Predictive Prescription Diets Could Be Closer Than We Think

Imagine an algorithm that would tell you exactly what to eat for your ailments and even prevent you from suffering from genetic disease.

No longer would the conundrum of choosing between keto, Mediterranean, paleo, or other trending, slick-sounding diets exist. Your algorithm would be form-fitting—not just to your medical diagnosis but also to your unique medical history, genetics, living environment, race, age, sex, medications, stress level, and microbiome.

Because people are more than just their illnesses, the multitude of factors in choosing a personal diet is important. An eating plan that works well for tackling heart disease might contain foods that don’t metabolize well for a particular individual, based on their constitution, or may not identify an ongoing environmental factor, etc. More insight is needed to provide a comprehensive, individualized plan.

In the current model of health care, issues like heart disease risk and metabolic syndrome are likely to be addressed with prescriptions than a prescribed diet, adding an expensive and sometimes unnecessary burden on the health care system and patients alike. Precision medicine, however, is now examining the efficacy of these current medical practices.

Reducing the burden of health care costs is but one goal of a five-year, $156 million National Institutes of Health (NIH) study on nutrition that begins this year.

Diving deep into the health and habits of 10,000 diverse Americans over five years, researchers are hoping to discover the connections between dietary guidance and optimal health to transform our approach to disease. The study began with planning in 2022 and is projected to begin enrolling participants this year.

Nutrition for Precision Health

Called the Nutrition for Precision Health, the study’s goal is to establish predictive algorithms to inform targeted eating approaches, expanding on what’s currently standard dietary advice for specific groups, such as pregnant and lactating women and diabetics. The aim is to develop more precise factors for each group, adding hundreds if not thousands of additional factors, such as metabolic fluctuations over time, microbiome signatures, home environment, and subjective measures of a person’s experience, such as stress, career, and other complexities.

In an NIH news release video, Dr. Holly Nicastro, coordinator for the Nutrition for Precision Health program, said, “We know nutrition, like medicine, shouldn’t be one-size-fits-all or one-size-fits-most, so we are looking to move away from that.”

As promising as it sounds, we are nowhere near this new model now. For one, diet rarely makes its way into doctor-patient conversations. A common complaint is how little nutrition training is offered in medical curriculums.

There also exists a gap between what’s currently known about diet and how, or even if, it’s implemented in family medicine. For example, though studies have connected cognitive decline with diet, most patients are given prescription medicines that often come with a multitude of side effects that may lead to yet another prescription. Being on the prescription merry-go-round can leave people feeling hopeless.

Could the Answer Be in Our Guts?

Frustration isn’t limited to doctors’ office practices. Even with promising studies, there are many dots that haven’t been affirmatively connected by researchers. But the microbiome—the millions of microscopic creatures called “microbes” cohabiting with humans—offers incredible promise in providing a better understanding of how each of us is unique.

The term “microbiome” was coined in 2001 and established a new frontier in health involving bacteria, fungi, and other microorganisms that inhabit the body, including the gut. Its connection to immune health offers more credibility to the notion that nutrition can cure disease and illness.

A deeper understanding of the microbiome could hold the answer to the age-old diet dilemma: Why do some people seem to lose weight effortlessly while others feel miserable following the same diet? An increasing number of Americans suffering from food allergies, intolerances, and sensitivities make universal diet plans even less appealing.

Increased knowledge of microbiology has also opened up more questions, said Dr. Christopher Gardner, Stanford University professor of medicine and nutrition scientist. For instance, scientists know digestion’s main role is to release molecules into the bloodstream, but they haven’t named each molecule or realized their precise functions. Nor has research developed an explanatory list of inflammation biomarkers or a comprehensive directory of flora.

“It’s all in the works, so, at the end of the day, I really think we’re going to have this fabulous trifecta of dietary manipulation of the microbiome to improve immune function,” Gardner said. “That would be the ultimate.”

Knowing more about this microscopic world is one way in which Nutrition for Precision Health could equip researchers—and eventually doctors and patients—to offer specific dietary recommendations. The study’s goal is to create directories with data from 10,000 diverse participants, including 500 who’ll be locked together for controlled diet and lifestyle studies for three two-week periods.

The NIH All of Us Research Program is inviting 1 million Americans to join a database that represents the diversity of our culture so researchers can learn more about how biology, lifestyle, and environment impact health. The subjects for Nutrition for Precision Health will come from this database.

