PERSONALISED NUTRITION

Dating back to Hippocrates (406 BC), the “Father of Modern Medicine” who believed that disease was the product of environmental factors, diet, and living habits and who is credited as saying “Let food be thy medicine, and let medicine be thy food,” it is generally accepted that “healthy” food and nutrition positively impact one’s health and wellbeing (1). What constitutes “healthy” nutrition has generally been broad-based and general, a one-size-fits-all approach relying on the findings of large population-based studies such as The Adventist Health Study (96,000 Adventists) which found that those who followed a vegetarian diet had a significantly lower risk of obesity, high blood pressure, and high blood sugar, strong risk factors for heart disease and early death (2-5), and decreased risk of colon cancer (6). By definition and due to historical limitations on our ability to rapidly and accurately ingest and analyze the copious amounts of relevant data involved in nutrition and nutrition research, such population-based studies do not and cannot account for the unique combinations and permutations of medical, genetic, cultural, contextual, food and nutrition data and other variables which influence an individual’s susceptibility to developing disease and/or responding to its treatment, the ultimate goal of personalized nutrition.

Today, due to a confluence of scientific and technological advancements, it is possible to conduct the intricate research required to understand and validate nutrition interventions for the prevention and treatment of chronic disease and, ultimately, to generate the evidence required for personalized nutrition to be incorporated into treatment guidelines and prescribed and reimbursed as standard of care.

What is personalized nutrition? Personalized nutrition is part of the broader category of personalized medicine which identifies and evaluates the unique variables (genetics, nutrition, exercise, sleep, microbiome etc.), and their interrelationships, involved in the prevention, development, progression, and treatment of chronic disease. In nutrition, population-based studies indicate that certain dietary patterns increase one’s risk of developing specific cancers. For example, consumption of red meat is associated with increased risk of colon cancer while the plant-based diet of the Adventists lowers it (7).

Yet many people who consume large amounts of red meat and minimal amounts of plant-based foods don’t develop colon cancer. The ultimate goal of personalized nutrition is to identify the myriad variables involved in these disparate outcomes, evaluate and understand them, and develop interventions to target or modulate the (operative) nutritional variables to prevent, treat or manage disease. Long term, this will involve molecular level data and an understanding of mechanism of action alone and in combination with other variables.

SUSAN BRATTON
Savor Health | United States

FASCICOLO SPONSORIZZATO DA

Today, personalized nutrition solutions range from consumer-oriented products that offer minimal personalization to medically-oriented products offering disease-specific customization. Examples of the former include weight loss or recipe apps singularly-designed for a single specific condition like diabetes (recommend foods that control blood sugar) or hypertension (recommend low sodium diets) but which do not account or personalize for the nutritional requirements or restrictions of other existing co-morbidities and conditions present in the patient. The latter more medically-oriented B2B solutions apply existing scientific evidence to an individual’s unique clinical profile, incorporating diagnoses, co-morbidities, BMI, medications, treatments, other clinical data to determine the most appropriate nutrition intervention (educational advice, recipes and food and eating tips) to prevent, manage or reverse their disease. Some also incorporate contextual (eating preferences, food allergies, cultural needs etc.) data which, while not clinically essential, are required to provide the most personalized experience for the user based on their other food and nutrition needs and preferences.

Savor Health, is an example of the latter focused today on leveraging nutrition to prevent and manage the symptoms of cancer and cancer treatment. Much in the way a medical oncologist determines the type, dose, and duration of chemotherapy for each patient, personalized nutrition for oncology symptom management is also highly personalized. Two patients with the same type of breast cancer, but who’s other clinical conditions differ, could be prescribed the same chemotherapy regimen but very different personalized nutrition intervention plans. For example, Patient A could have diabetes, a BMI of 35 and constipation while Patient B could have a BMI of 18, be taking coumadin, and have diarrhea. A personalized nutrition plan for Patient A would include a diet with fewer calories than Patient B and foods that are higher in soluble fiber to address the constipation. Patient B’s personalized nutrition plan would include a much higher calorie diet owing to her low BMI, minimize foods with Vitamin K as it is contraindicated for patients taking coumadin, and emphasize foods like bananas, rice, applesauce and toast to alleviate the diarrhea.

For the healthcare industry, personalized nutrition represents a novel effective and affordable intervention that can be used in combination with other interventions to improve overall survival and quality of life and reduce healthcare costs (8-10). For patients, personalized nutrition offers the clinical benefits of improved outcomes, lower symptom burden and better quality of life (11, 12). Additionally, unlike the majority of medical interventions utilized today, personalized nutrition provides patients and caregivers with meaningful psychological benefit by empowering them with greater control and independence. Nutrition is something that a patient or caregiver can do which gives them agency in their treatment journey. What we have learned in oncology is that cancer patients rank nutrition and side effect management as two of their highest priorities because nutrition is one of the few things under their control and side effects dramatically reduce their quality of life (13).

Why now? In its infancy, nutrition science has until recently been constrained by a dearth of financial (government and industry grants and private investments) and computational (rapid, powerful, and affordable computing) resources which has, in turn, limited the breadth and depth of scientific research required for it to be properly evaluated, validated and codified for broad-based adoption and reimbursement by the medical industry. Total National Institutes of Health (“NIH”) investment in nutrition-related research was approximately 1.9 billion in FY 2019. Incontrast, NIH investment in cancer research was approximately 6.5 billion in FY 2019 (14). Additionally, despite creative and aggressive attempts to control U.S. healthcare costs, the medical industry has been unable to slow medical cost inflation and healthcare spending as a percent of GDP has increased from 5% in 1960 to 18% in 2019. The industry has been forced to “think outside of the box” and explore new, effective and affordable levers like nutrition to reduce costs and improve outcomes. COVID-19 has accelerated this trend as it highlighted the importance of nutrition in health outcomes.

The promise of personalized nutrition is a scientist’s dream. Evaluating correlations among nutrients, clinical data, and health outcomes to answer the “why,” understand the “how,” and develop effective interventions based on them is exciting for the curious problem solver. However, for the humans that will ultimately receive these personalized nutrition interventions, personalized nutrition must incorporate more than just clinical information. What we have learned is that food and nutrition, a significant part of our everyday lives and culture, represent family, friends, culture, ethnicity, fun, socialization, a sense of control and independence and other important non-medical factors.

As a result, for personalized nutrition to be a successful interventional lever, the healthcare industry must, to the extent possible, meet patients where THEY are, on their terms and based on what is important to them rather than with the historical industry-centric approach. We must incorporate the human context and what matters to the individual to ensure high adherence and compliance. Just like the one-size-fits-all population-based diets which require clinical-level customization so, too, must we incorporate and customize based on context and intent.

Successful personalized nutrition technologies will need to be both validated and backed up by rigorous scientific evidence and offer a level of personalization and user experience which incorporates user preferences, context and intent.