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The Evolution of Truly Personalized Medicine: Epigenetics, Food, and Fitness

Most would not argue that there is ongoing transition in how our healthcare is being delivered. This article will examine some of these transitions as a result of breakthroughs in technology, as well as how genetic information, exercise, and diet will play an increasingly greater role.

When medical science was first getting its start, a more holistic philosophy was taken on how to treat illness and maintain health. Hippocrates is often deemed the father of modern medicine, and even today the allopathic physicians (M.D.s) take the Hippocratic Oath – to do no harm to their patients. Hippocrates knew, even in 400 B.C., that the best healer of the body is the body itself. For the most part, the best treatment is to create a strong body and get out of the way. Five guiding principles used in his philosophy for treatment include:

  1. Walking is man’s best medicine.
  2. Know what person the disease has, rather than what disease the person has.
  3. Let food be thy medicine.
  4. Everything in moderation.
  5. To do nothing is also a good remedy.

The second and fifth principles emphasize the power of knowing the individual and getting out of the way! The first and third principles show the power of exercise and food for healthy living. Even the genius, Thomas Edison, realized that a health maintenance organization (HMO) approach was the best method of healthcare both practically and financially. His quote, “The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease,” is evidence that a holistic, preventative approach is what he advocated. He is also quoted, “…you can’t improve on nature.”

One size does not fit all

Personalized medicine is now on the forefront and it utilizes the genetic and epigenetic data of a person to guide medicines and treatment plans. Cancer drugs have probably harnessed this advantage to the greatest extent, thus far. Former President Jimmy Carter received Keytruda (pembrolizumab) for his brain cancer and it boosted his immune system and beat the cancer. While most of America (71%), still doesn’t even know about personalized medicine, those who were familiar with it did not know it would yield better results with fewer side effects. The different directions of personalized medicine are still being realized, but the field of pharmacogenetics is the first to really jump on the bandwagon of highly effective, precision-based treatment.

The reasons some drugs work for some people and not for others, or why side effects occur in some individuals and not others, is due to individual variability in metabolism. Why are some people lactose tolerant, or some can drink alcohol with no problem, and others have severe issues? It is usually because of enzyme differences, which are under the control of our genes. Interestingly, our enzyme genes can often be turned on or off by “inducible sequences” known as promoters or suppressors of operons, respectively. These “switches” can be repressed or induced depending on our environmental stimuli. Thus, we actually have some control over our gene expression, and this field is known as epigenetics.

Knowing what gene variants someone possess or not will guide the personalized medicine physician on which drug to use or not. By knowing allergic reactions in advance or which medicines may have side effects will help physicians to not make a bad situation worse. Unfortunately, the cost of personalized medicine drugs is much higher than alternative treatments. There is still a lot of exploration to be done on all the various applications of this technology, but the bottom line is that understanding individual variations and enabling the body to do what it is designed to do is a very good thing! Companies like Toolbox Genomics is one of many companies that use your genetic information to then tell you what foods and supplements to eat or avoid, and which exercises may help you the most, and ones that you may not respond to so well. The reason physicians do an intake on family history, or run various tests is to collect information that will guide their treatment. A genetic test on certain gene variants is simply taking this a step further.

How does exercise and diet apply to our epigenetics?

Did you know that exercise is highly beneficial to not only help with fighting cancer once it is already present, but also to never getting it? Physical exercise or movement in general will shift the epigenetics so that genes that suppress tumors are increased, and genes that cause cancer (oncogenes) are decreased. It does this by changing the amount of certain reactions called methylations. Things go wrong when there is too much or too few methylation reactions. Exercise has been shown to reduce or even reverse the epigenetic mutations that often result in tumorigenesis or tumor production. Exercise has also been shown to reduce genetic factors associated with aging like telomere length.

