Picture this…you’ve been working with a client for the last 6 months and both you and them haven’t really noticed a significant shift in their health – even though you have literally put more time into them than anyone else. You see their name on your client list, your breath takes a sharp inhale, you prepare yourself for the impending assessment which is likely to reveal no change again, and have seemingly, the same conversation with them each time about what they have done and why they should continue. You learn new techniques, you ask your colleagues, you search different options, but all to no avail – they are a non-responder. You are desperate to see them improve, but you are stumped as to how.
While this is not the majority of clients, this occurs often enough to send you into a mild anxiety and at times can make you question whether you are cut out for this or not! You look at your other client’s results, they are following the same prescription and are moving forwards in leaps and bounds. They think you are better than sliced bread, and leaving their consultation, you are back to your best again. And because of this result, you persist with your ‘battlers’ – you push through assuming it’s either their adherence, or they need to do it for longer, or there is something mysterious about their body that you can’t explain… The good news…it is not your fault, it has far more to do with their parents and the environment in which they developed… and this article is a tribute to them as a unique individual with unique needs that when met will allow you to realise your full health and potential, and love the process along the way.
Personalised health is upon us…
…and it’s going to make the path to consistent client achievment so much more certain! In my time in clinical practice, the most common question people would ask me as a Dietitian and Exercise Physiologist is: “I know that I have to eat well and exercise, but I want to know what I need specifically for ME.” In other words: “I want you to reduce all of the information that is out there, and bring it down into a concise recommendation for me, for my individual circumstances, and in a way that suits my lifestyle”. Sounds a bit rich right? Well, the science would suggest that is exactly the right question!
Everyone is unique, everyone has different requirements, and those requirements will change daily based on the environment that they are exposed to. Up until now, giving a solution to that problem has been difficult. While we have known people are different genetically, understanding how they are different and then what to do about it has been too complex for a practitioner to calculate in the moment.
The good news: the answers are now here. The combination of science and technology make precision personalised health & medicine a possibility. In the next few years, everybody in the developed world will have an app on their phone that tells them exactly what to eat, how fast to run for optimal results, what to do at work and in what order to plan their day to keep their body and mind in an optimal state. Receiving an epigenetics based fully personalised program will be the norm.
Right now, an individual who takes up a generalised exercise program only has around a 60% chance that it will actually create an effect that is considered the predicted response. This goes for nutrition, medications and even stress relieving activities like meditation. If you have any doubts about this figure, get onto your database of choice and look up ‘exercise’ or ‘weight loss’ or ‘diabetes lifestyle intervention’ and ‘ inter-individual variability’. What if you get the prescription wrong? Well that’s the problem, if you don’t get it right, your client’s body will experience some sort of stress. In the short term, this isn’t a problem, not doing the thing that is appropriate for their unique biology can create imbalance in their body which can lead to disease over time.
So what is actually involved in understanding what a person needs, and why has it been so hard up until now?
We’ve been focusing on the wrong things
We haven’t had the right focus! For most of our time in the last 50 years, we have been trying to say ‘Kale is good’, or ‘HIIT (high intensity interval training) is the best for weight loss’, or, ‘meditation is the best stress reducer’.
Whatever the intervention, we have been focussing on the ‘thing’, not the person doing the’ thing’. For example, tomato has lots of nutrients that are on our typical ‘healthy list’. However, for some people, the content of salicylates can contribute to the development of hives and significant irritation – so is tomato a healthy or superfood? The answer: It depends.
HIIT training for some individuals is incredible for fitness, however, recent reviews of HIIT training studies have shown that around 33% of people will have a great response, with the remainder having an uncertain response right through to no response or an adverse response. A recent study looking at morning HIIT training performed by people with diabetes indicated that it can lead to a worsening of their blood sugar levels, while there were benefits for performing it in the afternoon….so is HIIT training good? The answer: It depends.
