It's been nearly 20 years since the Human Genome Project produced its first draft sequence. However, we're still waiting for our medical map—a complete picture of every person's genes linked to their genetic code that may determine preventable chronic disease states and health problems.
There aren't even any good maps yet. It turns out that lots of diseases don't fit into simple categories like "heart disease" or "cancer."
We've known about some of these genetic complexities for decades, but only now are researchers beginning to put together comprehensive descriptions of what makes us sick with chronic disease states.
And as they get closer to understanding how genetics affects everything from cancer risk to height to Alzheimer's disease, scientists hope that eventually, doctors will be able to tailor treatments specifically to each person's unique DNA makeup.
But figuring out those details isn't easy.
It takes enormous amounts of research money, sophisticated computing power, and cooperation among academic institutions worldwide.
While the technology exists today to make such genomic studies possible, getting started may require changing thinking about how science gets done.
That means more than just funding new projects.
New models for scientific collaboration must also be developed so that everyone has access to the tools needed to answer questions about human biology.
The Advent of Precision Medicine
In 2001, the first draft sequence of the human genome was published. Technologies and methods were swiftly developed that enabled large-scale analysis of human genetic variation and subsequently variation across other biological strata.
As investigators began using these technologies, a global research consortium discovered novel biomarkers for type 2 diabetes.
Emerging trends in precision medicine, such as the expanding use of big data and ad hoc collaborative networks, and evidence that such initiatives can lead to the development of medical treatments are enabled by the successes of the Human Genome Project.
Several initiatives have built new cohorts from scratch. Most have leveraged existing data and biomaterials already stored in biobanks.
Plans to kick off precision medicine into U.S. medical practice accelerated in 2015, with the NIH kicking off the Precision Medicine Initiative. (PMI), for which $215 million was initially budgeted by the federal government.
In the short term, the PMI is primarily focused on cancer.
In contrast, in the longer term, all health and health care areas will be studied, with specific emphasis placed on discovering predictive biomarkers for type 2 diabetes.
A significant feature of the PMI from the NIH is a cohort of 1 million people coupled with a research program called the All of Us Research Program.
The cohort, supported by a $55 million budget, is built around nationwide recruitment sites under the banner of the PMI Cohort Program.
Managed access for accredited researchers to biobank data and samples is intended to facilitate several significant goals. These range from related to gene-environment interactions, pharmacogenomics, risk stratification, mobile health technologies, health empowerment, and innovative clinical trials ( https://allofus.nih.gov)
The Advent of Precision Nutrition
Using dietary intervention known as precision nutrition (P.N.) may alter the course of chronic disease states.
Precision nutrition is based on individualized meal planning based on your DNA and microbiome. Precision nutrition is the next step in personalized medicine.
Microbes include:
- Programming the immune system.
- Providing nutrients for our cells.
- Preventing colonization by harmful bacteria and viruses.
The microbiome is the microorganisms (bacteria, fungi, viruses, and parasites) in your intestines.
The microbiome in your gut can have a significant impact on your health.
How your body responds to different disease states is guided by more than what food you eat. It includes your level of physical activity, quality of sleep, family medical history, and the gut microbiome.
The ideal of precision nutrition is to manage a chronic illness, e.g., diabetes and heart disease.
Instead of a one-size-fits-all approach to disease state management, it can more specifically tell you how your body will respond to certain foods and how particular food can alter the progression or start of a disease state.
Your phone and an app on it might be your best friend when it comes to dieting because it can reveal your favorite foods that are making you fat.
For instance, it may reveal that you tend to gain weight from consuming saturated (animal) fat. Or It may show that your body is deficient in vitamin B12, and you need to eat a hard-boiled egg every day.
In the future, precision nutrition may help prevent certain diseases or at least delay their onset and slow their progression.
For example, type 2 diabetes runs in your family; you are concerned about developing the disease. At age 25, you visit a Registered Dietitian for instruction in precision nutrition and diet planning.
With precision nutrition and your special diet and health plan, you might be able to stave off diabetes for 15 years, but remember there are no guarantees in life and health. This will take a commitment from you.
Would you follow this diet?
Precision nutrition is an exciting concept, but not without its challenges.
The first and most obvious challenge is the cost. DNA analysis costs $1,000, and insurance does not cover it.
That is only the beginning of the process and does not include the nutrition education costs or the dietician's time.
Another challenge with P.N. is human behavior.
Asa society, we worship food, and it has been instilled in many of us that eating means happiness.
Obesity rates in the U.S. continue to rise with no leveling off insight.
A national paradigm shift is needed to teach that our diets are an avenue to good health and consistent well-being to prevent chronic, preventable disease states.
