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Sunday, April 19, 2015

Personalised Nutrition: A look into the future

Personalised nutrition is the future. When the sequence of the human genome was first announced, it was believed that human biology had set a new boundary around its research challenges. It was believed to herald a new dawn in cancer prevention when President Bill Clinton and Prime Minister Tony Blair launched the human genome sequence project in June 2000. Clinton commented: “In fact it is now conceivable that our children’s children will know the term ‘cancer’ only as a constellation of stars” to which Blair added the this heralded: “a breakthrough that opens the way for massive advances in the treatment of cancer”. The era of personalised medicine had arrived and the road ahead was envisaged thus: You doctor would have your genome scanned to check some conditions such as blood pressure where your measurements were marginally high. She or he might find you had a genetic predisposition too high blood pressure and based on your genetic information, the ideal pharmaceutical treatment to stave off hypertension would be identified. Armed with a prescription from your doctor you would go to your high street pharmacist and buy the prescribed drugs and maybe what today is called a ‘companion diagnostic’, a home blood pressure monitoring machine.

The temptation to translate this model to human nutrition was very attractive and so genetic testing companies were set up where for about  €200 a pop, you could be screened for genetic variants associated with diet related diseases. The industry flopped for two reasons. Firstly, when someone is told to eat more fish oil because they have some genetic variant indicative of declining cognitive function in which fish oil fatty acids might play a protective role, it has to be borne in mind that those same fish oil fats influence blood clotting, blood lipids, inflammation, vision and so on. So how could they be sure that what was good for treating cognitive function was maybe bad for your vision or inflammation? Drugs have one single point of action. Nutrients have multiple points of action. The second is that it’s not good enough to tell Homer Simpson he has a genetic variant which influences his cardiac electrophysiology and thus he needs to “watch” his lipids and salt. No, Homer wants a solution, not a problem. There is no wonder drug and no pharmacist to help him. He has to go to the supermarket and start making choices as to the foods that will help balance his lipids and salt. So, he needs customised solutions.

Enter Food4Me, a €9m EU funded project, which looked at all aspects of personalised nutrition: Consumer attitudes, business opportunities, legal and ethical issues, new emerging technologies which give biofeedback and most importantly, an internet based proof-of-principle study of the value of fully internet delivered personalised nutrition which involved providing genetic information, blood analysis and a personalised dietary analysis with feedback and coaching. The latter was the biggest hit with the 1,300 subjects who too part in the 7-centre pan EU study. Subjects entered their data on habitual food intake following a simple template across the Internet. That food intake data was translated into actual weekly nutrient intake and these data were compared to established international standards. The feedback was graphic. If the little cartoon man was in red for calcium you had a major problem to tackle, if it was in amber, it was in need of addressing soon and if in green, it was ok. The subject then was told why they had the problem they had with each nutrient based on their habitual food choice. A high intake of cheese might put calcium in green but saturates in red. A high intake of soup might put energy in green but salt in red. So for the three most urgent nutrients, they received detailed coaching on how to change their food choice to optimise their diet. Unlike Homer walking into the supermarket knowing his problem but not his solution, our subjects went to the supermarket knowing exactly, for them, what foods to chose to optimise their diet. Did it work? Yes it did when compared to a control group who were not given personalised dietary analysis but generalised population healthy eating guidelines.

So the future is thus. Whether by smart phone or a home computer, food choice is inputted and nutrient intake calculated by the service provider who then tells the used the top three problems to solve and what food choices to make to improve things. In fact, the advice won’t be at food level but at a weekly menu level taking into account data on personal taste, access to food, allergies and intolerances and price. This data will be shared with three other players: your smart fridge, a range of supermarkets and your work canteen. The supermarkets will translate the weekly menu into a shopping list and give you a price whereupon you will make your choice and the groceries will be delivered to your door. The smart fridge knows what’s ay home and expects you to interact with the touch screen on the door to indicate what you’ve taken out. I log on: “Good morning Mick” it says and I press a button marked ‘the usual so it deducts a bowl of porridge with milk and sugar, a glass of orange juice and tea. The information is shared with my computer, which now builds up my weekly aggregation of nutrients. Now it re-adjusts its record of the food store. In work I pick a soup and roll and using my swipe card at the check out, and both my computer and smart fridge are informed. On Thursday, I choose fish and chips at work and I swipe my card and I now get a text telling me that I have now reached my 90% limit of salt intake and I have a shortfall in fibre intake. When I get home, my smart fridge that now knows this problem and knows what’s in the kitchen offers several menus to boost my fibre with low salt meal recipes. I pick one but don’t know how to cook it so the smart fridge scans You Tube for demo and away I go.  It’s the future. The white goods industry, the IT industry, retailers, caterers and the food sector are hatching it.

In this analysis I have left out genetic based information, which is a long way off and the postal based blood biochemistry, which is presently operational. If you’d like to read about the project click here and if you’re a little lazy, then watch a 15-minute video on the findings here.  

Wednesday, April 15, 2015

Scientific norms and the WHO


