Chat

Hi I am Melissa and I am a lecturer at a number of universities and consultant in the area of nutritional genomics in Melbourne.

Hi, I’m Liz Isenring from Bond Uni, Gold Coast

Hi There I´m Mariette Abrahams Dietitian based in Portugal

Hi I’m Megan, PhD Student, Brisbane

Hi, my name is Emily and I work in lecturing and research at Curtin Uni in Perth

No worries- looking forward to it

Mariette hi! Nice to see you joining us- it’s been a while since we have spoken

Absolutely- for the future and now.

Not matter what area of dietetics and nutrition practice you work in, nutritional genomics will touch on your area- either it is now or closely in the future. E.g. public health dietitians, research dietitians, private practice dietitian, corporate dietitians, clinical dietitians etc.

Hi, I am Amy, an APD currently living in Sweden

I see it touching our work

Hello, Im Katherine – a private practice dietitian

 Gives us a greater understanding of the role of genetics in health and disease, particularly chronic disease  Can help develop more effective therapeutic interventions for managing existing disease.  Early identification of disease susceptibility to help prevent or reduce risk  Help develop more targeted prevention strategies

 Take personalized nutrition/ individualised dietary recommendations to the next level (based on a person’s genotype).  Provide food based recommendations to change gene expression.  Development of functional foods  Development of public health messages conveying the role of genes and environment and how nutrition recommendations can be tailored to an individual’s genetic variations.

11.30am here in Sweden. I usually miss these things as they are am Aus, so this is great!

 Public are already accessing tests- either direct to consumer or through healthcare professionals- and we need to provide evidenced based advice if they ask us

Hi I’m Courtney, private practice dietitian, based in Sydney.

Is there meant to be sound?

Hey. Renee from Melbourne here 🙂 trying to do this via my phone due to a faulty laptop!

One from me

Where to start. We have people accessing tests all over the place. How do we access accurate and useful info

Anyone have an example of how it has touched their nutrition work

Hi I’m Vivian, dietitian based in Sydney – very interested in nutritional genomics!

Absolutely Liz, and this is a tough one

Hello all, Wolf Marx reporting in

Start with the evidence (journals etc) but go to the international bodies and associations

International society of nutrigenetics and nutrigenomics

Q2 1st factor Why did the patient have the test? What did they want to know? • Helps to direct you in your line of counselling • Helps you to understand whether the test results/ part of the test results could be useful in your response/recommendations to patient • Remember there are two main ways a nutrigenetic test can be used

I am all for this emerging area, but do we have enough/ any evidence to make recommendations yet?

Factor 2 Which company performed the test? • What are their expertise? Staff? Training? • What marketing claims do they make? • Do they perform test themselves or outsource it?

Hi Fiona Sutherland APD here from Melbourne, know very little about this topic but looking forward to learning more. Thanks Maree & Melissa!

Megan, I was also wondering this!

there is tonnes of evidence- to make recommendations- but I guess the main question is WHAT RECOMMENDATION?

There is a lot of evidence, we just need to know how to critique it to provide the right advice

Hi Everyone – Olivia here from UQ

Melissa, I was wondering if you know which companies offer credible testing?

Also a comment,your own knowledge and limitation. There is so much to learn and putting results into perspective that we need to be sure that SNP tested were done on the relevant population ie women only, Asians etc

Great comment Mariette- relevance of tests to diff population groups and sub populations is crucial

Are there companies that are known to perform reputable tests?

Courtney- it is hard to establish what is credible…

You have to think not only accuracy of testing on DNA sample BUT also interpretation and reporting

Factor 3 to consider (from Q2) Which HCP performed the test and why? Or did they order it off the internet? • What were their qualifications in recommending a test? • What is their knowledge of genetics and nutritional genomics? • Why did they recommend the test?

what areas do you feel we have good evidence currently. Eg I had a chat with a Prof from USA who felt this area in tailoring nutrition in older adults would probably only impact about 10%. Your thoughts?

IN regards to companies- look at their staff, expertise and also their claims

that will help with you decision on if reputable

Can you please give us one example of how you have used it in practice i.e.. Can we test for a specific gene which will identify patients who are more likely to malabsorb specific nutrients and therefore need more through the diet? Sorry for my ignorance in this area.

There are many SNPs that hold good evidence behind them Liz, starting with most well known MTHFR C677T, however it is the translation into how you advise on it which is where evidence starts to reduce

Good question Liz. In addition, is there any tests that seem to be ‘popular’ at the moment?

yes I agree, so how can we progress this and ensure dietitians are well trained and at the forefront of this advice?

