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There’s More to Precision Medicine than Genomics

by Kara Fitzgerald, ND

Precision medicine, which encompasses the concepts of individual uniqueness and personalized healthcare solutions, has to-date been most focused on genetics. Genetic-based differences in tumor cells, for instance, is one example of how precision medicine has started to play out.

Recently the team from the Microbiome Center at the University of Chicago have argued that this definition is too narrow, and that the microbiome is another key factor in understanding and applying personalized healthcare. In their published commentary they put forward four key points:

– More than 60 drugs are known to interact with the microbiome
– Microbial manipulation with probiotics and prebiotics can influence disease states
– Antibiotic treatments could become more targeted rather than broadly eliminating helpful as well as harmful bacteria
– Socioeconomic and environmental factors influence the gut microbiome and if we understand these we can better tailor solutions to individuals from different backgrounds

In functional medicine, these concepts aren’t new to us. We recognize that truly personalized medicine is more than the genome. Indeed, when President Barack Obama announced the Precision Medicine Initiative he also included environment and lifestyle along with genetic makeup.

Dr. Jeff Bland stated at the PLMI Thought Leader’s Consortium a few weeks ago that precision medicine must encompass all the different environmental inputs into one person’s life and physiology, from their genes to their microbiome, but also their environmental exposures (exposome), metabolic environment (metabolome) and microenvironments, epigenetic regulation (epigenome), diet, sleep, stress, relationships and more.

While it’s harder for the scientific research community to neatly fit these multivariable, ‘loose’ factors neatly into randomized controlled trials, Functional Medicine practitioners are already carving the way to personalized healthcare in their clinics every day.

This blog was originally posted on on Feb. 14, 2017. Posted with permissions.

Kara Fitzgerald, ND is a physician and clinical director in private practice at Dr. Kara Fitzgerald Functional Medicine in Sandy Hook, Connecticut. She is also on faculty at The Institute for Functional Medicine. Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland, Oregon. She completed the first CNME-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix (now Genova) Clinical Laboratory under the direction of Richard Lord, PhD. Her residency was completed at Progressive Medical Center, a large, integrative medical practice in Atlanta, Georgia.

Dr. Fitzgerald is lead author and editor of Case Studies in Integrative and Functional Medicine, a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine’s updated Textbook for Functional Medicine. She has been published in numerous peer-reviewed journals. Dr. Fitzgerald regularly lectures internationally for several organizations.

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