SNP! Crackle! Pop!: Adventures in Genetic Testing

SNP! Crackle! Pop!: Adventures in Genetic Testing

Rosalind Franklin: She might have been left out of the nobel, but at least she gets a spot next to this post. Lucky her. (Sorry readers, just a little molecular biologists inside joke). Image source: wikipedia.org

Rosalind Franklin: She might have been left out of the Nobel, but at least she gets the honoured spot as the featured image of this post. Lucky her. (Sorry, readers, just a little inside joke for the molecular biologists out there). Image source: wikipedia.org

“Do you find yourself easily able to bounce back from emotionally-charged situations?” Dr. Emily Fitzgerald, ND, asked while sitting across from me at her white desk. “The fact that this part of the gene is present and not deleted means that you are the ‘cool and collected’ type, the ‘Wolf of Wall Street’, if you will.” She went on, “We find here through our testing that most naturopathic doctors have the other version of this gene.”

Great, I thought, I was genetically unfit to practice naturopathic medicine; it was like something out of the movie GATTACA. I couldn’t help but feel let down by my genetic coding. I had always thought of myself as an empathetic and caring person and yet science was telling me the opposite. Wolf of Wall Street? Seriously? I hated the movie. In fact, I felt more at home sharing a collective vegan lunch with protesters occupying Wall Street than bidding on stock options. Surely this doctor must be mistaken. But alas, it wasn’t her fault. She was simply a messenger, reading out to me what was clearly spelt out in my nucleic acid.

Genes are funny things. We inherit one set from our mothers and another from our fathers. They don’t change throughout our lives and they are responsible for coding all of the proteins, enzymatic reactions and cellular structures that make up our beautiful bodies. However, I once read that interpreting the human body through genetic code is analogous to interpreting Shakespeare’s works by studying the alphabet; it’s not even a recipe, but a mere grocery list.

Dr. Mohammed, the CEO of YouNique Genomics, a Canadian lifestyle genomics company, will also assert that “genes aren’t everything.” Our environment has a lot to do with how they are expressed and this simple fact can explain why, despite the fact that I am missing part of the “emotional gene”, I am still able to regard my patients with positivity, appreciate literature and cry at sappy love stories.

Despite the Nature vs. Nuture debate, there is still a lot that can be garnered from looking at genetic coding. By studying my expression of SNPs (single nucleotide polymorphisms), or small variations in DNA, on only 14 of my 23,000 genes, Dr. Fitzgerald was able to tell me that I am a passionate person, I am capable of regulating my emotions when confronted with difficult situations, I can drink espressos after dinner without affecting my sleep and the Paleo Diet will only lead me to overeat. She told me how dopamine is metabolised in my brain, how my liver detoxifies and how my body digests cholesterol and lipids, giving me information about my long-term risk for heart disease. And she did all of this without looking at her crystal ball, not even once.

I previously associated genetic testing with detecting the risk for diseases such as early-onset Alzeimer’s or breast cancer. I had always thought that knowing one’s genetics was dis-empowering. After all, you’re born with your genetic code; what is the use of learning about something that you can’t change? It seemed to me as useful as tying yourself to a set of train tracks, powerless to stop yourself from being crushed under the freighter speeding towards you.

My mind changed when I learned about functional genomic testing like the kind offered at YouNique. Functional, or lifestyle, genomics don’t predict disease risk but rather only test for genes whose expression can be affected by lifestyle. The test I received was called the SNaP Shot. It looks at 14 genes, including those that code for dopamine metabolism, liver detoxification, methylation pathways and cardiovascular health.

One of the noteworthy pieces of information I learned was that my detoxification pathways are like a leaky faucet with a clogged drain. The enzymes that run Phase I liver detoxification, which make many toxins more toxic, are over-expressed, meaning that they work better than the  average person’s. However, I have less than optimal Phase II detoxification, which is responsible for neutralizing these toxins and allowing them to be safely eliminated from the body. This means that I need to start supporting my liver and increasing my production of glutathione, an important antioxidant. If I don’t do this? It’s written in my DNA, and perhaps that stars, that my risk of cancer from toxin exposure could be higher than normal. I bought a bottle of milk thistle the next day.