The alternate practitioners LOVE any test to do with methylation pathways, inflammation, detox and autism

What about epigenetic testing – is that happening anywhere?

What about epigenetic testing – is that happening anywhere?

Olivia, I believe credible epigenetic testing only in research due to complexity

I think being aware of some of the basics is a start

but methylation tests are around

and telomere tests

Yes, that’s what I would have thought. I have heard of some companies/groups “offering” it.

Defintely!

 Nutritional Genomics: Study of human genome, nutrition and health. It is the overarching term with a number of areas of science including nutrigenetics and nutrigenomics

 Nutrigenetics: describes “how human genetic variation results in distinct nutritional requirements

 Nutrigenomics: studies the effect of nutrients on the genome at the molecular, cellular and systemic levels, as well as the effect of nutrients on gene expression

Essentially nutrigenetics and nutrigenomics are the opposite of each other- nutrigenetics looks at how the genes we were born with affect our nutrition requirements, while nutrigenomics looks at the effect of food and nutrients we take in and how they affect gene expression

Nutrigenetics = simpler and more evidence to start implementing in practice as only need a DNA sample

Yes it’s the nutrigenomics that is the complete minefield!! 🙂

Nutrigenomics = more complex and difficult as usually need a sample of target tissue

Definitely olivia

…until we find appropriate markers in blood or somewhere else that are representative of what is going on in the target tissue…if ever

Epigenetics also falls under Nutritional genomics and is rapidly evolving

definetly Mariette and I have heard the newer nterm nutritional epigenetics

Can we have an example of nutrigenetics in practice?

Would it be fair to say the epigenetics modulates the nutritional genomics?

Yes Olivia- and the complexity continues 🙂

Thanks 🙂

SImple MTHFR C677T genetic test

a SNP in MTHFR gene

and how do we best manage this one?

causes some people to metabolise folate up to 70% less

I’m with Megan. As a newbie to this area I would love am example

we know this with good evidence and it is in our NRVs from 2006

that some people need higher folate levels

BUT THE BIG QUESTION IS HOW MUCH??

ANd this is where translation gets difficult

Do you assess their folic acid intake and supplement if appropriate with bioavailable folate?

because the evidence looks at just simple nutrient requirements all the way up to relating the SNP to disease states

Yes Mariette that is absolutely the start- look at it in terms of all other information you gather about the patient

so you know the context you are interpreting it in

scary thing is many gps and alternate prac are doing the test and then

giving out one size fits all advice

Dietitians in the know?

Q4 Nutritional genomics is an interesting mix of knowledge and skill- genetics, nutrition and genetic counselling

Perfect practitioner = geneticist+ dietitian+genetic counsellor all rolled into one.

However, when discussing nutritional genomics with the public it is more of a counselling role- so I think a dietitian upskilled in genetics, with training on how to discuss genetics with patients/the public is the way to go.

So we have to go back to the books 🙂 ?

lol yes olivia I think so

Dietitians should be the ones but are we vocal enough?

Lots…..

many dietitians have old school genetics training e.g. classic genetics

mutation= disease state

This sounds like something that will need to be added to the curriculum in the future!

but now we know so much more from human genome project

and our knowledge has grown

so yes we need to retrain I think

it is Amy

Be need to be more vocal and explain the science properly in an easy to understand way

Remember- geneticists don’t have a working knowledge of nutrition/how to provide nutrition recommendations/individuliased nutrition therapy. Genetic counsellors are taught how to discuss genetics with clients, but can have any type of healthcare professional background (most work in clinical genetics).

thats the key olivia

translation! And that is where dietitians come in

Sounds like some workshops could be well received Melissa?? Sign me up!

We definitely need to embed it in the curriculum.

I think it is fantastic that you are taking it on board so early, as often dietitians miss the window of opportunity and other less skilled groups become the “specialist” in the area. I take my hat off to you.

So once again, I come to dietitians being very well placed to advise on nutritional genomics to the pblic- but with extra learning and training. This highlights importance of building networks with geneticist and genetic counsellors. Build a strong network to work together to provide the best advice to customers.

