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Prevention Rules-Naturopathic Medicine, Epigenetics and GenomicsPaul Davis B.Sc., N.D.

How can I prevent disease? Could I have prevented this? What can be done to pro-actively prevent disease from developing? Is it just my genes? Currently the research shows that diet, lifestyle and environmental factors play a major role in the initiation and promotion of disease, so our state of health is de�nitely more than just our genes.

In our super-busy fast-paced lives we often neglect our health and forget that it has to be nurtured. However, in the long term it becomes evident that prevention is the best approach; the least painful and the most cost-e�ective.

The good news is that everyone can do something to improve their diet, lifestyle and environment! The 'bad' news is that it truly takes a pro-active approach that is dependent on personal e�ort and persistence in order to improve health and prevent disease. There's a learning curve that's a little di�erent for each individual and most people need support in this process. Support is key when you are trying to make changes to long term habits. With enough support most people can make signi�-cant changes in a relatively short period of time.

In fact there are simple, basic recommendations that can be integrated into most people's lives. Sometimes people just need a reminder, some education and encouragement to upgrade their diets and lifestyles. I recommend that patients come in once a year just to check in about how they are doing, address any early changes in their health before they become serious.

Unfortunately the majority of people wait until they have a diagnosis before they get mobilized to change their diet and lifestyle factors. Also, many people rely solely on conventional medical care because they mistakenly believe that complementary care cannot be integrated with conventional care. Actually, individualized diet and lifestyle medicine will always add some bene�t, whether a patient is receiving conventional care or not. It's also very important to realize when conventional care is indicated and not neglect to integrate it into a 'natural' treatment plan!

To e�ectively prevent disease it's important to take a detailed look at a person's 'life story', their current diet, their lifestyle, their physical environment, their social an emotional environment, their history of illness and family history of illness. It's also essential to do lab tests to identify areas of risk. All of these things together help create a picture of the patient's health that is either moving in the direction of increasing health or declining health.

The �rst step in my evaluation of a patient's health picture involves taking a careful case history and physical exam. Then the next step is having the patient track their diet, activity and symptom severi-ty for one week. This is the base from which I can assess whether a patient's diet and lifestyle is working for them or not. Even when we think we are eating really well day to day, looking back at the end of a week we can more easily see what we can tweak and change for the better. It's import-ant to create speci�c targets for reducing poorly-tolerated or low nutrient density foods and increasing well-tolerated high nutrient density foods.

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If there is evidence that food reactions are occurring, and an elimination diet does not provide signi�cant bene�t, I will recommend food allergy and sensitivity testing. Many people who are not feeling well have food allergies or food sensitivities that they are not fully aware of. Lab testing using a blood sample can reveal what our body is not tolerant of and provide a 'roadmap' for making better food choices. The plan is personalized for each patient and includes what to eat, a shopping list to make it easier to buy alternate foods as well as a menu plan to follow. Patients quickly become their own educators �nding resources that help them move forward!

Standard lab tests are often very helpful in determining levels of risk for speci�c diseases. A simple test like vitamin D level can be very helpful for assessing possible risk for osteoporosis. A high total cholesterol with a low HDL or elevated triglyceride level, or a borderline fasting glucose or hemo-globin A1c are �ags that a patient's metabolism is moving towards cardiovascular disease or diabe-tes. With targeted diet, lifestyle and nutritional treatment a patient can push back the needle from increased risk towards lower risk.

But to fully personalize a patient's treatment plan advanced lab testing is often necessary. Over the last 10 years many new lab techniques have been developed to address the knowledge gaps clini-cians have long struggled with. Now it is possible to test and analyze biomarkers of body metabo-lism in a more comprehensive and detailed way and use these to target speci�c areas of metabolism therapeutically.

For example, advanced lab testing can identify the relative amounts of friendly or unfriendly bacte-ria in the digestive tract. These intestinal bacteria, which are an important part of our microbiome, help regulate the entire immune system. Their composition can determine whether or not we will have reactions to foods, intestinal symptoms like IBS, or increased intestinal permeability, a condi-tion that has been implicated in autoimmunity.

Advanced lab testing can also look at methylation patterns in the body, an area of metabolism associated with brain function, mood, detoxi�cation and birth defects. There are tests that can help evaluate whether bone tissue is actively building or actively breaking down at any point in time. So rather than relying solely on bone mineral density testing every few years, a patient can get earlier feedback regarding the e�cacy of their current or new treatment plan.

