Personalized Wellness Past and Future

 In Artigos

Will the Science and Technology Coevolve?

Kanter, Mitch PhD; Desrosiers, Ashley MS, RD
Nutrition Today: July/August 2019 – Volume 54 – Issue 4 – p 174–181
doi: 10.1097/NT.0000000000000354
Nutrition Communication

Personalized wellness encompasses individualized diet treatment plans, exercise regimens, and antistress programs. In time, it will include health and nutrition recommendations and programs based almost solely on one’s genetic profile and predispositions. But how evolved is the science behind these products and services and where do the greatest opportunities lie to improve public health? This article reviews the state of the science and technologies and products currently driving the personalized wellness marketplace. It considers how highly developed genomics science is and whether the field is truly at the point of creating diet and fitness plans for individuals based on their genetic profiles. It is intended to explore how the science and technology may coevolve in the future.

We live in an era of customization, where consumers can personalize nearly every aspect of their lives. From a health perspective, there is rising demand to integrate personalization into medical, nutrition, and wellness services. Although the term “personalized wellness” can mean different things to different people, for the purposes of this article it is defined as a means of customized, individualized care for each person’s unique needs. It means breaking from the traditional “one-size-fits-all” approach to nutrition, health, and wellness that has long characterized the Western approach to healthcare.

Today, personalized wellness encompasses individualized diet treatment plans, exercise regimens, and antistress programs. In time, it will include health and nutrition recommendations and programs based almost solely on one’s genetic profile and predispositions.

Companies in several wellness-focused sectors are trending toward a personalized approach—think individualized nutrition plans, exercise monitors, and fitness trackers. Grocery stores are beginning to offer customers recommendations for healthy foods based on their shopping preferences, among other things. But how evolved is the science behind these technologies? How many of the current offerings are based on validated science, and how many are a clever repackaging of existing tools? Which products and services have gotten a bit too far out in front of the science? Most importantly, where do the greatest opportunities lie to improve public health?

To assess these issues, this article reviews the state of the science behind personalized wellness, as well as the technologies and products currently driving the marketplace. It considers how highly developed genomics science is and whether the field is truly at the point of creating diet and fitness plans for individuals based on their genetic profiles. How “personalized” can it really become? What will the science of customization look like in 5 years? In 25 years? And how much evidence is necessary before various technologies are accepted as part of routine care?

This article is intended to provide an overview of the key concepts that form the scientific foundation for the field, as well as the current technologies available in the marketplace. It broaches these and related issues to assess the state of the personalized wellness field and explore how the science and technology may coevolve in the future.

THE SCIENCE BEHIND PERSONALIZED WELLNESS

Personalized Medical Treatment

In the past, medical diagnoses were often made based on a patient’s outward appearance or their verbal description of symptoms, although it has long been common knowledge among health professionals that the same intervention may produce different results in different people.1 Today, healthcare providers use research from the early stages of the personalized medicine movement when assessing risk factors, ordering diagnostic tests, and recommending treatment options, often via biomarkers that can confirm the risk or presence of disease.2 Couples seeking to start a family can meet with a genetic counselor to determine which traits from each parent may influence the health of their unborn child.3

The future of personalized medicine looks even more promising with the advent of the burgeoning field of precision medicine. The National Academy of Sciences, Engineering, and Medicine defines precision medicine as “the use of genomic, epigenomic, exposure, and other data to define individual patterns of disease, potentially leading to better individual treatment.”4 While personalized medicine involves general tailoring of current scientific knowledge to assist an individual in their pursuit of health, precision medicine places an emphasis on exactness and specificity as well as utilization of a multifaceted approach.4 Both paradigms represent the future of fully integrative and comprehensive healthcare, wellness, and nutrition services, although the use of genomics in medicine is much further along than it is in some of the allied health fields such as nutrition.

One of precision medicine’s biggest informants is the field of genomic medicine, which uses genomic information about an individual as part of their clinical care.5 Genomic medicine exists because of the Human Genome Project (HGP), which was completed in April 2003.6 This incredible accomplishment—sequencing the entire human genome— occurred a mere 50 years after the discovery of DNA itself.6,7

Results from the HGP indicate that the human genome contains roughly 3.3 billion individual base pairs (nucleotides) that form roughly 20 000 to 25 000 genes. The human genome sequence is greater than 99% identical in all humans, with less than 1% of gene variation between people.6,8 Most variations are small single-nucleotide polymorphisms (SNPs), the substitution of one nucleotide for another in a gene sequence. Some changes are large, such as the addition or deletion of possibly thousands of nucleotides in a DNA sequence. Differences that occur in more than 1% of the population are called polymorphisms, whereas differences that occur in less than 1% of a population are referred to as mutations.8 Regardless of the type of genetic variation, any alterations to the genetic code could potentially result in genetic replication errors, synthesis of abnormal proteins, and development of or resistance to disease.6,7 Genomic medicine research seeks to uncover such alterations and how they affect disease states.

