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Genomic Medicine: What is the deal with 23andMe?

A relatively new medical discipline is emerging based on the notion of using your genetic material to tailor your medical care. I get asked a lot about it; How does it work and what does it mean? And what does 23andMe provide me with?

Here is typically how it works. There are a number of companies out there that provide test kits. 23andMe, Ancestry, Genova diagnostics, etc. From these tests you get your raw genetic data and input it into a database (i.e. Livewello or MTHFR support) that takes your genomic information and organizes it in to useful bits of information. It looks like this:

dna

The trick is finding someone who can read what the heck all this coding means. Essentially the yellow colours mean there is a minor change on a part of your gene and the red a bigger change. This is called a single nucleotide polymorphism, or SNP. Based on which part of the genetic material has been changed and how much is changed, this can have a major impact on your health or no real impact at all.

From the tests that I have seen, some common complications seem to be in the following categories:

Phase 2 liver detox: symptomatically this can show up as chemical sensitivities, problems processing medications, problems with sulphur based substances, fatigue, and much more.

Methylation: depending on where you have problems in your methyl cycle this can mean a problem with fertility and miscarriages if you cannot methylate properly.

Neurotransmitter (NT) function: if there is a problem clearing neurotransmitters then one may have more problems with anxiety. On the flip side if there is a problem in the coding for making NTs then one may have more depressive symptoms.

The good news is that finding the SNPs does not necessarily mean you will have these issues. Having a SNP and expressing the SNP is a very different thing. Your environment, what you eat, the lifestyle you live will all impact whether the gene will express itself or “turn on”. Knowing they are there means you can support yourself through proper nutrition and supplementation. For those that are expressing the SNP (having issues with chemical sensitivity, propensity for anxiety, problems with miscarriage, etc.), support through supplementation and lifestyle intervention is key.

Will this fix all your health problems? No. But what it will do is give you an understanding of some of the troubled biological processes occurring in the body. If you can support those, in my opinion, you have a better shot at clearing or dealing with other diseases processes in the body. For example, let’s say you have a serious illness, like Lyme’s disease. Figuring out your SNPs and addressing them will not necessarily address the Lyme itself, but it will lay the groundwork to help the medications and supplements you are taking to address the Lyme work better for you.

This is a very simplified view to a complicated medicine, but certainly it has value and is something that I am happy to discuss with patients.

Why fever is GOOD

Have you met the people that tell you, quite proudly, they never, ever, ever get sick? Do you find yourself feeling just a wee bit jealous? Stop feeling jealous.

Well, quite frankly, not getting sick ever, not spiking a fever ever, is a red flag. From an ND perspective, this means your immune system has taken a very long vacation. Which leave these “never sick” people ripe for big disease down the road. This is not a complete cause and effect, but there is a correlation.

Getting sick and having a response to it is a very good thing. The signs you have a cold, sneezing, runny nose etc. are ways your body rids itself of a virus. FEVER is also part of the process. And it’s an important part.

 Here is why:

  • A fever initiates a cascade of events in the body. It increases your white blood cells and antibody production (the good guys that fight bacteria and viruses).
  • Most bacteria and viruses can’t live past a certain temperature. Raising your core body temperature makes it harder for the invaders to survive.
  • Fever initiates iron storage in the Liver so bacteria can’t use it to survive.

Yep. Fever does all of that, and more:

  • Fever also plays role in the development of an active and healthy brain. Microglia cells are responsible for myelination and pruning synapses in the brain. They are activated by the immune system and are present during fever.  Microglia remove pathogens and damaged areas of the brain. They also strengthen the remaining healthy connections within the brain. This means more ability to focus and make connections about the world around you.

Set aside your fears!

A fever cannot cause brain damage unless it reaches 42 C for a long period of time. Your brain has a great way of keeping this in check during an infection. Usually you will not see temperatures rise about 41C. Seizures can sometimes happen in children with high fevers, and this is totally scary, but typically don’t cause permanent damage to the nervous system- it is still prudent to refer to ER or MD if seizure occurs however.

When to be concerned and when to refer to MD or ER:

  • If the fever continues to rise past 41C- 42C – this can indicate a more serious condition (meningitis can trigger higher fever accompanied by stiff neck, aversion to light)
  • Fever that lasts more than 5 days
  • If your child is un responsive, very lethargic, or will not stop crying for extended periods of time
  • When you are unsure… play it safe and call your doc!

GASed: Tired of Being Tired

An MD friend of mine (yes ND and MD can be friends!) asked me what adrenal fatigue is. This is not something that is part of the conventional medical speak, and so, when a patient walks into an MD’s office and says, “My naturopath says I have adrenal fatigue”, they scratch their heads and wonder what in the world is their ND talking about. Not because they don’t believe it doesn’t exist, just because they have not heard of it. So, patients, here is what you can tell your docs when they look at you with a puzzled stare.

The way I discuss adrenal fatigue is by looking at Hans Selye’s General Adaptation Syndrome (GAS) Model. Here it is:

1: Alarm: Upon perceiving a stressor, the body reacts with a “fight-or-flight” response and the sympathetic nervous system is stimulated as the body’s resources are mobilized to meet the threat or danger. Cortisol goes up to allow you to enter into the fight or flight mode.

2: Resistance: The body resists and compensates as the parasympathetic nervous system attempts to return many physiological functions to normal levels while body focuses resources against the stressor and remains on alert. Increase in cortisol if often noted here.

3: Exhaustion: If the stressor or stressors continue beyond the body’s capacity, the resources become exhausted and the body is susceptible to disease. Low cortisol output.

Now here is the catch: In this day and age, our stressors are not shorted lived. We have work stress, family stress, disease stress (yes chronic disease is a stressor), financial stress, stress, stress, stress. Our bodies can only sustain fight or flight for so long before functionally it gives up the ghost.

Symptoms of adrenal fatigue are, you guessed it, fatigue! Also memory loss, lack of concentration, excess sleep or poor sleep (light sleep or insomnia), sensitivity to noise, light and difficulty responding to any minute stressor.

There are tests that can be done to assess adrenal fatigue and certainly ways to fix it.

You can do a simple orthostatic blood pressure check:

From sitting or lying to standing. If the blood pressure drops instead of rises on arising, it is called postural hypotension. Low blood pressure symptoms include dizziness and light-headedness. In Adrenal Fatigue, low blood pressure usually occurs at rest. It is generally prominent when there is postural change.

Salivary cortisol

Salivary cortisol measures 4 points of cortisol in the day, giving a picture of how you are doing throughout the day. Saliva is a very convenient and effective way to measure cortisol levels because, unlike a blood draw, there is generally no anticipatory increase in cortisol levels. The reference ranges are also tighter than blood and give a better picture of what is going on.

Changes to address adrenal fatigue are numerous and varied depending on your health history and your symptoms. Typically, lifestyle interventions are recommended including yoga, tai chi, behavioural therapy, engaging in a balance between work and home life, etc. There are many herbals to choose from to support the physiological processes as well. These are generally best guided by your health care practitioner. Picking the right one out of dozens takes a little finessing.

All in all, I do believe that adrenal fatigue exists, at least in the naturopathic world! It does go by other names too, including “burn out” and “major stress”. It’s often also misdiagnosed as depression.