Imagine going to your annual checkup and handing the doctor a tiny chip that contains every genetically predisposed health condition coded into your DNA. Does diabetes or heart disease run in the family? Early lifestyle changes in combination with physician-prescribed foods and supplements could head off the disease before it even presents in predisposed patients. This emerging concept—called Lifestyle Medicine—used in tandem with nutrigenomics is quickly altering the landscape of modern medicine and helping physicians treat predispositions to disease instead of treating full blown diseases, improving health and curtailing costly medical procedures and pharmaceuticals.  

What’s more, that approach to medicine could only be about 10-15 years in the future, according to Jeffrey Bland, PhD, FACN, FACB, an internationally renowned researcher in the field of nutrigenomics, and chief science officer for Metagenics Inc., a nutrigenomics and lifestyle medicine company headquartered in San Clemente, CA.
 
“We have held this view throughout history that disease is something that befalls a person as a misfortune over which they had no control, that somehow within our genes laid a legacy of some fault in our physiology or metabolism that ultimately would produce the disease of choice that we inherited—heart disease, diabetes, cancer, osteoarthritis, dementia—all of these conditions have been defined in the tradition of medicine as being genetically linked, suggesting that the individual had little to do with it; it was just the luck of the draw,” he said.
 
He went on to explain that a new lifestyle medicine model emerged out of the discoveries of the Human Genome Project. “What is now being recognized is that these chronic age-related diseases, like heart disease, type 2 diabetes, arthritis or maybe even Alzheimer’s disease, are not necessarily flaws in our physiology but rather manifestations of unique responses our genes have to the environment in which they are exposed,” he said. “Therefore rather than having a disease, what we really might have is a unique genetic response to the environment that’s actually the genes doing what they’re supposed to do. The triggering of a genetic expression then triggers an alarm response to defend us against what we perceive to be a hostile environment that in the short term could’ve been good for us, but in the long term as it continues to be expressed as it’s exposed to the environmental signal this response becomes injurious to the body.”
 
In short, the disease in and of itself isn’t a product of bad genes; it’s a reflection of a unique genetic response to our specific environment, our diet, our lifestyle, the chemical and biological environment in which we live. Rather than ascribing to the centuries-old model that disease is locked in our genes as an inevitable consequence, this new model asserts that our genes are doing exactly what they are supposed to be doing by responding to perceived threats.
 
“If we are getting a negative response of ill health, rather than taking a drug to mask the symptom we ought to be changing the environment to which our genes are exposed to modify the genetic expression so that they’re not expressing the alarm that leads to inflammation, insulin or oxidative stress,” explained Dr. Bland. “It’s a remarkably exciting development in medicine because it gives options for people to engage much earlier in creation of an outcome in their health that is more than just a disease. It can utilize their genetic potential to achieve a higher level of health.”
 
To frame the concept of lifestyle medicine against a well known backdrop, Dr. Bland cited the example of gluten intolerance, which is associated with more than just Celiac disease, but also diseases as far ranging as gluten enteropathy, inflammatory bowel disease, rheumatoid arthritis and even heart disease. “In the context of lifestyle medicine, those who carry the genes for gluten sensitivity are not necessarily diseased, they just carry the genes for a unique environmental response to a food borne antigen called gluten such that by changing their environment (removing gluten from their diet), the genes no longer express the message of alarm which produces the disease enabling the patient to live a healthy life,” he said.
 
For conditions other than gluten intolerance or other food and chemical allergies, the key to health lies in understanding the unique sensitivities of a person’s genetic alarm system. For instance, following a low fat, low cholesterol diet is usually advised to everyone.
However Dr. Bland said that for heart disease candidates who present with certain polipoprotein E (apoe) genes, there is a much higher chance of triggering those genetic alarms if they don’t watch saturated fats and don’t include antioxidants in their diets.
 
“When should people get concerned, when they get an acute disease and become a candidate for the emergency room, or is it much earlier, when their biomarkers change and they start seeing a trajectory towards something as simple as elevated blood sugar or cholesterol?” he asked. “Those are indications that the genes are expressing an alarm response to the environment. Rather than taking a statin to reduce elevated cholesterol, why not ask the question why the body turns on the genes to synthesize cholesterol and how can we modify the environment to cool those genes off.”
 
First wave conditions at the forefront of this trend are metabolic disorders such as type 2 diabetes. “There is no drug therapy as successful for managing type 2 diabetes as lifestyle intervention because it’s the most significant singular rising disorder today,” said Dr. Bland. “Once the proof of concept is delivered in this area, it will spread rapidly to other diseases like cardiovascular disease and into the whole family of auto-immune diseases, which have to do with things like thyroiditis, which is increasing rapidly in women. These are all conditions associated with lifestyle modulation.”
 
He added that Alzheimer’s disease will also likely benefit from the lifestyle medicine approach.
“If we were to ask where the future for the prevention and treatment of Alzheimer’s disease is, I would also think it’s in this area,” he said. “I don’t think we’re going to see a drug in and of itself that will solve the problem of AD. I think what we will find is a genetically related susceptibility with lifestyle and environment triggers that produces the condition. Therefore, the solution is not the drug; it’s understanding the genetic uniqueness of the patient and designing their environment and nutrition correctly.”
 
The cost of initiating gene sequencing for the purposes of the lifestyle medicine approach isn’t cheap, but it will be. “ We’re now moving this year to what people three years ago thought was impossible—the ability to sequence a person’s whole book of life, their whole genome, for less than $1000 and it’s been suggested that the cost will very soon drop to less than $100,” said Dr. Bland. “Once everyone gets their genetic imprint on a chip that can be worn around the neck, stored on a computer or even on a phone, it will give access to a treasure trove of extraordinary information within each of our genomes that will tell us where our uniqueness lies.”
 
In the end, taking a genetically individualized approach to medicine won’t reveal everything about how we’ll get sick or how we’re going to die, but it will tells us how we can live an optimal life by basically modulating our environment to be consistent with our genetic weaknesses, said Dr. Bland. “It will have a profound influence on how doctors are trained, how medicine is delivered, how reimbursement happens, how people ultimately manage their diseases post-diagnosis—it will change therapeutics and the pharmaceutical industry going from  blockbuster drugs to microbuster drugs because people will have to be treated as individuals,” he concluded. “We are witnessing a transition in medicine (i.e., how nutrition and lifestyle play roles) that is unprecedented in the history of the human race.”