Medical researchers have developed improved diagnostics and more effective therapeutic strategies based on clinically validated evidence from genetics studies.6 Roughly 2000 genetic tests are regularly used in clinical settings. Most of these tests diagnose rare, single-gene disorders (Huntington, metabolic birth defects, phenylketonuria, etc), whereas some are used to determine validated genetic risk probability, such as testing for variations in the BRCA1/2 genes for breast cancer.7

Oncology is leading the charge in this area, and most respected clinics now incorporate genetic and genomic markers of individual cancer subtypes into cancer screening procedures,5 diagnostic classification of cancers,4,9 and treatment strategies for genetically unique cancer subtypes.4 Genomic medicine is also being used to improve treatment of infectious and rare human diseases,5 to tailor pharmacotherapies to individual metabolic and genetic needs,6 and to reclassify mental illnesses based on neurological molecular signatures.4

Although the utility of genomics technologies is currently greatest in the areas of disease diagnosis and treatment, the use of genomics information is beginning to trickle into allied health professional care as well.

Personalized Nutrition

In the nutrition arena, registered dietitians use dietary recalls, lifestyle assessments, and biomarkers, among other tools, to individualize interventions for clients. None of these tools are optimal for generating precise information, and some nutrition professionals have begun to use various genomics tests and markers to create more individualized assessments.7,10,11 Nutritional genomics is still in its relative infancy compared with precision medicine. As more SNPs are identified over time, and additional diet/gene relationships are elucidated, opportunities to use personalized nutrition in routine care could become as prevalent as precision medicine. In the interim, using genomics information along with biomarkers and other clinical tools is a viable use of this evolving technology.

Nutritional Genomics

Of relevance to nutritional scientists is information on how genes and nutrients interact on a cellular level to control phenotypic outcomes (ie, disease). The overarching study of such interactions is called nutritional genomics, and it is a burgeoning area of interest among health and nutrition researchers looking to develop personalized nutrition standards of care.7 The field of nutritional genomics is further broken down into nutrigenetics and nutrigenomics.

Nutrigenetics is the study of how genetic variability between people affects individual metabolism of nutrients and subsequent health outcomes.7 Genetic variability affects the way people process dietary cholesterol,7,8,12 folate,7,12 choline,7 lactose,12 starch,13 and caffeine,14 among other nutrients, all of which can influence an individual’s risk of developing cardiovascular diseases, micronutrient deficiencies,7 inflammation, oxidative stress, dyslipidemia,15 lactose intolerance, hypertension,12 and obesity.7,12,15,16

Nutrigenomics is the study of the interactions between dietary components and the genome.7 For example, recent studies have shown that diet modification in obese individuals leads to down-regulation of gene activity related to metabolism and insulinlike growth factor,7 which in turn can affect weight loss. Other studies indicate that a Mediterranean diet reduces fasting blood glucose and lipid levels as well as stroke incidence in subjects who possess a SNP correlated with type 2 diabetes.17

While research regarding the impact of genes on nutrient metabolism and the impact of diet on genetic expression is promising, the literature underscores the complexities associated with current research, suggesting the use of nutrigenetics/nutrigenomics in clinical settings is in the early stages. For example, studies on obesity and genetics have identified a relationship between BMI in individuals possessing multiple copies of the AMY1 gene that controls salivary amylase production.13,16,18 What the significance of this finding means from both an evolutionary and a therapeutic perspective is still unknown. Various evolutionary theories have been posited, and current technical discussions on the issue are akin to asking a version of the question: “What came first: the chicken or the egg?”

Further complicating the issue, diseases with nutritional implications are classified as either monogenic (controlled by one gene) or polygenic (controlled or influenced by multiple genes).1,6 Monogenic diseases were some of the first to be identified with the advent of genome sequencing due to the relative simplicity of their mechanisms of action and include phenylketonuria,1,7,12 sickle cell anemia,6 lactose intolerance,19 cystic fibrosis,5 and others. A disease controlled by only 1 gene does not mean that there is only 1 mutation that causes it. For instance, more than 900 different mutations in the CTFR gene that causes cystic fibrosis have been identified, each potentially responding in a unique way to various medical and nutritional treatments.5

Scientists have identified several genes involved in the development of polygenic diseases and are still working to determine how their combined influence produces differential health effects. There are 20 known genes associated with the development of obesity alone and thousands of gene combinations that can produce phenotypic results.

Finally, a subset of nutrigenomics is nutritional epigenomics,7 the influence of diet on changes in gene expression without changing the DNA sequence itself. That is, certain genes and proteins can be turned “on” or “off” based on the diet one consumes. Other lifestyle and environmental factors are epigenetic influencers as well. Epigenetic effects are maintained by methylation of DNA7; successful methylation is influenced by levels of folate, methionine, choline, vitamin B6, and vitamin B12 in cells,20 suggesting a strong nutritional influence.

Based on the complexities of diet-gene interactions and the distinct possibility different nutrients or nutrient combinations can influence specific genes or SNPs, it should be clear that unlocking the full therapeutic potential of nutritional genomics will require more research over the next several decades, but the opportunities are limitless.

