Genes and Nutrition

Dr. Elina Chernyak | Vail Colorado

We now know that our genes are not our destiny. Rather, our health depends more on what we do to our genes. Since the early 1980s, much has changed in our understanding of the role of the human genome in determining our health as we grow older. Human genomic diversity plays a far greater role than we formerly believed. We are far more different from one another than we appear from our observable phenotype of 10 fingers, 10 toes, 2 eyes, etc.

Humans look pretty similar to one another, and we also appear to be fairly similar within a narrow range of function. But not so similar at the biochemical level, according to research that gave rise to what Dr. Roger Williams described as “Biochemical Individuality”. He described Genetotrophic Disease, which can result from low levels of specific nutrients necessary for improved expression of genes. In other words, the lack of sufficient amounts of these nutrients resulted in imperfect expression of certain genes, giving rise to disease. The manner in which all genes are expressed is related to their exposure to specific nutrients.

The Human Genome Project, which is deciphering the code of the 23 pairs of chromosomes, is permitting us to recognize some unanticipated aspects of molecular genetics and molecular biology. The impact of nutrients on the expression of these genetic characteristics results in our diversified genetic potentials. We do not have just one "us" locked in our genes. There are many "we’s," only one of which is expressed at any moment. Exposure to various environmental factors alters the expression of our genes, producing what we call the phenotype, the observable characteristics of an individual.

Micronutrients in our diet, as well as proteins, carbohydrate, fat, vitamins, and minerals, influence the expression of genes. Everything we eat has an impact on our genes. Lipoic acid, N-acetyl-cysteine, vitamin E, and coenzyme Q10, for example, are known to have an impact on the modulation of gene expression. We are not just looking at the absence of nutrients relative to an existing disease. We are looking at conditions that are occurring decades before the appearance of the disease and its diagnosis.

At the physiological level, however, as we probe deeper into enzymatic variations and other functional differences from one healthy individual to another, we find far greater differences than we previously understood. Functional medicine looks at genetic underpinnings as well as the agents and influences from the environment that modify expression. It can help us understand that disease in individuals in midlife results from a series of changes in function that have occurred over many years.

In general, the efficacy of drug treatment is not very good. The response rates and treatment of different diseases like Alzheimer’s, cardiac dysrhythmias, depression, incontinence, high blood pressure, osteoporosis, schizophrenia, and rheumatoid arthritis, not to mention oncology, are in the range of 30 to 60 percent. That means they are 40 to 70 percent ineffective and often produce adverse side effects. Given this relatively low frequency of responders, the high cost and potentially serious consequences of adverse reactions to drugs, the idea of moving to a new form of personalized medicine based on genomics and proteomics becomes even more attractive.

The whole concept of how diet and lifestyle influence function and how messages that come from the outside world influence the translation of genes into our phenotypes represents a fascinating part of the functional medicine story. For example, a modifiable factor of unhealthy aging is altered immunity. A characteristic that differentiates healthy nonagenarians from unhealthy younger people is the absence of autoantibodies in the endocrine glands of the older population. By designing an appropriate diet for an individual based on his or her genetic needs, and by reducing antigens to which the person is sensitive, such as gluten in wheat or casein in dairy products, reduction in antigen exposure will result, helping to improve immunological function.

We can use certain biological markers to evaluate dysfunctional metabolism, and those markers may provide insight into where gene expression is increasing the risk or likelihood of various diseases, including heart disease, arthritis, and cancer. Genetic risk factors with modification of environmental factors lead to different phenotypic expression—turning off or turning on certain genes that give rise to longevity rather than premature expression of disease. In other words, it is a wake-up call. We are learning that if you carry certain genetic risk factors for neurodegenerative diseases, you may need to do something different from the person who does not carry those genetic risk factors.

Health care is not as deterministic as we once thought it was. We used to believe a person got what she or he got and there was nothing she or he could do about it. Genetics and developmental biology were linear. Now we know we can modify the function we possess at any chronological age by the way we treat the genome and various characteristics that are expressed. We might be able to uncover genetic messages to help us slow down biological age and toward improved function.