The fields of proteomics and metabolomics as well as pharmacogenomics, are all emerging because of the knowledge on how our genetics affects proteins, metabolism, and reactions to drugs, respectively. The field of nutrigenomics is rapidly expanding, and several companies are capitalizing on studying the relationship of how our genes affect how we process and utilize foods, as well as how food can affect our genes. Vitamins A and D, certain fatty acids, especially medium and short chain, some sterols (derived from cholesterol) and zinc have been shown to directly influence gene transcription. In direct effects include how diet affects gut bacteria, which in turn influences gene expression. Soon when nutritional recommendations are given, it will likely be “for this individual.”

The future of medicine will be taking our genetic information to a whole new level. Soon “smart” watches, clothes, hats, and other common devices will collect information that can benefit our health in many ways as the way healthcare is delivered continually evolves.

This article was featured in MedFit Professional Magazine. Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

walking shoes

Keep Walking: Benefits of Walking as Aerobic Exercise

Aerobic exercise (also known as cardio) is physical exercise of low to high intensity that depends primarily on the aerobic energy-generating process. “Aerobic” means “relating to, involving, or requiring free oxygen”, and refers to the use of oxygen to adequately meet energy demands during exercise via aerobic metabolism.

Generally, light-to-moderate intensity activities that are sufficiently supported by aerobic metabolism can be performed for extended periods of time. What is generally called aerobic exercise might be better termed “solely aerobic”, because it is designed to be low-intensity enough so that all carbohydrates are aerobically turned into energy. The bulk of the energy in this type of exercise is due to mitochondria ATP production which relies on oxygen for the metabolism of carbs, proteins and fats for energy.

Health Benefits

Among the recognized health benefits of doing regular aerobic exercise are:

  • Strengthening the muscles involved in respiration, to facilitate the flow of air in and out of the lungs
  • Strengthening and enlarging the heart muscle, to improve its pumping efficiency and reduce the resting heart rate, known as aerobic conditioning
  • Improving circulation efficiency and reducing blood pressure
  • Increasing the total number of red blood cells in the body, facilitating transport of oxygen
  • Improving mental health, including reducing stress and lowering the incidence of depression, as well as increased cognitive capacity
  • Reducing the risk for diabetes (One meta-analysis has shown, from multiple conducted studies, that aerobic exercise does help lower Hb A levels for type 2 diabetics)
  • Reducing the risk of death due to cardiovascular problems

How to Walk Properly and Correctly to Keep Walking

Starting from the foundation of our body, our feet, we need to keep in consideration and balancing our weight through a tripod that includes our heel, big toe and small toe during our gait circle.

Gait is categorized into two phases: stance and swing. The stance phase occurs when the foot is on the ground. In young to middle-aged adults, the stance phase makes up 60% of the gait cycle. The remaining 40% of the cycle is spent in the swing phase where the foot is off the ground and being propelled forward.

The more we keep repeating this cycle in the correct form the more we keep producing the right pattern for our body to keep walking/exercising, planting the benefits for our longevity.

Additionally, we need to consider the alignment of the rest of the body. Thorax and Pelvis should be in the same line allowing breathing to go in a constant rhythm with the heart and lungs. Usage of the diaphragm and full expansion of respiratory muscles will allow extra oxygen intake, leading to better performance and eventually weight loss.

Body Performance Benefits

In addition to the health benefits of aerobic exercise, there are numerous performance benefits:

  • Increasing storage of energy molecules such as fats and carbohydrates within the muscles, allowing for increased endurance
  • Neovascularization of the muscle sarcomeres to increase blood flow through the muscles
  • Increasing speed at which aerobic metabolism is activated within muscles, allowing a greater portion of energy for intense exercise to be generated aerobically
  • Improving the ability of muscles to use fats during exercise, preserving intramuscular glycogen
  • Enhancing the speed at which muscles recover from high-intensity exercise

Neurobiological Effects:

  • Improvement in brain structural connections
  • Increase in gray matter density
  • New neuron growth
  • Improvement in cognitive function (cognitive control and various forms of memory)
  • Improvement or maintenance of mental health

Walking is widely recommended for its health benefits. According to a recent U.S. Surgeon General report on physical activity and health in America, more than half of the U.S. population does not participate regularly in any type of exercise. That physical inactivity can lead to poor health. It is time to start making better choices and better habits. Let’s start walking!

