Genetic Testing in Integrative and Functional Medicine – Part 1

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Carrie Lam, MD


Integrative and functional medicine vs traditional medicineIntegrative and functional medicine came to the forefront for many medical practitioners and patients alike when they became dissatisfied with traditional medicine’s sole focus on what was considered “science-based” treatment approaches. Traditional medicine’s viewpoint of dealing with symptoms in isolation from the rest of a patient’s body, mind, and spirit can be too confining when it comes to certain conditions.

This evolution to a more function-centered approach as opposed to a disease-centered way of seeing the whole person has led to improved healthcare. It also looks at prevention, not simply illness and at living in a healthy state, not simply disease-free.

What is Integrative and Functional Medicine?

Practitioners of integrative and functional medicine take into consideration genetic, environmental, and lifestyle issues when listening to their patients describe the symptoms plaguing them. Their inclusion of these issues makes the process more of a natural medicine approach.

With the dramatic increase in chronic illness conditions and the lack of training traditional physicians have in dealing with these conditions, the move into integrative and functional medicine is needed.

Many of these chronic illness conditions have a genetic component that, along with environmental and lifestyle factors, lead to serious limitations on people’s lives. This shows the importance of the individual biochemical and genetic aspects of each person on his or her health.

This other approach in medicine realizes the necessity of considering nutrition, exercise, diet, and genetics in evaluating and remediating chronic illness conditions. The use of genetic testing in integrative and functional medicine is one way to take all of these factors into account.

SNPs and Integrative and Functional Medicine

Upon completion of the mapping of the human genome, we know there are 20-25,000 genes in each genome. With this knowledge came the information that there are over 80 million variants in the human genome.

These variants are comprised in part of single nucleotide polymorphisms (SNPs) and deletions or insertions in the genome. It is these SNPs that provide significant health information to providers of integrative and functional medicine to prevent or alleviate chronic illness conditions.

Knowing the presence of and placement of SNPs through genetic point mutation testing allows evaluation of the susceptibility to develop many of the chronic illness conditions that affect people today. In addition, this kind of testing helps pinpoint relevant SNPs and their corresponding metabolic markers in individuals.

Testing of this kind provides targeted interventions through the use of traditional medicine approaches as well as supplementation through integrative and functional medicine approaches. Monitoring of individuals’ progress is also made easier with genetic testing by measuring metabolic markers found in the original tests over a period of time.

Individual monitoring of this type is necessary when this kind of personalized intervention and supplementation is used. If there is an overload of either medications or supplementations, there can be an impact on the performance of metabolic processes that can lead to side effects. These side effects can influence functions and responses, such as the immune response.

Individual SNPs will determine how well medications and supplements are working.

Genetic Testing in Relation to Diet and Weight Loss

The relation of life balance to integrative and functional medicineIntegrative and functional medicine practitioners not only deal with illness, they also provide health and wellness evaluations. Current research has shown how important a role genetics plays in the prevention of many chronic health conditions.

Genetic testing can show vulnerabilities to conditions and suggest options for individuals. This kind of testing can also provide valuable information concerning how individuals can respond to different attempts to live more healthy lives.

Genetic testing has been shown to be effective in several areas: diet, eating behavior traits, nutritional needs, exercise, body and weight, and metabolic health. For each of these areas, there are certain genetic markers that can provide information regarding how genetics will affect each of these areas.

Diet

People are seemingly obsessed with weight. How to lose it and keep it off, how to re-distribute it to look more attractive. Professionals in integrative and functional medicine are approached regularly for help in this area.

Everyone knows it’s hard for some people to lose weight on any kind of diet, while others can lose weight any time they want. It’s not just due to lack of willpower that people don’t lose the weight they want. It may also be due to genetics.

Research has shown about 88 percent of people have bodies that resist burning fat through low-intensity exercise. Most people will gain weight if they eat almost any carbs (about 45 percent of people) or almost any fat (about 39 percent of people).

The reason for this is a diet and type of exercise matched to specific genotype lead to weight loss. These diets and exercise types are not the same for everyone.

For example, let’s look at adrenoceptor Beta 3 (ADRB3) with an SNP on rs4994. There are different variations of this gene. If you are either an AA or TT genotype, you have what is called a genetic privilege and just about any kind of exercise will work for you. On the other hand, if you don’t have either of these AA or TT genotypes, this is a genetic disprivilege and only a high-intensity type exercise will help you lose weight.

Further analysis of other genes and SNPs can tell you the type of diet, either low carb or low fat, that will work best for you. In fact, using a diet matched to your genetics can result in a loss of two and half times as much weight as a diet not matched to genetics.

The connection between diet and integrative and functional medicineIn addition to choosing the right diet to lose weight, choosing the right diet may also help you avoid developing a chronic health condition. Research has shown diet to be implicated in many chronic illness conditions, so genetic testing to determine your specific vulnerability to illnesses and your response to particular foods may help prevent them.

Knowing your predisposition to illnesses can lead to targeted dietary and lifestyle changes that may modify any existing conditions and help prevent future developments. Future research may bring more information regarding bioavailable components in foods that can aid in alleviating health issues.

COMT and CYP19 Genes

Research has identified certain genes that work together and appear to show that some people retain fat regardless of, or in spite of, exercise.

In one study, researchers found two genes, COMT and CYP19 that appeared to be involved in patterns of fat loss and exercise. Having one CYP19 gene and variants of that gene did not affect fat, intra-abdominal fat, or total fat. However, having two of these genes seemed to be related to slightly more decrease in body mass index and significantly more decrease in total fat and percentage of body fat.

The researchers also found that having one genotype of the COMT gene and one copy of the CYP19 gene seemed related to significant loss of BMI, total fat, and percentage of body fat.

Why and how these genes and combinations work isn’t known yet. More research is needed to determine this. Other research suggests women with a specific CYP19 variant may also have increased levels of estradiol and estrone which may make it harder for them to lose fat through exercise.

Environmental Factors

Integrative and functional medicine can be a factor behind the success of your weight loss programWeight loss or gain is not solely at the mercy of your genetics however. A combination of genetics and environment is likely behind your success or failure regarding your weight loss attempts.

The thinking of professionals is divided on the subject of genetics versus environment/lifestyle choices. One set of these professionals regards environment to be the telling component. They point to the teaching over the years that food is a reward for good performance at anything. This, combined with constant reminders about food that are around us all the time, makes it hard for some people to lose weight and/or keep it off.

Others believe losing weight and keeping it off are more related to biological functions. They have found people to be metabolically different after losing up to ten percent of their body weight. Their brains also seem to respond to food differently. The emotional response to food is greater, but the brain regions that deal with food restraint are less active. This sets up the person to regain the weight lost.

Further research into why people lose weight and maintain that loss will be needed. Some of that research has to be on the genetic basis of weight loss.

Read Part 2 | Part 3

© Copyright 2018 Michael Lam, M.D. All Rights Reserved.


Dr. Lam’s Key Question

Integrative and functional medicine considers every aspect of an individual’s life in order to best deal with the symptom picture presented. This examination of the whole person leads to finding the root cause of illness conditions. Better outcomes of interventions will result.


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