The Microbiome as a Factor in Personalization

Much like the HGP, the Human Microbiome Project led to the creation of a “representative” blueprint of human microbiome genes in 2012.21 Although all humans share this “core microbiota,”21,22 research has estimated that the gut microbiome can be as much as 90% different between individuals.23 An individual’s diet, health status, and other lifestyle factors22,24 play a larger role in shaping the microbiome than genetic influence alone.

The functional diversity of an individual’s gut microbiome affects many biological processes, the most relevant of which is its effect on an individual’s metabolism of food.23,25 Gut microbes are responsible for the production of short-chain fatty acids from fermentation of nondigestible fiber. Short-chain fatty acids assist in preservation of colonic integrity, mediate blood glucose homeostasis, influence de novo lipid synthesis and storage, regulate the inflammatory response, and promote appetite regulation.26 In addition, gut microbes produce vitamins and other compounds that humans do not have the genes to synthesize, including B12, B6, B5, niacin, biotin, tetrahydrofolate, and vitamin K. A healthy balance of gut microbes also influences iron absorption.27 Put simply, an individual’s gut microbial community plays a large role in determining what nutrients are available from food.

Studies show that consuming a typical American diet results in less variety and functionality of gut microbes compared with a healthful diet high in fruits and vegetables.28 Microbial population imbalances that affect the body’s ability to absorb energy from foods are also found between obese and lean humans, with the obese microbiome becoming more like that of a lean person after weight loss or bariatric surgery.25 Research in mice suggests that it is easier to destroy a healthy microbiome via an unhealthy diet than it is to create one by making healthy lifestyle changes and that poor eating habits early in life can prime the gastrointestinal flora to be more resistant to improved diversification regardless of improvements in eating habits later in life.28 This strong susceptibility to diet quality is especially fascinating considering the relatively complete rejuvenation of microbial diversity seen in individuals who complete broad-spectrum antibiotic treatment for illness.23 It remains to be determined the extent to which dietary changes, microbiota restorative therapies, or immune modulation may alter disease course.25

The Mayo Clinic Center for Individualized Medicine has an ongoing Microbiome Program that studies the relationship between microbiome composition and the development of celiac disease and gluten insensitivity, irritable bowel syndrome, rheumatoid arthritis, and various other conditions with the goal of designing individualized diets to maintain health and prevent disease.29,30 The project has led to the creation of data sets cataloging changes over time in both microbiota and hosts from 3 cohort groups: (1) pregnancy and preterm birth, (2) onset of inflammatory bowel disease, and (3) onset of type 2 diabetes.21 Projects like these will one day allow the development of personalized nutrition recommendations based on this most individualized facet of human interaction with food.

The Science in Review

Effective integration of truly personalized wellness into routine clinical care based on omics technologies and/or the microbiome is likely years away, but the future looks promising.

So far, the explosion of genetic research has been used primarily to enhance risk stratification and develop more effective screening processes for disease, which helps patients and providers have more honest conversations about risk, diagnosis, and/or prognosis.8 Providers are a crucial link to help mitigate the risks associated with this field. For example, consumers may struggle to fully interpret actual risks of developing a disease for which they have a genetic tendency. Misinterpretation of this risk may cause undue anxiety or needless lifestyle changes, reinforcing the role of a trained professional who can help put things in context. This is just one example of downsides that must be considered with the proliferation of genetic—and other personal health—information that is now available.

Consumers who purchase available technologies need to understand that information gleaned from omics or microbiome testing currently tell a part of the story, but not the entire story. When coupled with other diagnostic tools, they can help to strengthen recommendations, giving a more complete picture of a person’s personal health profile. The science is evolving—albeit rapidly—and additional data points can help provide a more robust health/wellness picture for the consumer at this time.

NEW TECHNOLOGIES AND THE MARKET FOR PERSONALIZED WELLNESS SERVICES

Although personalized wellness information based on genomics data remains incomplete as the market waits for the science to catch up, scientific advances in tracking technologies have allowed for the generation of personalized health and performance goals that include aspects of well-being such as mood, attention, endurance, and weight maintenance.12 Further, increased online access to scientific research, technology, and health recommendations has, in some instances (for better or worse), lowered individuals’ exclusive reliance on healthcare providers for health and wellness information.

While the growth of personalized wellness technologies has enabled health and wellness entrepreneurs to create companies and product lines that provide an opportunity for consumers to manage their health outside the doctor’s office, the consumer is often left to police the quality and validity of the devices they rely on to provide personal advice. A call for greater regulation has been made by some in the industry31 to ensure apps and products are independently validated. Currently, oversight of these products is few and far between.

