respond to prescribed drugs or are
actually harmed by them, for reasons
to do with their genotype,14 which are
often related to SNPs in the drugmetabolising genes the liver produces.
Gene chips are tiny plastic wafers
with several embedded wells, each of
which contains a separate gene variant
probe (these seek out and chemically
bind to a matching piece of DNA),
which can be used to test a clinical
sample for the presence of a set of
SNPs. Each well is, in effect, a miniature
test site for an SNP and the presence of
many wells on a chip enables carrying
out many SNP tests in parallel.
Such chips have been designed
for pharmacogenomic testing, allowing
SNP screening of patient DNA so
those who metabolise certain drugs
poorly can be rapidly identified.15
Assigning only good responders to
a specific drug is likely to increase
compliance with medication saving
the healthcare system money and
should improve patients health.
Nutrigenomics has much in
common with pharmacogenomics.
16 OPTIMUM NUTRITION
A MATTER OF
OPINION
THE RESEARCHERS VIEW
Dr Jim Kaput, of the University
of California Davis, Center of
Excellence in Nutrigenomics, is
founder and chief scientific officer
of NutraGenomics, a biotechnology
company developing nutritional
solutions for chronic and
stage-of-life diseases.
Nutrigenomics will change how
nutrition professionals provide advice
to their patients and customers, since
the advice will be more personalised
than that we have been able to give in
the past. The data that will be needed
for this personalisation are quantitative
information about lifestyle including
nutrient intakes, genetic analyses, and
measurements of physiology, probably
supplemented by metabolomic or
proteomic analyses.
THE CAMPAIGNERS VIEW
Dr Helen Wallace, deputy director
of GeneWatch UK.
Nutrigenomics is, at best, a
distraction from tackling the social,
economic and commercial factors
underlying the current epidemic of
obesity and diet-related disease.
Personalised nutrition is a marketing
strategy aimed at selling value-added
products to rich consumers. Except
in rare cases, there is no scientific
basis to tailoring diets to an
individuals genes and this approach
is more likely to mislead consumers
than to improve their health.
THE PRACTITIONERS VIEW
Dr Michael Culp, naturopath and
director of Integrative Health
Solutions Ltd.
Nutrigenomics is quite distinct from
genetic medicine. Both are genetic,
but they are as different as counselling
and brain surgery, both of which are to
do with neurology. I am already using
nutrigenomic tests in practice mainly
with patients who have a history of
heart disease, cancer patients, and
those with high cholesterol who are
not responding to treatment. With
cancer patients, I look at gene
variants to see if we can strengthen
detoxification. I see this usage
increasing in the future we will be
able to make the second generation of
these tests more clinically relevant.
AD
COVER STORY
APPLYING PRINCIPLES
Dr Jim Kaput of the University of
California Davis, one of the pioneering
figures in the field, has devised five
principles of nutrigenomics that guide
both laboratory and population-based
research.20 These are: 1) common dietary
chemicals act on the human genome,
either directly or indirectly, to alter gene
expression or structure; 2) under certain
circumstances and in some individuals,
diet can be a serious risk factor for a
number of diseases; 3) some dietregulated genes (and their normal,
common variants) are likely to play a
role in the onset, incidence, progression
and/or severity of chronic diseases;
4) the degree to which diet influences
the balance between healthy and
disease states may depend on an
individuals genetic makeup; 5) dietary
intervention based on knowledge of
nutritional requirement, nutritional
status and genotype (i.e.individualised
nutrition) can be used to prevent,
mitigate, or cure chronic disease.
Bioactive molecules in food can
affect gene expression thereby
modulating biochemical signalling
pathways. To give just two examples
of many, the green tea polyphenol
11-epigallocatechin-3-gallate (EGCG)
reduces signalling in the NF-kappa B
pathway, whose activation has been
associated with aggressive breast
COVER STORY
LOOKING TO
THE FUTURE
Nutrigenomics could lead to many
innovative products and services in
the future, such as
Branded cereals tailored to your
sub-genotype maybe four to six
different varieties containing the
right combination of micronutrients
such as folic acid.
Milk with an age-range label to
match your fat and calcium
requirements full fat for the young
and the elderly, skimmed or semiskimmed for those in between.
Genotyping using fast-turnaround,
disposable gene chips could be
part of your interaction with your
personal trainer or nutritional
therapist, helping them to
prescribe your optimum diet
and exercise programme.36
But do not expect these benefits in
the near future nutrigenomics is
very much an emerging field.
18 OPTIMUM NUTRITION
FACING CHALLENGES
However, nutrigenomics is very much
an emerging discipline and there are
many challenges scientific, legal
and ethical. One important feature
is the multidisciplinary nature of
nutrigenomics, which requires input
from molecular biologists, clinicians,
bioinformatics experts, epidemiologists
and nutritionists. Its progress also
relies on a wide range of different
technologies and tools, some of
which are still in need of validation or
development. It is for this reason that
OMIC RESEARCH
Proteomics is the study of the
complement of proteins in
an organism.
Transcriptomics is the study of
the sub-set of genes transcribed
into protein in a cell.
Metabolomics is the study of
the complement of metabolites
(breakdown products) in a cell.