I also learned that my body has a 30% reduced ability to use folate, meaning that I need to increase my intake of this vitamin or else risk problems with inflammation, which has wide-spread affects. I also found out that I respond poorly to saturated fat intake: it makes me hungrier by stimulating ghrelin, the appetite hormone, and can lead to weight-gain if my diet is uncontrolled. This is relevant in the natural health world because the Paleo Diet involves eating a diet high in saturated fats to achieve the exact opposite aim: controlling hunger. Genetic testing is the future!

What was the immediate result of the information I received by donating a vial of blood and an hour’s consultation time to YouNique? I learned that I need to support my liver (hence the milk thistle) and increase my folate intake. The truth of my long-term disease risk is there, written in my genome, which won’t change, that much is true. What I hadn’t considered, however, is our power to rewrite the future, by using naturopathic medicine to work with the building blocks we inherit. Our genes will always be the same but what we learn about how they are expressed will continuously evolve. Genomic testing, as Dr. Mohammed pointed out, is a living and breathing test. With the same test results, our treatment plans can evolve as our knowledge in the area grows. The more science learns about how lifestyle affects our genes, the more we can work with what we’ve got.

To end off, Dr. Mohammed told me a story in which he was examining a rather unfavourable genetic report before meeting the patient it belonged to, a naturopathic practitioner. When the ND entered the room, Dr. Mohammed was taken aback. Surely this healthy, spry, attractive individual was not the same person whose genes indicated an increased risk of obesity, inflammation, toxic exposure and heart disease? However, this individual had chosen to “walk the talk”, as we say in the field, and live his life in a healthy and holistic way. And, by doing so, he was able to change the course of his own personal health history; a great novel whose prologue began being written moments after his conception but whose conclusion he will be able to co-write. Shakespeare was given the alphabet. We are given a crazy combination of four nucleotides. Shakespeare wrote Hamlet. Through lifestyle genomics, I’ve come to realize that what we write with the information we’re given just might be up to us.

To learn more about lifestyle genomic testing and how it can help you affect your own health, contact me.

 

Listening to My Body (and why my pants are too tight)

Listening to My Body (and why my pants are too tight)

New Doc 7_5I am in my grade 12 photography class. I am 17 years old. I have my head on the desk in abject despair, as I succumb to the intense stress that was my last year of high school, where every academic move I made would dictate my future. I remember catching sight of my thighs nestled on the hard-backed plastic chair beneath the desk. And, although my struggles in that moment were seemingly unrelated to my body, I remember feeling a sense of satisfaction as I made a mental note of how the once-curvy lines of my thighs were straightening themselves out, flattening and loosening some of the fat that cushioned my thigh bones. From this satisfaction, I drew a sense of calm; I was losing weight, therefore things would be all right. The notion sounds ridiculous now but, at the time, I associated thinness with all the things I valued: friendship, love and even success. These things could only take place in someone inhabiting a thin body. I would, naturally have to complete the prerequisite of achieving “thinness” before I could have any of those things. This belief, rather than creating a connection between the rest of my life and my experience in my body, only served to fragment my bodily experience, as I tried to form my shape into the mould I thought it should inhabit.

Fast-forward more than 10 years later. There is a sale at a store I used to frequent as a teenager. Since all my jeans have the coordinated foresight to spring holes at the same time (between the thighs, naturally), I decide to go in and try on some pants. When I realize that I take a full two sizes smaller than the last time I ever slid this brand of jeans over my hips, my chest is filled with the same contented bubbling I experienced that afternoon in photography. The anxiety of my future – my career, my empty wallet and my relationship -relaxes. I walk out with two pairs.