Tracking and Monitoring Devices

Over the past decade, the amount and types of monitoring technologies that help consumers personalize their lifestyles have soared. The introduction of the iPhone in 2007 revolutionized the industry. Since that time, wearable technology has allowed consumers to track various lifestyle factors in new and easy ways, and thousands of apps have been developed that give users a window into their personal health status by tracking movement, nutrient intake, and sleep, among other things. In fact, the use of wearable-based wellness devices has become so prevalent and so well accepted that insurance companies have taken notice and are beginning to capitalize on the technology. Apple and Aetna announced a collaboration that will offer wearable-based wellness services to members. This collaboration will, according to Aetna, leverage the Apple Watch to offer incentives and health management tips to participants in an effort to prevent chronic disease and improve quality of life.32

Wearables: Fitbit, the Apple Watch, and Others

The first wearable tracking device, the Fitbit Tracker, was sold in 2009.33 Early iterations of these devices generally calculated distance walked, calories burned, and duration and intensity of activity.34 Since that time, Apple and Fitbit have made the largest contributions to discovery of the “quantifiable self,” a term referring to the vast array of numerical health measurements that can be recorded and analyzed from an individual at any given time via wearable technologies.35 Newer versions of these wearable devices include such features as a smart scale that measures weight and BMI plus heart rate monitors, GPS tracking technology, sleep stage analysis, oxygen saturation monitors, and menstruation tracking.36 Some offer motivational tools such as “badges” for completing movement-based objectives.37

Personalized Nutrition Services

Personalized nutrition services currently include online, direct-to-consumer (DTC) (or healthcare practitioner) genetic testing kits, microbiome analyses, disease-focused services, and nutrition and fitness programs. All are relatively newly available to the public, and most are experiencing tremendous growth. The personalized nutrition industry alone is poised to grow from an estimated $93 billion in 2015 to $127 billion in 2020, according to data presented at the 2018 Personalized Nutrition Innovation Summit.38

Companies differentiate themselves from their competitors by recommending “actionable steps,” or specific actions a customer can take to improve their health and well-being based on the results of some form of biological analysis. All incorporate an array of technologies and services designed to provide a personalized experience. Some, but not all, companies employ registered dietitians to help interpret results and counsel and motivate clients, which is an opportunity to harness the specialized expertise of nutrition professionals.

Direct-to-Consumer Genetic Testing Services

Direct-to-consumer testing companies offer personalized health recommendations via saliva, blood, and/or fecal samples provided by the customer. These companies cannot yet advertise diagnostic certainty, although they do use science to educate customers and healthcare providers about individual risks of developing certain conditions and advise adoption or avoidance of behaviors accordingly.7 Many DTC companies are using databases of customer information to facilitate advanced omics research that will one day support diagnostic utilization of omics analyses for consumers and the healthcare community.

Many DTC companies integrate professional lifestyle management coaching, meal plans, supplement packs, and athletic training advice based on individual omics analysis. For instance, OME Health integrates genetic, microbiome, and blood testing into their analyses; Inside Tracker collects genomic and biomarker data from blood tests every 3 months to create and modify personalized menus, whereas Habit touts a systems biology approach by providing detailed third-party anthropometric, lifestyle, DNA, biometric, and metabolic data analyses used to create personalized meal plans. In addition to their tracking services, LoseIt! offers DNA testing to integrate genetics into their personalized weight loss recommendations, as does Nutrigenomix, which distinguishes itself from its competitors by making tests available only through qualified healthcare practitioners. Nutrigenomix also offers specific tests for sports performance and fertility.

Lastly, 23andMe uses whole-genome sequencing technology to determine individuals’ genetic risk and carrier status of diseases such as late-onset Alzheimer’s disease, Parkinson’s disease, macular degeneration, and autosomal recessive polycystic kidney disease. 23andMe was one of the first DTC companies to receive federal permission to conduct studies with consenting users’ data. Its 2017 Genetic Weight Report confirmed genes mediate the effects of diet and exercise.39,40

Microbiome Analysis

Several companies offer microbiome sequencing and interpretation services to customers. As mentioned previously, more and more data are accruing on the relationship between an individual’s gut microbiome and his/her risk and prevalence of various disease-related conditions.

Two of the biggest names in microbiome analysis are Viome and Day Two. Viome possesses exclusive license to proprietary technology originally developed at the Los Alamos National Laboratory that makes use of advanced metatranscriptomics technology to measure gut microbe metabolism. Viome provides quarterly microbiome analyses and pairs these with questionnaires to create individualized food and nutrient recommendations. It encourages whole food and lifestyle alterations to achieve better gut health.

Day Two primarily addresses customers’ blood sugar issues that may be mediated by the gut flora. The company utilizes a postprandial glycemic response algorithm along with microbiome analysis to create personalized nutrition plans for individuals seeking help with blood sugar control.41 The Mayo Clinic Center for Individualized Medicine’s Microbiome Program worked together with DayTwo to validate the algorithm and plans to continue its partnership with the company to further their exploration of microbiome-based health interventions.29

Disease-Focused Services

Some apps target users with specific chronic diseases and glean information from disease and nutrition-focused research to encourage healthful lifestyle changes. The number of companies that have entered the market in the past few years alone has been dramatic. Diabetes management and weight loss are two of the most prevalent conditions addressed, although far from the only ones. Companies occupying this space include Yes Health, which was the first all-mobile lifestyle-focused diabetes prevention program, and Omada Health, which receives federal government reimbursements for its diabetes prevention curriculum and triggers electronic “nudges” such as educational videos to provide praise and tips for further improvement. Both Livongo and Vida Health provide personalized coaching to improve chronic disease and basic public health outcomes (ie, smoking cessation). Virta Health was founded in 2014 with a mission to “reverse type 2 diabetes in 100 million people by 2025” using mobile app biomarker tracking, remote physician supervision, online community support, and individualized treatment plans for carbohydrate intake and nutritional ketosis.