  • Walking can help you attain that trim figure you’ve been “dieting” to have. It allows you to burn off fat without losing muscle and without depriving your body of the essential nutrients it needs. And it can help tone your muscles and shape up your legs.
  • Before you begin walking for fitness with freestyle walking programs, you need to consider a few preliminaries, including your age and your overall health. It’s pretty easy to figure out that walking doesn’t require much in the way of equipment. One of the only, and by far the most important items that you’ll need, is a pair of comfortable walk­ing shoes. If you don’t take time and care in selecting your walking shoes, you may be in for some serious discomfort.
  • You also need to learn how to measure your heart rate and listen to your body, so you’ll know where to begin and how hard you need to work to increase your fitness and health. You may have heard similar claims made for other aerobic exercises, but consider this: The only exercise that will do you any good is the exercise you do, and walking is easy, as easy as putting one foot in front of the other.

Dimitrios Triantafillopoulos is a Master Personal Trainer, supporting people, athletes and other trainers to make them feel better with their body and themselves. He holds a Bachelor’s degree in Kinesiology and Sports Science, a Master’s Degree in Nutrition and Sport Fitness, as well as a Medical Fitness Specialty. Dimitrios has attended numerous seminars in Performance Training and Specialized Nutrition, and is also a Certified Instructor in Vibration (Power Plate) Acceleration Training and Electro – Stimulation Training. He is currently a Fitness Manager at Crunch Fitness in New York City.

pexels-marcus-aurelius-4064177

Mental Habits and Chronic Pain

People faced with the day in day out experience of ongoing muscle and joint pain often develop mental habits to help them cope that can actually make their condition worse.1 Emotions such as anger, depression and/or making comparisons to how things used to be before the physical problem began, distracts the brain temporarily to help override current sensations of pain. While these mental habits can provide fleeting relief, they also serve to prolong chronic pain conditions by changing brain chemistry and altering the mind and body’s response to pain.

pexels-marcus-aurelius-6787542

The Essential Ingredient to Sticking With It…

If you’ve got this “special sauce,” you’ll overcome any obstacles placed in your way to perform your best…anytime!  Regardless of whether it’s sticking with lifestyle change to improve your health, a nutrition plan, cutting back on smoking or drinking, adhering to a medication regimen, following through with physical therapy appointments, or adhering to an exercise program, this essential ingredient will make all of the difference.

weights-water

Taking it Slow. Not Every Fitness Goal Needs to Be Fast and Hard.

Senior Woman Holding Fitness Sign With Family In BackgroundGo big or go home? We all want to see fantastic results from our hard work and dedication to any fitness program. If we maintain nutrition, eat well and work as hard as we can, we are going to see results: that is inevitable. But, do we have to train as hard as possible each and every time we workout, each and every day? Sure, we fit in a rest day, but what else can we do to make sure we are restoring our bodies and minds?

Fitness goals are most easily reached when they are part of every aspect of our lifestyle and not compartmentalized into a few hours of the day. We have limited energy sources no matter how healthy we are, so it is important to maintain awareness about how each of our decisions and actions influence our wellness and choose accordingly.

From a physical aspect, we can slow down some of our workouts to build strength. This works in a variety of ways. By increasing resistance, continuing muscle exertion over a period of time and working muscles beyond the support of initial momentum, strength can be gained, even with relatively light weights or by using the weight of the body alone. This can be true of some weight training programs and is something you can discuss adding to your fitness routines with a certified personal trainer. It is also one of the key elements of building strength through yoga practice and asanas (yoga postures). An additional consideration from a holistic health perspective is the effects of the stress hormone cortisol on weight loss. By taking part in calming physical activities such as restorative, gentle, yin and meditative yoga practices, it is possible to reduce stress, allowing the body to shed weight, heal and be at top capacity for more intensive strength and cardio training when you are working with your personal trainer or in other group fitness programs. By taking time to slow down, you can actually optimize performance and fitness results.

