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1. Read a peer-reviewed article about a nutrition subject as closely related to this course as possible in a

recent magazine or Internet.

2. Present your comments on the article, using the following format and submit a copy of the article
with your assignment.
Name of publication: The Scientic World Journal
Date of publication: 4 June 2013
Authors: Deanna M. Minich, Jeffrey S. Bland
Author's credentials, if known:
Deanna M. Minich, PhD, FACN, CNS: Her academic background is in nutritional science,
including a Masters Degree in Human Nutrition and Dietetics from the University of Illinois at
Chicago (1995), and a Ph.D. in Medical Sciences (Nutrition) from the University of Groningen in The
Netherlands (1999). In conjunction with her academic degrees and extensive teaching experience at
the university level, she is both a Fellow (F.A.C.N.) and a Certified Nutrition Specialist (C.N.S.)
through the American College of Nutrition and has received education in functional medicine through
the Institute of Functional Medicine.
Jeffrey S. Bland, PhD: A nutritional biochemist and registered clinical laboratory director, Dr. Bland
is a former professor of biochemistry at the University of Puget Sound, and a previous Director of
Nutritional Research at the Linus Pauling Institute of Science and Medicine. Dr. Bland has authored
five books on nutritional medicine for the healthcare professional and five books on nutrition and
health for the general public. He is also the principal author of over 120 peer-reviewed research
papers on nutritional biochemistry.
A brief synopsis of the article:
Personalized Lifestyle Medicine - Relevance for Nutrition and Lifestyle Recommendations
This article discusses the role of personalized lifestyle medicine as a comprehensive solution to
unsustainable healthcare costs associated with modern chronic diseases, as well as the inability of
mainstream medicine to improve the safety and outcomes of current clinical treatments for chronic
disease. The authors emphasize the need to personalize nutrition and lifestyle recommendations to
each person, given the failure of generalized recommendations for the masses by various health
agencies (U.S. Department of Health & Human Services, American Heart Association, American
Cancer Society, American Diabetes Association) to effect any real change in chronic diseases and
healthcare costs.
The recognition that nutrition and lifestyle factors are the primary cause of chronic, preventable
diseases can no longer be ignored. The need for lifestyle medicine is now even recognized by the
American Medical Association, calling on its member physicians to acquire and apply the 15 clinical
competencies of lifestyle medicine. The authors emphasize, however, that lifestyle medicine needs to
be personalized to each individual due to several variables such as age, gender, ethnicity, family
history, lifestyle habits, and medication or supplement use, but especially due to genetic variation
within the population. This genetic variation makes pharmaceutical, nutritional, or physical activity

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recommendations detrimental or unsafe for portions of the population. The authors discuss the
important impact of whole foods versus individual nutrients, and the need to account for the many
constituent parts of whole foods, such as phytonutrients and fiber. The implication is that real whole
foods should be the first choice for nutrients, over supplements, due to the important and
individualized impact of food synergy on an individual. Supplements, however, have a role in
situations where diet cannot provide adequate amounts or activated forms of nutrients due to genetic
single nucleotide polymorphisms (SNPs) or compromised health needs a boost in certain nutrients.
The authors cite the growing number of examples of personalized nutrition approaches from
published literature, such as methyfolate (5MTHF) for a methylene tetrahydrofolate reductase
(MTHFR) SNP, and emphasize the use of personalized lifestyle medicine as being propitious with the
rising frequency of these types of cases. Additional examples of numerous other clinical conditions
that would benefit from a personalized lifestyle approach are noted as well, such as ketogenic diets
for epilepsy, or iron restriction for hemochromatosis. The authors also address how to apply
personalized lifestyle medicine to physical activity, stress and behavior, and environment and toxin
load. In the field of exercise genomics, nine specific SNPs have been associated with inherited heart
response issues, demonstrating a variable need for exercise among different individuals. Stress and
behavior responses can also be impacted by inherited SNPs and genetic variants, such as certain
catechol-O-methyltransferase (COMT) enzyme SNPs being associated with mental illness and
posttraumatic stress disorder.
Environment and toxin load are degraded and filtered by the bodys cytochrome P450 family of
enzymes in phase II liver detoxification. Many CYP-450 SNPs have been known for several decades
to variably impact pharmaceutical drug response from person to person. However, these enzymes,
along with secondary detoxification pathways (conjugation), are responsible for filtering out both
exogenous and endogenous toxins. Should one have the CYP-1B1, -1A1, or -3A4 SNP variants,
estrogen metabolism will be impaired, creating toxic intermediate metabolites that cannot be utilized
properly and can be carcinogenic. This might be compounded if the person also has the COMT SNP,
which is also involved in estrogen metabolism, and responsible for converting intermediate estrogen
metabolites to more stable and safer compounds. Even with ideal lifestyle choices that prevent
exposure to exogenous toxins as much as possible (i.e. cigarette smoke, alcohol, etc.), ones own
body can produce (endogenous) toxins that tax the detoxification system, and must be accounted for
when determining a patients treatment plan.
The authors point out the need to assess ones genomic profile along with molecular diagnostic tests
as the primary means by which personalized lifestyle medicine can be effective. They also point out
the likelihood for greater patient compliance from treatments based on genetics. There is a need,
however, to improve the knowledge base of genetic and epigenetic recommendations to more
thoroughly identify the metabolic impact of various SNPs and epigenetic changes in gene expression.
Given the growing paradigm of personalized medicine (in general) utilizing genomic profiles and
new technological diagnostic tools to assess functional biomarkers each year, the authors state that
customized nutrition and lifestyle treatment plans will gradually become personalized to each
individual in addition to the current standard-of-care pharmaceutical treatments. The authors argue
that the documented evidence is mounting which shows how seriously nutrition and lifestyle choices
can impact health, how personalized lifestyle medicine can be key throughout all stages of health, and
how it will ultimately provide the best form of care, reducing costs, and improving safety by
minimizing side effects.