Although each of these programs has some issues, and their boasts of rapid weight loss or reversal of type 2 diabetes remain unsubstantiated, disease-based apps are a step up on the personalization scale for remote disease monitoring and management and a likely sign of how health maintenance will be administered in the future, with less face-to-face time with a clinician, and more online inputs.

Food/Nutrition Tracking Services

Numerous food tracking, calorie counting, and meal planning apps exist, and they run the gamut with respect to the technologies they employ to generate information for their consumers. MyFitnessPal, one of the first such products on the market, calculates daily energy needs based on anthropometric data, standard formulas, and meal ingredients selected from a database of common foods. Other nutrition tracking apps on the market include ImpactVision and SmartPlate, which use photograph imaging technology to analyze nutritional content of foods; Slow Control, which offers a “smart” baby bottle holder that tracks ounces of fluid consumed and monitors the feeding environment42; LoseIt!, which connects customers to the app’s weight loss user “community” for inspiration, support, and guidance; and Nutritionix, a dietitian-developed food tracking company that boasts the most comprehensive grocery and restaurant nutrient databases available, tracks food intake and daily calorie needs via a voice recognition device, and shares food logs with individual health “coaches.” HAPI Labs uses indicator lights and “gentle vibration” to notify users that they are eating rapidly, which, they suggest, could lead to weight gain or gastrointestinal distress,42 as well as an activity and sleep tracking bracelet, among other services.

Personalized Wellness Products and Services: Do They Work?

While it is outside the scope of this article to review the full body of evidence on the field, this section offers a sampling of the published literature. To begin, studies of the reliability and precision of wearable devices have produced mixed results in randomized controlled trials. In general, research suggests hip-based trackers are more accurate than those worn on the wrist43 and that the pedometric function of the trackers is the most reliable feature.44–48 A study of 23 adults outfitted with 2 products worn on the hip or the wrist found that devices worn on the hip estimated steps within 1 step of 100% accuracy and underestimated calories burned by 6% compared with the wrist devices, which were off by 11 steps per minute and overestimated calories burned by 21% on average.43

The effectiveness of wearable technology for promoting/monitoring weight loss is equally ambiguous. One study found that wearables were not as effective as traditional behavioral counseling in a weight loss study of obese patients over 24 months.47 A 6-month study of subjects with mental health issues using Fitbit to monitor step count found improvements in weight, but not fitness, possibly due to small sample size.49

A pan-European study led by researchers at Newcastle University in the United Kingdom50 provided personalized nutrition advice to subjects from 7 countries via an online portal. One group received personalized nutrition advice based solely on analysis of their current diet, one based on diet plus biomarkers, and one on diet, biomarker, and genotype information. All 3 groups displayed improved eating habits after 6 months. The groups that received advice based on biomarkers and/or genetic information did no better than the group that received advice solely based on diet. This suggests personalized nutrition feedback works; however, the efficacy of technology layered on top of the advice was questionable.

Interpretation of microbiome research is currently limited to correlational conclusions, as the field is in its relative infancy. Ongoing projects such as The Mayo Clinic Center for Individualized Medicine’s Microbiome Program should, over time, help elucidate issues regarding the implications of one’s gut bacteria on his/her overall health.

Further, there is an ongoing need for synthesis of individual studies to help inform evidence-based practice guidelines.1 The Academy of Nutrition and Dietetics Evidence Analysis Center published a scoping review on nutritional genomics in precision nutrition.51 The intent was to help inform if a deeper systematic review should be conducted. This particular scoping review identified 32 studies that examined the effect of utilizing nutritional genomics in nutrition practice on nutrition-related outcomes. The authors acknowledged a lack of consistency in terminology, methods, and measurements in the published literature, but ultimately concluded a systematic review could be warranted. Such efforts will be needed to help better connect science, technology, and practice.

Additional research is needed to assess the precision and effectiveness of the various kits, tools, devices, and technologies currently being marketed to consumers, particularly as new products enter the marketplace. One issue that has arisen in the face of the rapidly evolving digital technology is the appropriate level of evidence that should be acceptable to regulators, healthcare organizations, and consumers, particularly as it pertains to devices to be used in healthcare management. One school of thought has been that digital devices used for health/medical treatment or diagnoses should be held to the same level of scientific rigor as other evidence-based medical devices.52 Others feel that too much oversight would stifle the creativity necessary to move new products forward in a rapidly evolving field.53–55 This debate will undoubtedly continue. The outcome will certainly have ramifications for the level of science consumers find acceptable in the devices and services they purchase moving forward.