Nourishing your mind can also come in handy, as a way to promote your health when you are not busy exercising or working. Take time to read, learn, talk with fitness experts, organize your time and plan your meals. A wealth of free information is available online to support you in your fitness goals. Blogs with entries from personal trainers and other fitness experts are a great place to start. Personal trainer certification organizations such as the National Council for Certified Personal Trainers (NCCPT), maintain blogs with a variety of advice for personal trainers and fitness enthusiasts. You may also get inspired and decide to take your fitness goals one step further. Once you get involved learning more about fitness, biomechanics and how amazingly capable your body is, you may even get inspired to become a personal trainer or group fitness instructor yourself!

If you find yourself interested in learning more about how to incorporate fitness into every aspect of your life, maybe even your work, you can find out more from the NCCPT.

No matter where you are at in your fitness journey, don’t forget to take some time for yourself. Slow down sometimes to speed up your progress!

Reprinted with permission from NCCPT.


John Platero is the founder and CEO of the National Council of Certified Personal Trainers (NCCPT) which has certified thousands of personal trainers both nationally and internationally.

Back pain

Three Steps to Ease Back into Exercise After a Back Injury

According to studies, Low back pain affects nearly 80% of all adults.  Most low back injuries come from the following: wearing high heels (women), performing manual labor and people who sit for long periods of time (greater than 3 hrs.). Although these statistics are alarming, there are some simple steps one can take to make sure that they avoid current and future back pain or injury. These steps all involve simple exercises that can be performed from anywhere, including one’s office.

Step #1: In order to prevent further injury or a relapse, the 1st thing one should do is stretch common muscles that are tight and may have caused the lower back pain in the first place. Tight muscles are known to overwork and when this occurs, they become overactive and let us know through pain. These muscles include: erector spinae, hip flexors, calves and the lats (the big back muscles). For each stretch, you want to hold the stretch for 30-120 seconds and perform the movement for 1-2 repetitions 3-5x/week. (View Stretches: http://www.webmd.com/back-pain/living-with-low-back-pain-11/five-back-pain-stretches)

Step #2: After you have stretched the tight muscles, now it is time to focus on strengthening the muscles that are weak or underactive. Muscles become weak or underactive typically from lack of use or overuse by the muscles that assist or oppose the weak muscles. For example, if your hip flexor is tight, it could cause your glutes (butt) muscles to become weak.  The muscles that tend to weak with a lower back injury include: certain core muscles, the butt and hamstrings. For each strengthening exercise, you want to perform 1-2 sets of 10-15 repetitions 3-5x/week. (View core exercise: http://www.webmd.com/back-pain/living-with-low-back-pain-11/core-strength-for-back-pain; http://www.webmd.com/back-pain/lower-back-pain-10/slideshow-exercises)

Step #3: Now that you have isolated the lower back with stretching and strengthening exercises, now it is time to focus on integrating your entire body back into exercising. Integrated exercises involve using as many muscles as possible in one given exercise. By performing integrated exercises, you will ensure that the your hip joint (which can be misaligned with low back injuries) starts and remains in the right position and the proper muscles are working as they should be. For each integrates exercise, you want to perform 1-2 sets of 10-15 repetitions 3x/week. (View integrated exercises: http://www.allthingshealing.com/Chiropractic/Corrective-Exercise-for-Back-Pain/8558#.VIoTN74zf8E)

If you follow these three simple steps, you can avoid low back pain setbacks and ensure that your back is strong enough to handle your daily activities of life.


Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD.

STRESS pencil

A Stress Management Plan for an Aging Population

April is National Stress Awareness Month!

Fortunately today, there are many tools to help individuals cope with stress. The first step is to acknowledge that you are stressed and to know what is stressing you. Once you are aware of your stressors, you need to make a stress management plan to follow. The journey may not be perfect but it is a work in progress. Most individuals aren’t going to know how to develop a plan or where to start. A trained individual such as a certified personal trainer can help to formulate the best plan for each client and make changes as the client achieves each milestone in the process.