What this new view of genetics is really saying is that we are expressing certain messages in our genes and thus creating the environment of our bodies. We haven’t changed the genes; we have just expressed our function in various ways. It is not just the "luck of the draw" that contributes to our health and disease patterns. Those patterns are a consequence of our genes coupled with the decisions we have been making about how to treat those genes. That is a very different view of how much flexibility, or functional capability, there is in people’s genes, based on the decisions they make and the counsel they receive.

In a study of identical twins from twin registries in the Swedish Census Bureau, investigators at the University of Pennsylvania found that only 20 to 30 percent of susceptibility to common forms of cancer, a major cause of death, is determined directly by our genes. In other words, the concept that we inherit our potential for a long life from our parents in "the luck of the draw" is only 20 to 30 percent true. Seventy to 80 percent of that chance depends on what we do to the genes we inherited throughout the course of living, according to this study.

These are exciting times in medicine. We have moved beyond a philosophy that advised, "Wait until it is broken and try to fix it," toward molecular preventive medicine, which is the basis of functional medicine and the patient-centered approach. Many chronic symptoms patients experience, for which no clear diagnosis exists, are early warning signs of suboptimal metabolism that are a consequence of poorly expressed genetic characteristics. These symptoms accumulate in their damage until eventually a diagnosis can be afforded. If we recognize the symptoms early on and couple them with the antecedents, triggering events, and mediators, we have a therapeutic potential to modify the course of that metabolic dysfunction, improve outcome, and reduce pathology. That is the basic strategy and philosophy underlying functional medicine.

As the human genome gets sequenced, we will learn more and more about the loci on the genome that code for specific factors. In an editorial in the Journal of the American Medical Association two years ago (1996;276:1511), Dr. Lin pointed out that 7 percent of enzymes may have double copies, one of which is being expressed from genes under one set of environmental conditions and the other expressed under a second set of conditions. In other words, if a person eats, lives, thinks, and breathes a certain way, he or she might be expressing a poorly functioning enzyme. Under more optimal conditions, the genes may be expressing a better functioning enzyme from their genes.

What we want to do is optimize the expression of those characteristics that promote proper function. Ultimately, the goal is to establish a molecular milieu associated with resistance, resilience, organ reserve, and lower biological aging. If we modify certain nutritional and environmental characteristics in our lives, we could ultimately prevent or delay expression of certain diseases.

We could each be involved in constructing a self-administered health promotion program, that looks at the individual in the context of his or her life – genetic background and personal health habits. It involves designing a program that promotes full penetration of positive gene characteristics and their expression and putting to sleep or turning off those gene expressions that may lead to premature illness and death.

Food, and its impact on this messenger system, is a tool that I can use to try to restore balance. Making lifestyle choices and environmental modification to match the person’s genetic need are good medicine. These practices are based in strong science and founded on the principles of normalizing intercellular messages to promote functional reserve and redundancy, knowing that we are all going to be exposed to agents that may encourage dysfunction.

We are coming full circle, to the recognition that the ways we eat, think, act, and believe manipulate the phenotypic expression of our genes through the course of our lives. Those factors are much more important than the medicine we take or the surgery we have. Communication between our diet and our genes gives rise to the expression of function. Micronutrients, macronutrients, and conditionally essential nutrients in our diet play continuous roles in washing over our genes to give rise to their function.

What we are seeing for the first time is a bridge crossing a chasm that seemed to be impassable. On one side was medicine; on the other side were nutritional supplements, and it seemed the two would never meet. Suddenly, the importance of functional physiology is emerging from the research. Researchers are discovering how in so many ways we depend on specific nutrients to promote functional physiology. If we expect to live healthy lives for 8, 9, or 10 decades, we must heed the specific nutrient requirements of our bodies. It's like you have an opportunity now -- women and men -- to tap into the real wisdom of your body, using your full intelligence. How you do it, starting in your 40s or early 50s, will determine the quality of the next 40 years of your life.

Dr. Elina Chernyak, D.O., is an osteopathic physician practicing holistic medicine in Vail, Colorado. She practices integrative and functional medicine, and offers her services as a general practitioner, nutritionist and patient advocate. She is a member of the Institute for Functional Medicine and has studied under some of the most influential holistic and alternative doctors in the United States, Canada and Russia.