I am wearing the jeans on the subway when I run into my former boss. She and I chat about the weather and the school and she tells me that her young daughters refuse to wear pants because “they encumber their knees at circle time.” We chuckle at the humor of the situation and my mind travels to my closely wrapped thighs, feels the snugness of denim surrounding them. For me, pants serve as a container for the flesh that threatens to spill out of them. I remember wondering when my definition of “comfort” evolved from the freedom of the body to expand, move and breathe to this feeling of secure confinement I experience inside my jeans. I doubt these pants would allow my knees to properly stretch themselves out and bend at circle time. Luckily, when you’re pushing 30, you get to sit in chairs while people tell you stories.

As a naturopathic doctor, I preoccupy myself with the relationship our bodies have with our environment and lifestyles: how do the products we use affect our hormones? How does the food we eat and the movement we engage in affect our internal terrain? How does our mindset prevent disease? What I often don’t ask is how the learned relationship one has with their body affects health. Does the way I view my lower body cause me to engage in behaviours that affect my health? How are my tight jeans impeding lymphatic flow? How do they affect my digestion? Does my sense of self-worth affect my blood sugar? The answer is it absolutely can, if my sense of self-worth causes me to ignore my body’s food cravings and hunger signals. The way we treat ourselves and imagine our own health stems from our relationships with our bodies, which in turn dictates our future health states.

Susie Orbach, a feminist psychotherapist and author, once wrote that female babies are breastfed for less time, and picked up and cuddled less than male babies. She goes on to describe how this early treatment of women, “characterized by emotional deprivation and feelings of unentitlement”, secures the female’s place as a second-class citizen in society. More than that it teaches women to disconnect with our bodies. If our needs are not met at an early age, we are led to believe that these needs are wrong. We are taught to ignore the smelling, farting, bleeding, overflowing, curving bodies we are born with and try to recreate a “false body” that is perfect and that begins to believe it is “comfortable” being squeezed and starved and stuffed into pointy-toed shoes. Or we simply develop the ability to de-identify with the discomfort. This mechanism can lead to injury or disease if we fail to truly listen to what our bodies are trying to alert us to. (Matthew Remski writes about this extensively in his amazing research project on yoga injuries called What Are We Actually Doing in Asana (WAWADIA). I’ve been devouring his articles this week).

Orbach goes on to theorize that the symptoms the body produces in a disease state just might be a cry for help; the body is attempting to insist on its existence, to demand to be heard. So what then are menstrual cramps? Are they simply a result of inflammation or a hormonal imbalance caused by lifestyle or are they attempts made by the body to cry out, “I am female! I am menstruating! I am in need of attention!”

I remember a patient I had who would deny herself life pleasures. Convinced she needed to lose weight, she would ignore her hunger signals, even proudly telling me that she would turn to her stomach and tell it to “shut up” when the grumbling became too loud. Her chief complaint was chronic pain. I wonder if her body’s pain was simply its way of telling her it existed. I wonder if she’d have found a way to sufficiently answer her stomach’s calling, the pain would have subsided. Perhaps by listening to the experience of our bodies we can start to properly take care of our health. We can start by wearing comfortable pants that don’t “encumber the knees”, moving naturally, embracing our sexual appetites, feeding ourselves the food we truly crave and answering the need for physical touch and rest.

In a society that tends to view the body as an object, a machine that sometimes gets jammed with inconveniences such as pain, menstrual issues and eczema, I wonder how our collective health would change if we began to experience the body as a tool for healing and self-growth – something inherently wise.