When it comes to what is best for your health, there is no stock standard answer anymore, it will always depend not only on the person, but their stage of life, their activity levels, their stress levels, environmental conditions (pollution, climate, altitude, season). Every part of the environment influences the person, and so the recommendations for health need to account for this in order to be truly personalised and have a better chance of being effective every time!
Shifting from generalisations to personalised health
The focus is now shifting away from the ‘best thing’, food, exercise etc’, approach and transform back to being about the ‘person’ to whom it is being implemented. However, to get this right, it becomes a little complicated. It’s not just about the food and exercise. The weather, season, exposure to pollen and pollution all have their own unique impact on clients. The amount they work, when they work and how they use your brain through the day will alter what they need to rest and recover adequately. Even the state of their relationship will alter the way they interact with food cravings for some people, while for others it will affect them less. The body is constantly changing and in order to personalise and optimise, they need to understand how their body works, the things that are going to be best for it right now, and the timing with which to apply those things.
It’s not just a matter of understanding genetics. You also need to understand their genetic expression, i.e. the genes are turned on right now, which gives a resulting phenotype. What are your symptoms at the moment? What is their body and mind experiencing in this moment? How did their body develop? What hormones are dominant within their body? How did their body recover from that exercise? Without these bits of information, carbs that would have been good for their recovery and muscle building following exercise, are now creating a small pudge on their stomach or hips because of inactivity.
The most helpful and effective models in personalised health are those that account for an individuals genetics, how their body developed through childhood, what the predominant influences on their body have been (hormonally, neurochemically, environmentally), the function/dysfunction of their body right now, AND how their body is behaving in response to their behaviours right now. While the full science of this is beyond the scope of this article, the examples below will give you an idea of how these sciences come together to make personalised health care possible, understandable and easily applicable.
A female personal trainer of 39 years has been working intensely in the gym for 4 years. Throughout her life she had always carried more body weight than the average, and whenever she was stressed in her life she would find it would increase further. So for 4 years, early morning training, lower calorie eating (5 meals per day), and high intensity weight training had been her weapon of choice.
It is one of those situations where she was getting no result (i.e. had not experienced weight loss in 4 years) while doing everything ‘right’…for someone else’s body – super hard work for no return. It turns out that after going through the phenotype assessment (with ph360 – the leading platform in this space), her body was predicted to be more aligned with strength training in the afternoon (no HIIT in the morning).
Her metabolism was predicted to be more suited to 2 to 3 meals per day, lower meat intake, with the majority of her food to be eaten by lunch time. 8 weeks later with over 40cm total loss from hips, waist, rib and chest, she realised that it wasn’t her fault, but she was just putting her body in the wrong environment.
In complete contrast to this, another individual with a different phenotype (gene expression) required 6 meals per day, regular meat intake, morning HIIT training to be in alignment with their body. Going from consistent spotting and an irregular menstrual cycle, correcting her lifestyle from 2 meals per day and afternoon exercise meant a return to normal cycle, and a documented regression of a uterine polyp. 2 people, opposite needs, but being treated in line with their body to receive a normalisation of their body.
These cases are not in isolation, nor do they appropriately summarise an entire body of scientific literature however they highlight the point that personalisation is crucial, it is here for us to use, and we are doing a disservice to our clients without considering it.
The future is bright for personalised health
Over the next few years, you will be presented with wonderful ways of supporting your clients to reduce fat, cure disease, balance hormones, improve physical function and optimise life. If the solution is not tailored to their gene expression, and if it doesn’t account for not only how they developed, but what they are experiencing right now, then there is a moderate to high chance that you will be experiencing that sinking feeling that accompanies a non-responder far too regularly than you would like to.
Healthcare is too important to be generic with. It’s time to personalise and the support for that to happen is here for you.
Cameron is a passionate and driven health professional, speaker and industry leader focussed on eliminating chronic disease and pain while supporting people to live their potential. He specialises in personalised health, the application of epigenetics and health professional education.