Thanks megan- it was a hard slog for many years

How much in dietetics training and how much as intensives for APDs and ongoing PD

and many critisisms

it is in DAA curriculm but more as optional I believe

It is incorporated in the curriculum in the UK but my experience has been that new grads are so excited about the area but have no one to turn to and experienced ones are not confident to incorporate it into practice. How can this gap be bridged?

most unis now putting it in but as an FYI

not a HOW to do in practice

So what shall we be telling our student nutritionists and dietitians? Introducing them to the terminology and how to be critical? Is this enough?

Agree Mariette- and british dietetic assoc has done great work

yes they are

I think so- not just terminology but more about the practical issues etc they will come up against

and how to critique genetic research is essential

maybe you need to make a movie Melissa and we can show it in class 🙂

I like to think of it as you need to look for 3 pieces of evidence

absolutely

1. what is the evidence on the variation itself

2. what is the evidence of the effect on health

the first 2 usually have good evidence

3rd one is where geneticists kinda stop

so the evidence is piling up for nutritional genomics and variations

but not what to do about it!!!!!

Is the testing itself expensive?

love the movie idea

but with icecrea

no amy not at all

oop no $$ are coming down

yes, it is rather mind boggling. and the working out what to about it costs big bucks!!

soooo much cheaper now

private industry is driving this space

ice cream is fine with me

Are there any popular tests doing the rounds that have little evidence? That we should be aware of?

last yr american company offering whole genome

FOR $99

over the internet!!!

now THAT is ridiculous

but in Aus some healthcare professionals are charging big $$ some very cheap

Are any dietitian’s doing research in this area? Melissa maybe you could get some! (free labour work horses we are 😉 )

Lots amy unfortunatley

a good rule of thumb is if nutrigenetic test is saying it predicts disease

usually means didgy test

oops dodgy

And I know some US dietitians recommending the $99 one and then picking out the nutriion related ones

An example?

most nutrigenetic variations that we can use now are not gene-disease

Thats scary mariette- what if they find out info the patient doesnt want to know

ethics!!!!! Do they tell them???

yes that is terrible

I think targeted testing is better than the whole genome – too many risks at this stage

Amy an eg is a NG test that tells a patient they WILL get type 2 diabetes

I guess they take clinical responsibility for that, I am not sure

Big difference

when it was prob looking at genes involved in carb metabolism

and what does it really mean anyway

What are the dangers to watch out for if more and more people are having their whole genome tested? Can just anyone offer telling the general public what the results mean?

Of course Emily- this are is not strongly regualted in aus

its just like anyone can offer nutrition advice

And any healthcare prof can conduct a genetic test (currently)

are their impacts on insurance policies in the US?

another space for misinformation to raise its ugly head

Mariette do you know?

I heard recently tat all genetic testing needs to be declared in Canada.

In Aus- any genetic test has potential to affect life insurance

n the US although it is a fear in the US. The FDA has just last week changed its regulation on genetic testing so things will change albeit slowly for the nutrigenetic trsting market

let’s collaborate on a textbook for dietitians, or a handbook; although you’re probably already doing that!!!

My advice to dietitians…

dont get put off on this area!

Count me in for a textbook!

be excited

be open minded

be leaders

yet be critical

That is what I was thinking Olivia! Do you have anything happening in terms of info for dietitians Melissa?

Be ingeneious haha

lol we actually Olivia not a text book but

I am dveloping a Monash University Nutritional Genomics short course 5-6 week online short course + 1 day practical seminar for dietitians

great advice, valid for all nutrition areas too

Will be in Feb 2015

Mariette- maybe we should 🙂

well done 🙂

Thank you

A book wouldn’t go astray either 🙂

indeed!!!

Also a good read is Lynette Ferguson: Nutrigenomics and Nutrigenetics in Functional Foods and Personalized Nutrition

Maybe Olivia we should talk too 😉

I will be in touch!

Lynette is Head of dietetics at Auckland

and is head of nutrigenomics NZ

Would love to chat. Might need to visit Auckland too 🙂

And work with clients

yes thank you Melissa!!!!! well done 😀

You’re welcome

I had a great time

And great to see so much interest

🙂

we’ll stay in touch re this area – we need strength in numbers

Thank you very much for sharing your knowledge, Melissa

Good Night/Day All

Thanks for having it at an appropriate time for us up this end of the world!

Absolutely Olivia! That teleconference 🙂

Sure thing Melissa 🙂

Thank you melissa (and everyone!). A very interesting discussion!

Thanks Wolf and everyone else for listening (I can ramble 🙂 )

we sure do!

g’nite – time for pizza. My genes like it.

Thanks to DC for organising!

Yes thank you Maree and Bond