To share one last story, I remember sitting across from Teresa, our school counsellor, while I was still a naturopathic student. At the time I was deciding to break up with my then-boyfriend thereby ending a 5-year relationship. I told her I had never been clear on the difference between the fear and apprehension that came with seizing something good and the repulsed feeling of avoiding something bad. This has led me to make decisions in my life that weren’t necessarily right for me. She asked me to cultivate the two feelings and locate their positions in my body. “See if there is any difference,” She told me. As I tuned in I immediately noticed that fear was closer to my heart. It was higher up and it bore the faint pleasant glow of excitement behind its initial anxiety. Disgust was located lower down. It felt like a stomach ache, a sense of doom, of indigestion: a hard-to-digest truth. It was in this moment that I fully appreciated the body’s wisdom. The old adage “listen to your gut” began to ring true to me. My gut was sending me a message that was loud and clear, but it was up to me to listen to it.

So what are some exercises we can do to cultivate body awareness and re-inhabit our bodies? 

– Practice regular body scan mediations, such as those prescribed by the Mindfulness-Based Stress Reduction (MBSR) model taught by Jon Kabat-Zinn.

– Try Susie Orbach’s “Mirror Exercise” in her book Fat is a Feminist Issue or spend 3 minutes a day for 21 days staring at a body part that you have a hard time identifying with. By staring at the nose you’ve always felt was too big on a regular basis, you are able to incorporate it into your sense of self and accept it as something beautiful, in the way you would come to love the same nose on your grandfather, daughter or dear friend.

– Set a timer every hour while at work to remind yourself to tune in to your body and your breath. Notice your feet planted on the floor and move your awareness up through your feet to the top of your head. Ask yourself if there’s anything your body needs: are you thirsty, hungry, bored or lonely? Do you need to stand up and stretch? Do you need a hug?

– Get regular acupuncture or constitutional hydrotherapy to help the flow of Qi through the body.

– Finally, touch yourself. Practice ayurvedic self-massages or apply a natural moisturising lotion or oil before bed. Practice self-care in the form of hydrotherapy. Even placing the hands over the heart and breathing into that area will help to release oxytocin, a hormone responsible for love and bonding, creating feelings of calmness and attachment to the physical body.

7 Reasons For MDs to Collaborate with NDs

7 Reasons For MDs to Collaborate with NDs

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Dear Medical Doctor,

I am a naturopathic physician. On a Facebook page hosted by some peers in my profession, a young naturopathic doctor expressed distress at having her attempt to forge ties with one of her patients’ medical doctor thwarted. Needing her patient to obtain the diagnostic testing covered under provincial insurance only when ordered by a medical doctor, she wrote a letter to the patient’s MD, explaining the case, her assessment, the natural treatments that the patient was taking and her reasons for asking for diagnostic testing to be done. She expressed her hope to work collaboratively with this professional in order to provide better care for their mutual patient.

The response was less than ideal. The MD wrote a short, snappy letter, making clear his disinterest in “working collaboratively” with “alternative health practitioners”. He told her, bluntly, that he would not welcome further communications regarding their mutual patient.

Rookie mistake.

Whether a patient seeks consult from a naturopathic doctor or not, natural medicine is here to stay. The good news for medical doctors, however, is that naturopathic doctors can help make their lives easier and contribute significant benefits to patient management. Here are some reasons for working with naturopathic doctors:

1. Naturopathic doctors are highly trained.

NDs go through 4 years of undergraduate education, taking prerequisite courses in biochemistry, biology, psychology, physiology and chemistry. Naturopathic medical school consists of an additional 4 years of intense, full-time study that includes the completion of two licensing exams, one board exam, 3 clinical exams and a 12-month clinical internship working with patients in an out-patient setting. NDs are trained in medical diagnostics, physical exams and can perform procedures such as taking blood, injections, pelvic exams and prostate exams. With extra training NDs are being certified in IV therapies, minor surgery and pharmaceutical prescribing.

Naturopathic doctors speak the same language as medical doctors and our training and medical opinions can be trusted.

2. Patients that see naturopathic doctors in addition to medical doctors do better overall.

In a 2013 randomized clinical trial by the Canadian Medical Association Journal, it was found that high-risk patients decreased their risk of heart disease when using both naturopathic medicine and conventional treatments together rather than just conventional medicine alone. NDs have the time to teach patients how to make changes that benefit their long-term health. Adding a naturopathic doctor to your patient’s healthcare team can help decrease their risk of chronic diseases, such as cardiovascular disease, the leading cause of death among Canadians.