THE FUTURE OF PERSONALIZED WELLNESS

Effective integration of truly personalized health and wellness information into medical diagnoses and treatments (including nutrition therapies) is evolving. Nevertheless, it is premature to fully incorporate the limited findings of genetics research into diagnostic manuals, as the interplay between disease subtypes and distinct molecular causes is still too complex to tease out. Further, behavior, lifestyle, and socioeconomic factors interact in ways that cannot be accurately quantified or measured using current standard genetic study designs.55 The causal effects of these behaviors on one’s microbiome or the epigenetic changes they may evoke need to be more fully elucidated.

The groundwork has been laid for the continued advancement of personalized wellness–focused science. Large-scale government projects such as the HGP and Human Microbiome Project made crucial forays into complex and poorly understood areas of science, ultimately discovering the blueprints for functional health. Massive private research undertakings across the personalized wellness industry will continue to inform these human health blueprints. Routine clinical visits currently generate thousands of underutilized medical data points on individual health and disease.55 Integrating this trove of information with current and past research in an open-source format would allow for faster identification of clinically meaningful gene-behavior-environment interactions and drastically reduce the need for several types of broad, time-consuming, and expensive studies. Several groups have initiated development of such repositories with some success.4,7,30 Future research of this nature will likely expedite findings with clinical utility.

From a business perspective, it is evident that entrepreneurs are not content waiting until all the intricacies of nutrigenomics, the microbiome, and various other biological/technological details are sorted out. Companies previously uninvolved in medicine and nutrition are beginning to make inroads into the personalized wellness market sphere, drawn by the popularity of these services and potential for large market gains. Some companies are forming partnerships with other companies, research laboratories, and medical teams with the aim of building credible, science-based, consumer-friendly personalized wellness products.

In the meantime, consumers should understand that any genetic, microbiome, or other data they glean as a part of a personalized evaluation based on these evolving technologies can be illuminating but incomplete. The future of personalized wellness is bright. Twenty-five years from now the systems for preventing, diagnosing, and treating health and disease-related conditions based on one’s personal attributes will look vastly different than they do today. But as is the case with any evolving technology, what is true today may be obsolete in a week. There is still much to be learned in the burgeoning area of personalized wellness. Early adopters of these new technologies should keep this in mind as they make health-related decisions or select trackers, kits, or other modalities designed to provide personalized health and wellness information.