Precision nutrition is still in its infancy, and more studies are needed to determine if it has applications across all populations and age groups.
Dr. Frank Hu, Professor and Chair of the Department of Nutrition at Harvard, recently stated: "To address major public health problems like diabetes, we need to combine public health strategies with precision nutrition technologies."
Treatment of Diabetes Now and In the Future
Several major U.S. initiatives predate the PMI and have diabetes and its risk factors at their core research initiatives.
One of these initiatives, the Diabetes Prevention Program, has been replicated in several other countries, focusing on populations at high risk for developing diabetes.
Others include the Million Veteran Program (MVP) and the Accelerating Medicines Partnership in Type 2 Diabetes (AMP T2D).
The MVP uses genomics and other health data obtained through electronic medical / health records and follow-up surveys in about 600,000 military veterans aged 50–69 years old.
The AMP T2D seeks to gather genomic and metagenomic data and create an analytical engine that can mine the genetic basis of diabetes and related traits while safeguarding the confidentiality of the results.
Access to data is a central pillar of AMP T2D.
Through the T2D Knowledge Portal (www.type2diabetesgenetics.org ), the consortium has assembled multiple populations' genetic and phenotypic data from participants with and without type 2 diabetes, creating a central repository for such data ( www.type2diabetesgenetics.org/informational/about ).
The partnerships that these initiatives have with diabetes drug companies will help them contribute to precision diabetes medicine. Along with health tech companies for apps, and potentially medical device industries, which are required to translate research into therapeutics approved by the U.S. Food and Drug Administration (FDA).
The treatment of Type 2 diabetes is an outstanding choice for precision medicine for the following reasons.
1) There are numerous different drug classes available to lower blood glucose after metformin with varying mechanisms of action but the same principal aim.
2) At the individual level, the glucose-lowering response to each drug appears to vary significantly.
3) There is no straightforward "best" overall treatment outside a small subset of people who have specific complications in common.
For the balance, current treatment guidelines do not provide information on which drug class is best for lowering blood glucose for which people.
4) There is significant heterogeneity in the clinical phenotype of type 2 diabetes, making it plausible based on the drug mechanism of action that people with different underlying physiological processes will have varying responses to the different drug classes.
What Are Some Benefits Of Precision Nutrition?
There are many potential advantages to precision nutrition:
1. Personalized nutrition allows patients to receive tailored advice about their unique nutritional needs based on genetics, metabolism, lifestyle, and other relevant variables.
This allows them to make changes throughout life without feeling overwhelmed by conflicting information from public sources.
2. With precise data about your personal biology, you will be able to understand how certain foods affect you.
You can then use this knowledge to better target your own treatment options.
This approach helps avoid taking medications that don't work well for you, potentially saving money on costly side effects. Additionally, this method avoids unnecessary testing, procedures, hospitalizations, and surgeries.
3. By understanding where you stand relative to others in terms of your biochemistry, you can get insight into what treatments might benefit you best.
Based on these insights, you will likely find yourself at a lower risk of developing complications from diabetes, heart disease, stroke, cancer, Alzheimer's, dementia, arthritis, and osteoporosis.
In addition to preventing these conditions, you could improve your quality of life by losing weight safely without depriving yourself of nutrients.
Reducing your risk of metabolic syndrome, disease progression, and glycemic responses from foods while improving glycemic control. Therefore reducing your risk of developing Type 2 diabetes.
4. If you are overweight, precision nutrition can assist you in reaching a healthy body weight through an individually customized program focused on achieving desired caloric balance.
People who follow a low carb/high-fat diet often experience improvements in insulin sensitivity, lipid profiles, inflammation markers, and cardiovascular function.
5. The ability to accurately measure blood sugar levels has allowed researchers to test different dietary interventions and see which ones produce more significant health benefits or fewer adverse events than the current standard care.
6. Several clinical trials have demonstrated that consuming specific macronutrients—protein, carbohydrates, fat, and fiber—in moderation is associated with reduced risks of chronic illnesses like type 2 diabetes, obesity, hypertension, and coronary artery disease.
These findings should give doctors confidence that adding or removing particular nutrients does not compromise overall patient wellness.
7. It makes sense to eat foods that contain antioxidants because we know those substances may protect against oxidative stress damage caused by free radicals. However, it's important to note that some antioxidant supplements do not offer any significant protection beyond that provided by fruits and veggies. So if you want to optimize your intake of powerful antioxidants, stick with real foods.
8. Evidence shows that omega-three fatty acids may play a role in reducing symptoms of depression and anxiety, improving sleep patterns and cognitive functioning, and aiding recovery after surgery.
Omega 6 fats may promote mental illness; however, there isn't enough scientific evidence to support this claim.