3. Naturopathic medicine decreases the burden on the healthcare system.

A colleague of mine practised as a registered nurse in Ontario for several years before deciding to begin studies at the Canadian College of Naturopathic Medicine and become licensed as a naturopathic doctor. When I asked her why she told me that she was tired of the “revolving door.” “The revolving door?” I asked, puzzled. She explained that, as a nurse she would often see the same patients time and time again – patients with diabetes who were having trouble managing their blood sugar and mental health patients, for instance – who would come into the emergency room, receive treatment and leave, only to return again after a short time. There was no one addressing the root cause of these patients’ ailments and, therefore, it was only a matter of time before they returned to the emergency room. Working with a naturopathic doctor helps patients take responsibility for their health, addresses the root cause of disease and assists patient in learning how to manage chronic disease more effectively, freeing up the emergency room for actual emergencies.

4. Naturopathic doctors address family physician shortages.

Many Canadians do not have a family doctor and many medical doctors are far too busy to take on new patients. Referring patients to be co-managed by a naturopathic doctor can reduce their need for doctors visits, reduce medical clinic wait-times and allow medical doctors to take on more patients on their rosters. Also, by focussing on lifestyle changes, finding the root cause of disease and anticipating health issues such as seasonal allergies, colds and flu or traveller’s diarrhea, NDs can help patients prevent disease. We can effectively take on the ailments that are not appropriately treated with pharmaceuticals (viral colds, for instance), freeing up time and space in medical clinics.

5. Naturopathic doctors can take on chronic, long-term cases.

Chronic acne, digestive concerns, musculoskeletal pain, fatigue and mental illness, cardiovascular disease, hormonal imbalances such as uterine fibroids, PMS, PCOS and endometriosis are all chronic conditions, difficult to treat with medications, that benefit hugely from lifestyle changes. Many patients who suffer from these conditions experience immense benefit when treated with gentle, natural therapies and lifestyle changes. Naturopathic doctors excel at treating chronic, long-standing conditions that are upsetting to patients but often aren’t “serious” enough to warrant conventional care or perhaps aren’t responding to conventional care.

6. There is someone managing drug-nutrient or drug-herb interactions.

It is estimated that more than 70% of Canadians have used a natural health product. That number is only increasing as the public recognizes the need for nutritional and herbal supplementation. However, interactions between natural remedies and medications are real. Naturopathic doctors are trained in pharmacology and are prepared to anticipate interactions and avoid products that have the potential to interfere with certain medications and medical procedures. Collaborating with an ND also means that there is a recorded history of all the natural products your patient is taking and your patient is far less likely to self-prescribe remedies that have the potential for harm.

7. NDs excel at providing stress relief.

“My doctor told me it’s just stress,” a family friend told me over dinner. No surprise. What can sound to some patients like a back-handed dismissal is actually a concrete truth; some sources estimate that 90% of physician visits are stress-related. Naturopathic doctors offer a wide range of therapies such as talk therapy, lifestyle counselling, homeopathy, acupuncture, botanical therapy and nutritional supplementation all of which are effective at helping reduce stress and improve the body’s response to stress. As a society we tend to focus on physical health and lifestyle and neglect the importance of mental health. Naturopathic doctors are well-positioned to offer that kind of care.

Dear medical doctor, we naturopathic doctors appreciate everything that you do. We would love the opportunity to work with you as part of a collaborative team for the benefit of our mutual patients. So please, no more of the above-mentioned letters.

In the words of Vanilla Ice, “Stop. Collaborate and Listen.” Your patients will thank you for it.