REFERENCES

1. Murgia C, Adamski M. Translation of nutritional genomics into nutrition practice: the next step. Nutrients. 2017;9:366.
Cited Here…
2. Langfelder-Schwind E, Karczeski B, Strecker MN, et al. Molecular testing for cystic fibrosis carrier status practice guidelines: recommendations of the National Society of Genetic Counselors. J Genet Couns. 2014;23(1):5–15.
Cited Here… |
PubMed | CrossRef
3. March of Dimes. Genetic Counseling. https://www.marchofdimes.org/pregnancy/geneticcounseling.aspx. Updated November 2016. Accessed July 31, 2018.
Cited Here…
4. Post by former NIMH director Thomas Insel: improving diagnosis through precision medicine. National Institute of Mental Health. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2011/improving-diagnosisthrough-precision-medicine.shtml. Published November 15, 2011. Accessed August 12, 2018.
Cited Here…
5. What is genomic medicine? National Human Genome Research Institute. https://www.genome.gov/27552451/what-is-genomic-medicine/. Updated November 6, 2018. Accessed September 9, 2018.
Cited Here…
6. A brief guide to genomics. National Human Genome Research Institute. https://www.genome.gov/18016863/a-brief-guide-to-genomics/. Updated August 27, 2015. Accessed September 9, 2018.
Cited Here…
7. Camp KM, Trujillo E. Position of the Academy of Nutrition and Dietetics: nutritional genomics. J Acad Nutr Diet. 2014;114(2):299–312.
Cited Here…
8. Attia J, Ioannidis J, Thakkinstian A, et al. How to use an article about genetic association: A: background concepts. JAMA. 2009;301(1):74–81.
Cited Here… |
View Full Text | PubMed | CrossRef
9. DNA sequencing. National Human Genome Research Institute. https://www.genome.gov/10001177/dna-sequencing-fact-sheet/. Updated December 18, 2015. Accessed September 9, 2018.
Cited Here…
10. DeBusk R. Diet-related disease, nutritional genomics and food and nutrition professionals. J Am Diet Assoc. 2009;109(3):410–413.
Cited Here… |
PubMed | CrossRef
11. Yuskiv N, Potter BK, Stockler S, et al. Nutritional management of phenylalanine hydroxylase (PAH) deficiency in pediatric patients in Canada: a survey of dietitians’ current practices. Orphanet J Rare Dis. 2019;14(1):7.
Cited Here…
12. Van Ommen B, van den Broek T, de Hoogh I, et al. Systems biology of personalized nutrition. Nutr Rev. 2017;75(8):579–599.
Cited Here… |
View Full Text | PubMed | CrossRef
13. Marcovecchio ML, Florio R, Verginelli F, et al. Low AMY1 gene copy number is associated with increased body mass index in prepubertal boys. PLoS One. 2016;11(5):e0154961.
Cited Here… |
PubMed | CrossRef
14. Guest N, Corey P, Vescovi J, El-Sohemy A. Caffeine, CYP1A2 genotype, and endurance performance in athletes. Med Sci Sports Exerc. 2018;50(8):1570–1578.
Cited Here… |
View Full Text | PubMed | CrossRef
15. Curti M, Jacob P, Borges M, Rogero MM, Ferreira SR. Studies of gene variants related to inflammation, oxidative stress, dyslipidemia, and obesity: implications for a nutrigenetic approach. J Obes. 2011;2011:497401.
Cited Here… |
PubMed
16. Rukh G, Ericson U, Andersson-Assarsson J, et al. Dietary starch intake modifies the relation between copy number variation in the salivary amylase gene and BMI. Am J Clin Nutr. 2017;106:256–262.
Cited Here… |
PubMed | CrossRef
17. Corella D, Carrasco P, Sorli J, et al. Mediterranean diet reduces the adverse effect of the TCF7L2-rs7903146 polymorphism on cardiovascular risk factors and stroke incidence: a randomized controlled trial in a high-cardiovascular-risk population. Diabetes Care. 2013;36(11):3803–3811.
Cited Here… |
View Full Text | PubMed | CrossRef
18. Perry G, Dominy N, Claw K, et al. Diet and the evolution of human amylase gene copy number variation. Nat Genet. 2007;39(10):1256–1260.
Cited Here… |
PubMed | CrossRef
19. Peltonen L, Perola M, Naukkarinen J, et al. Lessons from studying monogenic disease for common disease. Hum Mol Gen. 2006;15:R67–R74.
Cited Here… |
View Full Text | PubMed | CrossRef
20. Zeisel SH. Metabolic crosstalk between choline/1-carbon metabolism and energy homeostasis. Clin Chem Lab Med. 2013;51(3):467–475.
Cited Here… |
View Full Text | PubMed
21. National Institutes of Health Human Microbiome Project. https://hmpdacc.org/hmp/. Updated 2018. Accessed August 19, 2018.
Cited Here…
22. Gupta VK, Paul S, Dutta C. Geography, ethnicity or subsistence-specific variations in human microbiome composition and diversity. Front Microbiol. 2017;8:1162.
Cited Here…
23. Ursell L, Metcalf J, Parfrey L, et al. Defining the human microbiome. Nutr Rev. 2012;70(suppl 1):S38–S44.
Cited Here… |
View Full Text | PubMed | CrossRef
24. Chen L, Zhang Y, Huang T, Cai YD. Gene expression profiling gut microbiota in different races of humans. Sci Rep. 2016;6:23075.
Cited Here… |
PubMed
25. Khanna S, Tosh P. A clinician’s primer on the role of the microbiome in human health and disease. Mayo Clin Proc. 2014;89(1):107–114.
Cited Here… |
View Full Text | PubMed | CrossRef
26. Morrison D, Preston T. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism. Gut Microbes. 2016;7(3):189–200.
Cited Here… |
PubMed
27. Kau A, Ahern P, Griffin N, et al. Human nutrition, the gut microbiome, and immune system: envisioning the future. Nature. 2011;474(7351):327–336.
Cited Here… |
View Full Text | PubMed | CrossRef
28. Griffin N, Ahern P, Cheng J, et al. Prior dietary practices and connections to a human gut microbial metacommunity alter responses to diet interventions. Cell Host Microbe. 2017;21:84–96.
Cited Here… |
PubMed | CrossRef
