Monday, January 20, 2020

Personalized Nutrition -- Because Everything is Deeply Intertwingled!

Nutrition is hard to get right because everything is deeply intertwingled. Personalized Nutrition is changing that!

This new perspective on nutrition is gaining attention, as an aspect of personalized medicine, and is the subject of a new paper, Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association.  (I saw it as it was finalized, since my wife, Dana Reed, is a co-author, and a board member and part of the nutrition science team at ANA.)

The key idea is:
Personalized nutrition (PN) is rooted in the concept that one size does not fit all; differences in biochemistry, metabolism, genetics, and microbiota contribute to the dramatic inter-individual differences observed in response to nutrition, nutrient status, dietary patterns, timing of eating, and environmental exposures. PN has been described in a variety of ways, and other terms such as “precision nutrition,” “individualized nutrition,” and “nutritional genomics” have similar, sometimes overlapping, meanings in the literature.
I have always been something less than a poster child for following nutrition guidelines, for reasons that this report cites:  "...guidelines have only limited ability to address the myriad inputs that influence the unique manifestation of an individual’s health or disease status."

I frequently cite the conundrum from Woody Allen's Sleeper, when the 1970s protagonist had just been awakened by doctors after 200 years:
Dr. Melik: This morning for breakfast he requested something called "wheat germ, organic honey and tiger's milk."
Dr. Aragon: [chuckling] Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties.
Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge?
Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true.
Overstated to be sure, but the real issue is that "one man's meat is another man's poison." Determining which is which for a given person has been impractical, but now we are not only learning that this is far more intertwingled than was thought, but we are gaining the ability to tease out what applies to a given person.

I come from this not from biology, but from machine learning and predictive analytics. My focus is on getting smarter about how everything is intertwingled.

One of the most intriguing companies I have run across is Nutrino, a startup acquired by Medtronic, that analyzes data from continuous glucose monitors used by diabetics to understand the factors that affect their glucose response over time. They correlate to specific food intakes, activity, sleep, mood, blood tests, genomics, biomics, and more. They call it a FoodPrint, "a digital signature of how our body reacts to different foods. It is contextually driven and provides correlations, insights and predictions that become the underpinning for personal and continually improving nutrition recommendations." This is one of the first successful efforts to tease out how what I eat (and what else I do) really affects me as an individual, in all of its real-world intertwingularity.

It is time to move beyond the current so-called "gold standard" of intervention-based studies, the randomized double blind placebo controlled (RDBPC) clinical tests. Reality is far too intertwingled for that to be more than narrowly useful. It is time to embrace big data, correlation, and predictive analytics. Some early recognition of this is that drugmakers are getting the FDA to accept mining of patient data as a way to avoid need for clinical trials.

We have a long way to go, but I want to know how likely it is that a given amount of deep fat or hot fudge, or wheat germ or kale (in combination with the rest of my diet, behavior and risk factors), will have a significant effect, over a time frame that can motivate whether or not I indulge in my chocolate or eat my spinach.

It is not enough to know that the dose makes the poison -- I want to know if the average man's poison is really just my meat.

Before very long we will know.


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