Sincerely,

Talia Marcheggiani, ND

Prevention is Not Just Screening: 6 Ways to Prevent Disease

Prevention is Not Just Screening: 6 Ways to Prevent Disease

Preventive medicine is a buzz-phrase that many medical professionals love to throw around. However, in the conventional medical system the term prevention is often used to apply to what should be known as screening. Tests such as PAP smears, mammograms and colonoscopies do not prevent cancer, they simply attempt to screen a large portion of the population to detect the presence of these cancers at an early stage, when treatment can be most affective. They are recommended for silent diseases that only produce symptoms once they are advanced, but they are screening exams, they do not, in and of themselves, prevent cancer. If one of these tests comes back positive, it means that the patient’s body is already along the course of disease and needs treatment.

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The Therapeutic Order

The Therapeutic Order

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First things first: sunshine, fresh air and clean water.

Contrary to common belief naturopathic doctors are not just doctors who prescribe natural remedies to patients. (This means you can not avoid visiting a naturopathic doctor by going to a local health-food store and prescribing yourself a bunch of vitamins and supplements!) After all, as previously “naturopathic” therapies invade scientific literature, more up-to-date medical doctors are prescribing things like fish oil and probiotics to their patients. However, this doesn’t make them naturopathic doctors any more than prescribing rights make us medical doctors! Naturopathic doctors differ from the traditional medical model not so much in what we prescribe or our principles (do no harm, treat the whole person, prevent disease, doctor as teacher, support the body, treat the cause), which medical doctors arguably share with us, but in something called the Therapeutic Order.

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When the Tests Come Back Negative

Many people come to see a naturopathic doctor only after they have already been to see everyone else, having run around the ring of the conventional medical establishment, all to have them conclude, “there’s nothing wrong with you.” Sometimes a patient might have heard, “it’s all in your head,” but they basically mean the same thing: “there’s nothing we can do for you. Now please leave us alone.” For the patient it might be a nice to hear that nothing serious is the the matter with them when the blood tests and other diagnostic testing come back negative, however, the symptoms that caused them to seek help in the first place still persist, leaving them feeling hopeless and confused.

After traveling to Costa Rica I experienced rapid weight gain, which I could not attribute to a  change in diet or a sedentary lifestyle; I still watched what I ate and exercised. The feeling that I was gaining weight despite what I did made me feel helpless, like my body was acting of its own accord. It damaged the trust I had in my body, hindering the relationship I have with it, and the feelings of getting larger in a society that praises thinness made me feel self-conscious and ashamed.

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To Coffee or Not To Coffee?

That is often the health question… On this blog I have openly admitted to loving coffee. Throughout the course of applying my studies in naturopathic medicine to my own life, I’ve been able to make necessary changes to my diet and have watched the way I eat evolve quite dramatically over the past three years. I was once a vegetarian, who ate a carb-heavy diet, full of pasta, and now I follow a whole foods diet, free of diary, gluten, processed foods and refined sugars. There is one thing I’ve been unable to give up for good, however, and that’s coffee.

I can go time without it and often put myself to the challenge to do so. But, while it’s been over a year since I’ve bitten into a baguette, I just can’t say good-bye to coffee forever. And should I even try? When it comes to coffee, there are few foods that receive more mixed messages with regards to the health benefits or risks. Here are some of the pros and cons to visiting your favourite local beanery.

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Notes on the Community Healthcare Panel

Notes on the Community Healthcare Panel

Last Wednesday, November 14, a group of exceptionally socially-minded classmates and I held a Community Healthcare Panel. Despite the fact that it was held on a Wednesday night, the event proved to be nothing less than engaging and inspiring and, because of its success, I was asked by a number of students who couldn’t attend to offer up a synopsis of what was covered. So, here are my rough notes:

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6 Uses for Castor Oil

At a teacher training I recently attended, we were given the task of deciding what we would take with us if we were to go to a deserted island.  While other people chose things like hatchets, food, water (and a boat), I automatically thought: castor oil!  Sometimes I forget that the rest of the world isn’t living under the naturopathic bubble.

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