29. Rosen S. This diet’s for you: personalized nutrition to improve your health. Mayo Clinic. https://individualizedmedicineblog.mayoclinic.org/2016/12/15/this-diets-for-you-personalized-nutrition-to-improve-your-health/. Published December 15, 2016. Accessed August 21, 2018.
Cited Here…
30. Microbiome Program. Mayo Clinic. http://mayoresearch.mayo.edu/center-forindividualized-medicine/microbiome-program.asp. Accessed August 21, 2018.
Cited Here…
31. Chu W. Personal nutrition trends: hands-on with health leads consumers to seek professional advice. Nutraingredients.com. 2019. https://www.nutraingredients.com/Article/2019/01/25/Personal-nutrition-trends-Hands-onwith-health-leads-consumers-to-seek-professional-advice#
Cited Here…
32. Bresnick J. Apple, Aetna create wellness program based on apple watch, health payer intelligence. January 29, 2019. https://healthpayerintelligence.com/news/apple-aetna-createwellness-program-based-on-apple-watch
Cited Here…
33. Marshall G. The story of Fitbit: how a wooden box became a $4 billion company. https://www.wareable.com/fitbit/youre-fitbit-and-you-know-it-how-a-wooden-box-becamea-dollar-4-billion-company. Published September 9, 2016. Accessed October 15, 2018.
Cited Here…
34. Ewalt D. Getting Fitbit. https://www.forbes.com/2010/06/11/fitbit-tracker-pedometerlifestyle-heatlh-lifetracking.html#547a3e2e5556. Published June 11, 2010. Accessed October 15, 2018.
Cited Here…
35. Patel M, Asch D, Volpp K. Wearable devices as facilitators, not drivers, of health behavior change. JAMA. 2015;313(5):459–460.
Cited Here… |
View Full Text | PubMed | CrossRef
36. Fitbit.com. https://www.fitbit.com/home. Accessed October 15, 2018.
Cited Here…
37. Fitbit Inc (FIT.N). Reuters.com. https://www.reuters.com/finance/stocks/companyProfile/FIT.N. Accessed October 15, 2018.
Cited Here…
38. 2018 Personalized Nutrition Innovation Summit Agenda. https://personalizednutritionusa.com/events/personalized-nutrition-2018. Accessed July 25, 2018.
Cited Here…
39. 23andMe releases first-of-its-kind genetic weight report. 23andMe.com. https://blog.23andme.com/23andme-and-you/23andme-releases-first-of-its-kind-geneticweight-report/. Published March 2, 2017. Accessed September 28. 2018.
Cited Here…
40. Multhaup M, Lehman A, Koelsch B, et al. The science behind 23andMe’s Genetic Weight Report. 2017. https://permalinks.23andme.com/pdf/23_17GeneticWeight_Feb2017.pdf. Accessed September 28, 2018.
Cited Here…
41. Meyer M. Big data and health discoveries that are worth salivating over. International Food Information Council Foundation Food Insight. https://www.foodinsight.org/23-and-menutrition-health-genetics-nutrigenomics. Published August 1, 2018. Accessed August 25, 2018.
Cited Here…
42. SlowControl.com. http://www.slowcontrol.com/en/#. Accessed September 28, 2018.
Cited Here…
43. Diaz K, Krupka D, Chang M, et al. An accurate and reliable device for wireless physical activity tracking. Int J Cardiol. 2015;185:138–140.
Cited Here… |
PubMed | CrossRef
44. Bai Y, Hibbing P, Mantis C, et al. Comparative evaluation of heart rate-based monitors: Apple Watch vs Fitbit Charge HR. J Sports Sci. 2018;36(15):1734–1741.
Cited Here… |
PubMed
45. Paul S, Tiedemann A, Hassett L, et al. Validity of the Fitbit activity tracker for measuring steps in community-dwelling older adults. BMJ Open Sport Exerc Med. 2015;1:e000013.
Cited Here…
46. Bendetto S, Caldato C, Bazzan E, Greenwood DC, Pensabene V, Actis P. Assessment of the Fitbit Charge 2 for monitoring heart rate. PLoS One. 2018;13(2):e0192691.
Cited Here… |
PubMed | CrossRef
47. Jakicic J, Davis K, Rogers R. Effect of wearable technology combined with a lifestyle intervention on long-term weight loss: the IDEA randomized clinical trial. JAMA. 2016;316(11):1161–1171.
Cited Here… |
View Full Text | PubMed | CrossRef
48. Nelson B, Kaminsky L, Dickin D, Montoye AH. Validity of consumer-based physical activity monitors for specific activity types. Med Sci Sports Exerc. 2016;48(8):1619–1628.
Cited Here… |
View Full Text | PubMed | CrossRef
49. Naslund J, Aschbrenner K, Bartels S. Wearable devices and smartphones for activity tracking among people with serious mental illness. Ment Health Phys Act. 2016;10:10–17.
Cited Here…
50. Celis-Morales C, Livingstone KM, Marsaux CF, et al. Effect of personalized nutrition on health-related behavior change: evidence from the Food4Me European randomized controlled trial. Int J Epidemiol. 2017;46(2):578–588.
Cited Here… |
View Full Text | PubMed
51. Rozga M, Handu D. Nutritional genomics in precision nutrition: an Evidence Analysis Center Scoping Review. J Acad Nutr Diet. 2019;119(3):507–515.
Cited Here… |
PubMed | CrossRef
52. McCartney M. Innovation without sufficient evidence is a disservice to all. BMJ. 2017;358:j3980.
Cited Here… |
View Full Text | PubMed | CrossRef
53. The Lancet. Is digital medicine different. Lancet. 2018;392:95.
Cited Here… |
PubMed | CrossRef
54. Shaywitz D. Will real world performance replace RCTs as healthcare’s most important standard? Forbes. May 11, 2018. https://www.forbes.com/sites/davidshaywitz/2018/05/11/will-real-world-performancereplace-rcts-as-healthcares-most-important-standard/#660835793557. Accessed January 2019.
Cited Here…
55. National Research Council of the National Academy of Sciences. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. Washington, DC: The National Academies Press; 2011.
Cited Here…

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Recent Posts

Start typing and press Enter to search