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Your reaction (positive or negative) and why: (Please limit your comments to 2-3 double spaced
pages.)
I found this article to be very thorough, informative, and optimistic for the future of personalized lifestyle medicine and the primary role it plays in health management and disease outcomes.
The authors thoroughly cite many published articles supporting the evidence of the growing fields of
nutrition and personalized lifestyle medicine and its inevitable implementation with its lower costs
and safer outcomes. While the article delineated many successful examples of utilizing individual
genomic profiles to design nutritional and lifestyle treatments, for me, it brought to mind the
implications of a gradual implementation of personalized lifestyle medicine within current healthcare,
nutrition, and lifestyle choices. It should be noted that the goal of personalized medicine, by
definition, is to uncover the biochemical pathways for a given individual that are impaired or
overactiveto find the underlying cause of signs and symptomsnot simply the suppression of
symptoms with drugs. This definition of personalized medicine is not shared by all. Some groups,
especially pharmaceutical companies, define personalized medicine to be the treatment of an
individual with a pharmaceutical drug that will be properly metabolized by her cytochrome P450
enzyme system after determining which CYP-450 SNPs are present. While one could argue that this
approach may improve the outcome of a pharmaceutical drug (avoiding death or damage), it does not
ensure the absence of side effects or the best outcome compared to other treatment options as outlined
in this article. The numerous examples in the article of personalized treatments for metabolic
imbalances caused by genetic variation leaves little room to argue against the merits of personalized
lifestyle medicine. While I fully support the paradigm of personalized lifestyle medicine, the process
of change is very slow within our disease management healthcare system. The implications of this
article suggest that there will need to be significant changes in our current broken system. For
instance, pre-existing (genetic) conditions cannot be held against someone. In fact, the insurance

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companies should recognize the cost benefits of personalized medicine, and they would embrace it if
they were smart. Given that they exist to make money at the expense of the insureds healthan
inherent conflict of interestit may be that personalized medicine ushers in the cash-pay model for
services and gradually eliminates, or minimizes, the third-party insurer model. Currently,
personalized (lifestyle) medicine for chronic disease is provided primarily under the cash-pay model
using physicians trained in functional and integrative medicine, because insurance companies wont
cover treatments even if they are effective. This cash-pay model is growing as the demand for
effective treatments grows and doctors recognize their inability to help their patients within the
constraints of third-party insurance companies.
The impact of personalized lifestyle medicine on nutrition has the potential to gain compliance from more people as they discover why they must eat certain foods to be healthy. Were this
proactive approach to be available at the birth of a child, the process of training optimal nutrition
habits could be more easily facilitated by parents if they have a dietary outline of which nutrients
their child should augment and which ones they should avoid. For adults with entrenched unhealthy
nutritional habits, the genetic profiling can strongly influence one to comply. However, for that
segment of the population which may refuse to alter nutritional choices despite having their genomic
profile, it will likely require some sort of incentive-based program to impact behavior. One
consideration could be to have government stop subsidizing parts of the food industry, such as sugar
manufacturers, that are manufacturing processed, refined, nutrient-depleted, food-like edible
substances that comprise about 80% of our grocery store shelves. This is incentivizing the wrong
foods. Were they to subsidize real whole foods and their minimally processed, nutrient-dense
products (i.e. almond flour, coconut milk), healthy foods would become very affordable. Indeed,
subsidizing real foods may be the only way to counteract the food industrys penchant to create
value-added, nutrient-poor Franken-foods. At the very least, declining to subsidize the sugar