Both omega three and omega six fats appear to prevent the development of asthma, allergies, eczema, celiac disease, inflammatory bowel disease, Crohn's Disease, multiple sclerosis, rheumatoid arthritis, psoriasis, ulcerative colitis, and possibly even breast cancer.
9. While many studies show that people tend to eat more when they feel stressed out than when feeling relaxed, another recent research review found no conclusive link between psychological distress and unhealthy eating habits.
Current evidence indicates that high-stress situations increase appetite and energy consumption. Studies suggest that such increases are due to increased activity within central pathways involved in regulating hunger rather than alterations in emotional states per se.
10. When looking for new ways to manage their diabetes, people often turn to complementary therapies, including acupuncture, yoga, meditation, hypnosis, biofeedback, nutritional counseling, herbal remedies, homeopathy, chiropractic medicine, and various forms of alternative medicine.
Studies have shown that most of these approaches can help reduce physical and emotional pain and stabilize mood swings.
They also seem to trigger less fatigue, nausea, vomiting, headaches, dizziness, muscle aches, weakness, joint soreness, and diarrhea.
Some people say that using them alongside conventional medical therapy provides additional relief. But since science hasn't studied whether any of these methods work, it's impossible to tell if they make a difference.
11. There's growing interest among consumers to try fasting diets—and plenty of companies offering programs promising fast weight loss.
Unfortunately, there's little solid evidence that intermittent calorie restriction leads to long-term weight management success.
Precision Nutrition in the Treatment and Management of Type 2 Diabetes and Diabetes Care
Let's take a look at the results of the Twin Precision Nutrition (TPN) study.
The study's objective was to research changes in hemoglobin A1c (HbA1c), oral diabetic agents, insulin resistance, other ambulatory glucose profile metrics between baseline and post 90 days of participation in the study using Digital Twin Technology in the Twin Precision Nutrition (TPN) Program.
TPN was a retrospective study of patients with type 2 diabetes who participated in the program and had at minimum 90 days of follow-up.
The TPN machine learning algorithm (A.I.) app (https://apps.apple.com/in/app/twin-health/id1456423142) used daily a continuous glucose monitor (CGM) and food intake data logs to develop food guidelines that would enable individual patients to abstain from foods that caused blood glucose spikes and replace them with foods that do not produce glucose spikes.
The app creates a personalized precision nutrition plan designed to improve your metabolism and adapt to your body's nutritional needs as it heals.
Physicians had electronic access to daily CGM data, titrated medications, monitored patient conditions, and adjusted meds as needed.
Results demonstrated that of the 89 patients who initially enrolled in the TPN Program, 71.9% or 64 patients continued in the study and complied with it for at least 90 days. The study analyses were performed on these 64 patients.
At the 90-day follow-up assessment:
- mean (± standard deviation) HbA1c decreased from 8.8 ± 2.2% at baseline by 1.9 to 6.9 ± 1.1%,
- mean weight had been reduced from 79.0 kg (179 lbs) ± 16.2 kg at baseline to 74.2 (163.5) ± 14.7 kg,
- mean fasting blood glucose had fallen from 151.2 ± 45.0 mg/dl at baseline to 129.1 ± 36.7 mg/dl.
- Homeostatic model assessment of insulin resistance (HOMA-IR) had decreased by 56.9% from 7.4 ± 3.5 to 3.2 ± 2.8.
At the 90-day follow-up assessment:
- all 12 patients who were on insulin had stopped taking this medication;
- 38 of the 56 patients taking metformin had stopped metformin;
- 26 of the 28 patients on dipeptidyl peptidase-4 (DPP-4) inhibitors discontinued DPP-4 inhibitors;
- all 13 patients on alpha-glucosidase inhibitors discontinued these inhibitors;
- all 34 patients on sulfonylureas were able to stop taking these medications; two patients stopped taking pioglitazone;
- all ten patients on sodium-glucose cotransporter-2 (SGLT2) inhibitors stopped taking SGLT2 inhibitors,
- one patient stopped taking glucagon-like peptide-1 analogs.
The results prove daily precision nutrition guidance based on CGM, food intake data, and machine learning algorithms can benefit patients with type 2 diabetes, reduce body weight, and require fewer medications for blood sugar control.
Adherence for three months to the TPN Program, using the app resulted in patients achieving:
- a 1.9 percentage point decrease in HbA1c,
- a 6.1% drop in weight,
- a 56.9% reduction in HOMA-IR, a significant decline in glucose time below range,
- and, in most patients, the elimination of diabetes medication use.
Precision nutrition is in its infancy. As more studies are completed and more disease states tested, the advent of personalized medicine using holistic approaches offers a new way of practicing preventive medicine.
It is exciting to watch this develop and improve disease state outcomes.