Epigenomics is the study of DNA
methylation, which can alter the
activity of a gene.
Pharmacogenomics is the study of
the interaction between prescription
drugs and an individual genotype.
Nutrigenomics is the study of the
interaction between food and an
individual genotype.
IN PRACTICE
In one sense, the result of an
SNP screen is just another piece of
biochemical information, like a glucose
tolerance or cholesterol test. However,
there are special ethical considerations
to be applied to any kind of DNA
testing even though the results of
an SNP analysis are not as strongly
predictive as the result of a test for a
single gene disorder.24
The personal nature of genetic
information means that a persons
right to privacy, and autonomy over
it, must be strictly maintained. If they
want to withhold their consent when
it comes to sharing the information
with third parties (donating their
sample to a biobank for large-scale
research, for instance), then that has
to be respected. People further need
to be assured that they will not be
OPTIMUM NUTRITION 19
COVER STORY
TRAINING ISSUES
Initially, nutrigenetic tests and services
were offered direct to the consumer,
usually over the internet, by Sciona
and others. This model offers autonomy
to the consumer who may be well
informed and motivated. Concern arises
over the tied-in selling of nutrigenetic
products, without proven health
benefits or face-to-face advice.25
Today, most companies operate via a
healthcare practitioner who administers
the test and provides counselling and
follow-up. But there is a big issue about
the knowledge and training of these
practitioners. Genetic counsellors
understand the issues of risk and
susceptibility, but are in short supply
and do not have specialised nutrition
knowledge. Conversely, nutritionists are
not usually also qualified in genetics.
A team approach to delivery may be
best, reflecting the multidisciplinary
nature of nutrigenomics.26
At the moment, nutrigenetic
testing is aimed at the proactive, top
end of the market, but these tests
may fall in price and filter down
through the population and become
more accessible,says Dr Astley, who
believes that specialised diet clinics
may start to emerge although
perhaps not within the NHS.
There is a strong feeling that
anything to do with genetics should
only be done through a practitioner,
says Sue McGinty. After the Sciona
affair, she gave evidence for BANT to
the Human Genetics Commission,
which wanted to ensure the effective
oversight of genetic tests supplied to the
public other than through a medical
practitioner. The resulting report Genes
Direct makes the recommendation that
complementary therapists, and others,
would need training and accreditation
in giving genetics advice if they were
to consider including a nutrigenetic
dimension to their practice.27
McGintys report on nutrigenetics
for the Nutritional Therapy Council
Education & Training Committee
proposes a competency framework for
nutritional therapists.28 Implementing
new standards would require that
educational and peer support processes
are developed by those regulating and
representing nutritional therapists, she
says. Members of the public wishing to
benefit from nutrigenetic counselling
will need to be assured of appropriate
standards of quality assurance.If you
20 OPTIMUM NUTRITION
MEDICINAL PURPOSES
As nutrigenomics advances, it is likely
to lead to the development of a range of
new types of foods whether they are
classed as medical foods, nutraceuticals
or functional foods. Dr Tom MacMillan,
executive director of the Food Ethics
Council, has some concerns over what
nutrigenomics appears to be doing
to the priorities of both public and
private sector food research.
The Food Ethics Council is an
independent research and advocacy
group that aims to make the food
system fairer and healthier from farm
to fork. Its attention was caught by a
paper in the British Journal of Nutrition
signed by 87 leading scientists and
calling for an international push to
harness nutrigenomics for public and
personal health.30 Our concern was that
the sector might run away with itself.
They should not promise what they
cannot deliver to get extra resources,
comments Dr MacMillan.
Accordingly, the Food Ethics
Council has laid out its concerns in its
paper Getting Personal.31 For instance,
the science base of nutrigenomics is
not yet well established and there is
a danger that associated new food
products could bear misleading health
claims. Much functional food product
development is underpinned by public
sector research and therefore public
money. Nutrigenetics may mean that
access to healthy food is via premium
price products, which may be out of
reach to those who need them most.
So that does not solve the problem of
the nations health and obesity crisis.
Dr MacMillan would rather see
the food industry focus on product
reformulation containing less fat, salt
and sugar than on functional foods.
In public health terms, this could be
more effective,he says.Trusted brands
have a real opportunity to show you
dont have to pay more for health.
There is also the possibility that
functional foods based on genotype
ON THE MARKET
Genovations is a product of
Genova Diagnostics (formerly
Great Smokies Diagnostic
Laboratories) and is a range
of SNP-based profiles for
heart disease, bone health,
detoxification and the immune
system, www.genovations.com.
GenoSolutions offers a
comprehensive nutrigenetics
profile including bone health,
detoxification, antioxidative
capacity, insulin sensitivity, tissue
repair, www.genosolutions.com.
Sciona the Mycellf test analyses
SNPs from 19 genes involved
in heart health, bone health,
detoxification and antioxidant
capacity, inflammation and insulin
sensitivity, www.sciona.com.
Genelex offers a similar range of
tests to Sciona, analysing SNPs
from 19 genes, covering heart
health, bone health, vitamin B
use, detoxification and antioxidant
capacity, inflammation and insulin
sensitivity, also including an
optional weight loss programme,
www.healthanddna.com.