The smaller group of 500 who’ll be studied for two weeks will help researchers overcome a major hurdle in human nutrition research: full control of subjects’ diets so there can be no “cheating.” Subjects will live in a metabolic chamber, a research lab where fecal and blood samples can be obtained, while they follow three different diets so that the physiological and metabolical effects can be measured in real-time.

Why Nutrition Studies Are Complicated

Complexities in nutrition research don’t revolve only around unknowns in microbiology but also around the weaknesses of major players—research subjects, the government, and the diet industry.

First, results aren’t always duplicated, as a 2019 Advances in Nutrition article demonstrated. It highlighted at least three microbiome-related studies’ variable outcomes despite nearly identical interventions, noting that dietary factors can’t always predict metabolic outcomes, in part due to our diverse microbiomes.

“The field of precision nutrition is still in its infancy, although the rate at which it is developing resembles more the growth spurt of a gangly teenager. Growing pains are to be expected and an abundance of frustration is unavoidable, as with any typical teenager,” the article stated.

Second, most nutrition studies aren’t funded beyond a year, Gardner said. “Let’s say we change the microbiome. It is malleable. It absolutely is malleable, but can you maintain the changes you achieve is a question we really don’t know,” he said.

Third, many research subjects aren’t interested in sustaining new diets. Gardner pointed to an NIH-funded study he did years ago in which the participants were fed a specialized diet for a month and their LDL cholesterol was lowered. Such studies are expensive, due to the cost of meal preparation, but most didn’t continue the diet because they didn’t want to change their shopping, cooking, and eating habits—even with a recipe book.

Fourth, a great deal of research is industry-funded, which can lead to products that haven’t been extensively vetted. On the other hand, layers of bureaucracy in government-funded studies slow down the pace of research and product development. A 2022 Frontiers in Nutrition article drew these distinctions as it urged those involved in the Nutrition for Precision Health study to maintain scientific integrity while bearing fruit for consumers to be able to integrate new knowledge easily and practically.

One recent study seemed to have that kind of impact, albeit in a very organic way. The American Gut Project, a crowdsourced study launched in 2012 that garnered more than 11,000 participants who paid their way into research, led to countless podcasts, articles, and challenges on increasing plant consumption.

Published in 2018 in mSystems, the project’s big takeaway was that regardless of what diet participants followed, those who ate more than 30 different plant types per week had more diverse gut microbiomes than those who ate 10 or fewer types of plants.

Achieve Better Gut Health Now

That study was good news for those who want to experiment with their diets because the research teases out more specifics. There are a few other tactics for diet and other lifestyle choices that experts agree make a difference in microbiome health.

Dr. William Li, president and medical director of The Angiogenesis Foundation, suggested in an email interview with The Epoch Times that people eat mostly plant-based foods, especially those with dietary fiber such as kiwi, broccoli, bok choy, carrots, and apples. Probiotic foods that naturally contain healthy bacteria should also be eaten, including yogurt, pao cai, kimchi, sauerkraut, and pickles.

“Just as importantly, a microbiome-friendly diet should avoid … too much ultra-processed foods that contain artificial preservatives, colorants, flavorings, sweeteners,” wrote Li, who authored the book “Eat to Beat Your Diet.” “These chemicals have been shown by researchers to disrupt the healthy gut bacteria (less beneficial bacteria), allowing harmful bacteria to grow.”

Antibiotics will wipe out both bad and good bacteria in the gut, and their overuse is problematic for immune health, Gardner said. A 2021 study in the journal Cell Research pointed out that the most studied sources of microbiome variation are antibiotic treatment and diet.

While probiotic supplements may seem like a great idea to rebuild missing microbes, Gardner said it’s a “buyer beware” market since it’s barely regulated. Inconsistencies in bacteria levels in supplements, toxicities, and contaminants are all concerns in this growing market.

Li said marketing claims are mostly ahead of the science and warned consumers that if something “sounds too good to be true, it probably is.”

Finally, Li said being more mindful about eating will aid in digestion. He recommends adopting traditional values surrounding food, such as preparing fresh, locally grown, and in-season food, and sitting down with people rather than eating while watching TV or scrolling your phone.

“Most people are conditioned by lifelong eating patterns that have been shaped by marketing of ultra-processed foods, the appeal for quick and convenient foods (usually not fresh and highly processed), and inexpensive foods that are mass-produced,” he wrote. “These forces make it difficult to quickly change behavior toward healthier eating patterns.”

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