Advanced lab tests are now being used to evaluate an individual's gluten intolerance very accurate-ly. Multiple gluten-related peptides, not just alpha-gliadin are tested so it is possible to detect reactivity that was not shown with a standard test. As well, testing is available that can identify foods that cross-react with gluten. These non-gluten containing foods can trigger gluten-like immune reactions in sensitive individuals. The tests are done with a blood sample and re�ect the individual's reactivity. Gluten has been shown to increase intestinal permeability, a condition that can lead to increased food allergies and sensitivities, as well as in�ammation. Chronic tissue in�am-mation is now known to contribute to the progression of many common diseases such as cancer, cardiovascular disease and arthritis.

Prevention Rules-Naturopathic Medicine, Epigenetics and GenomicsPaul Davis B.Sc., N.D.

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The goal in preventive medicine is to identify risk factors through family history, �nd early markers of metabolic dysfunction and use these clues to create a treatment plan to prevent disease. In the relatively new �eld of 'predictive immunology' clinicians test for early biomarkers of autoimmune disease in the hopes of delaying or preventing disease onset. Looking back at stored blood samples from people who developed lupus (SLE) later in life, researchers were able to show that speci�c antibodies were already elevated 5 or more years before these patients were diagnosed.

Autoimmune disease is complex but one of the things that is now understood is that we lose 'self tolerance' on an immunological level over time, due to a variety of factors including toxic exposures, chronic infections, cross-reaction with foods we are intolerant of, nutritional de�ciencies and lifestyle or emotional stresses. So family history is an indicator of potential risk but what happens in our lives, yesterday, today and tomorrow is what determines whether this potential will turn into active disease or not. The �eld of predictive autoimmune testing is growing because patients and clinicians are realizing that we don't have to just wait around for disease to happen, we can directly in�uence the causal factors, and to a signi�cant extent, shape the outcome. Early improvements to diet, lifestyle and environmental factors are ideal but starting where you are now is more bene�cial than simply ignoring the risk.

Recently there has been quite a lot of press on the pros and cons of genomic testing and how it relates to the �eld of epigenetics. Since the human genome was mapped in 2003 various research centres and labs have been looking at speci�c gene variants, called SNPs, pronounced 'snips' (single nucleotide polymorphisms) and �guring out how they may apply to human health and disease. Speci�cally, researchers have been studying SNPs for enzymes that regulate key metabolic path-ways. Some of these pathways have been shown to impact immune function, detoxi�cation func-tion, neurological function, drug metabolism, and these relate to risk for cardiovascular disease, cancer, osteoporosis, Alzheimer's disease and many other degenerative diseases.

The interesting and practical thing about genomic testing is that it has been shown that the func-tion of these SNPs can be in�uenced by our diets, lifestyles, environmental exposures, nutritional status and levels of stress. The things we do, think, eat, drink, breathe and are exposed to all 'talk' to our genes every day, turning on or o� key metabolic pathways that either increase our level of health or decrease it. Food really is medicine if it's the right food for you. The same applies to all aspects of our lifestyles and the environment we live in. Doing these tests is a way to have a window into an individual's unique genetic traits and respond to and in�uence these personal risk factors pro-actively, before onset of disease.

Prevention Rules-Naturopathic Medicine, Epigenetics and GenomicsPaul Davis B.Sc., N.D.

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The Naturopathic model of health care holds the view that we must aim to: Do no harm, Work with the intrinsic healing processes of the body, Treat the causes of disease when possible, Treat the whole person, Educate patients so that they are able to help themselves, and whenever possi-ble...Prevent disease!

It's both a challenging and exciting time in the �eld of medicine. The rapid increase of chronic disease is overwhelming our existing health care system and this trend is expected to increase over the next decades. Our understanding of epigenetics has changed how we think about our genes. Our 'book of life' is not a �xed destiny but a �eld of possibilities. Some of these were turned on early in our lives, some are still waiting to be turned on and others can be turned up or down simply by the choices we make today. A preventive approach is a pro-active approach that integrates the best evidence from conventional and complementary health care to maintain and improve health. We're closer to this goal than we have ever been previously and that's great news...if we use it!

Prevention Rules-Naturopathic Medicine, Epigenetics and GenomicsPaul Davis B.Sc., N.D.