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industry, would at least create a more level playing field between Franken-foods and real foods.
Eventually, the concept of applying sin taxes on candy, sugary beverages, refined foods, and other
nutrient-poor, highly refined foods and drinks is a realistic option to pay for the growing health crisis
in our country. Those who choose to eat properly and optimize their health, regardless of underlying
genetic SNPs, cannot be considered as having an equal financial burden for healthcare as those who
choose not to eat healthy foods and drinks. Additionally, having underlying SNPs that impact
metabolic pathways and make one more vulnerable to certain disease processes should not excuse
someone from adhering to good nutritional habits. On the contrary, such individuals may need to
refrain from occasional indulgences that others may be able to metabolically assimilate without
concern. Some may require more restricted diets than others, but all should observe zero to moderate
intake of nutrient-poor indulgences, as even genetically fortunate individuals (if they exist) can
acquire chronic diseases if they ingest sufficient amounts of unhealthy foods over time.
Lifestyle choices such as smoking, drinking alcohol, lack of physical activity, and lack of
stress reduction practices (including lack of sleep) have a well-documented adverse impact on health.
The article mentions various SNPs that can magnify the severity of impact if one chooses any of these
poor lifestyle habits. Some employers are now giving incentives to employees to not only eat healthy
and exercise regularly to maintain a healthy weight, but to abstain from smoking and drinking
alcohol, and even to participate in mindfulness based stress reduction programs. Tobacco already has
a steep sin tax applied to it, with alcohol having a moderate tax, but it is difficult to tax a sedentary
lifestyle, lack of sleep, or mindfulness meditation. An incentive-based program of some kind, in
combination with personalized lifestyle medicine, is likely to gain the most compliance in changing
lifestyle habits. The increasing success of nutrition and personalized lifestyle medicine, combined
with growing consumer awareness, will eventually pressure government officials to redistribute
subsidies and insurance companies to reassess their business model. It remains to be seen how long

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insurance companies and lobbyists will fight for the broken paradigm and delay the inevitable
collapse of a disease management system that has been flawed from the beginning.

Choosing Peer-Reviewed Articles

Huntington College of Health Sciences strives to provide our students with the best possible
experience in the research and evaluation of research in the field of Health Sciences. Many of our
assignments will require students to evaluate or select peer-reviewed or refereed journals or articles.
Peer-reviewed articles are those that are written by experts in the field. For us here at Huntington
College of Health Sciences those will usually be in some area of the health sciences field. These
reviews are done by the authors peers in the field to assure the accuracy of the content of the article.
When a reviewer actually does the article review they are, in most cases, unaware of who the author
of the article actually is, therefore, they are able to give an unbiased opinion on its contents.
Huntington College may require these articles for an assignment because they are more likely to be
based on expert opinion and have been reviewed by other experts in the field. These are the
preferred sources of information on the subject you are researching.
Sometimes it may be difficult to tell whether the article is peer- reviewed or not. In that instance you
may do the following:

You might also find the website for the journal on the internet. In some or most instances the
website will indicate if the article is peer-reviewed.

If you are using a database search to find an article, limit your search to peer-reviewed
articles.

If you have a hard copy available, examine the publication to see if it is peer-reviewed.

Check the database Ulrichsweb.com. You must type in the full title including any initial or
article in the title. There will be a symbol next to the article to indicate if it is a peerreviewed or refereed article. You may want to ask for volume 5 of Ulrich's which lists the
major peer-reviewed journals within the "Refereed Serials" section at your local library.

A good resource for better understanding the process of finding peer-reviewed articles is
http://lib.calpoly.edu/research/guides/peer.html.