As many as 20% of people experience depression in their later years

A stress management prescription is also needed for aging adults since the mind and body become slower to adaptations. The stress response lasts longer and seniors experience different symptoms then younger adults. Some key symptoms can be: crying, overeating, wounds taking longer to heal, heart palpitations, anxiety and depression. As a trainer, you will most likely be working with the client’s doctor who is treating them for these symptoms. There is a myriad of modalities that you can use to help your client drastically reduce their stress levels while they heal. As a fitness professional, incorporating meditation, exercise, yoga, Pilates, and many other techniques can help your client’s symptoms improve mentally and physically. The question is can we do more than telling clients to take a class? The answer to this question is an emphatic yes!

The causes of stress for this population are also different and depend on which decade in life they are in. Some examples are: loneliness, being institutionalized, fear of having enough money for retirement, loss of independence and many other causes. The problem is that many people can’t asses their own stress level and don’t know where to turn for answers. Chronic stress is harmful in many ways, but can be minimized once the individual becomes aware of their stress level and knows there are stress management professionals who can help.

Today, 53% of Baby Boomers are using complementary approaches to try and relieve stress and help with other conditions such as: anxiety, depression, chronic pain, stress, and hypertension. Complementary approaches are not limited to but include; exercise, nutrition, yoga, Pilates and Tai-Chi. Research conducted by the National Center for Complementary and Integrative Health shows that meditation can help to relieve symptoms for example chronic pain. As a fitness professional it is important to realize that these modalities must be used in conjunction with conventional medicine.

When training clients, it is important to see them as a whole person through the dimensions of wellness. As people, we have many things going on mentally and physically that are very complex. A stress management plan helps to streamline what can work best for your client and their current needs. The plan can evolve and most likely will depending on what is going on in your client’s life at the time. When you can assess and classify your clients you then know which complimentary approaches will work better for them. This will in turn, will help to keep your client engaged and on track with their goals.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness. Become a Stress Management Exercise Specialist today!

 

Sources:

https://consumer.healthday.com/encyclopedia/aging-1/age-health-news-7/aging-and-stress-645997.html

https://www.slideshare.net/soniya302/stress-among-elderly

http://www.elderly.gov.hk/english/healthy_ageing/mental_health/stress.html

https://www.stress.org/seniors/

http://www.providencecare.com

http://www.health.harvard.edu/aging

 

Male doctor explaining the spine to a senior patient in medical office

3 Curves = Straight: The Importance of Neutral Spine in Exercise

I have been teaching strength training, as well as Pilates based mat and Vinyasa Yoga for over 2 decades. As a former dancer, I know that I was always struggling with having a “flat stomach” or having a “flat back”. Dancers, in trying to achieve that “perfect turnout” and “flatness”, were often taught to “elongate the spine” by “tucking the pelvis” under, which basically leads to a posterior tilt. Unfortunately, this idea is often taught in fitness to the general population. Trainers and teachers alike, some coming from the dance world, will tell students to “protect their back” by tucking the pelvis such as during standing exercises, even bicep curls, or worse, curl their knees into their chest while lying on the ground or bench, and attempting to do a chest press. Students will be so conditioned to this ROUND SPINE and TUCKED PELVIS, that eventually when they stand, this is their posture. Over time, the discs can bulge, and the forward pelvis will eventually lead to lower back pain they were trying to avoid, as well as knee pain and other issues.

I am a reformed pelvic tucker. I advocate neutral spine when teaching, whether it be standing work such as bicep curls, pronated work such as plank and push-ups, or supine work such as leg lowers and overhead triceps.

The spine has 3 curves: the cervical spine (at the neck) has a concave curve, the thoracic spine (back of the rib cage) has a convex curve, and the lumbar spine (lower back) has a concave curve. And if you want to add a 4th, the pelvis/sacrum has a convex curve as well.

Together, this “S” shape is what keeps a body “straight”. Constantly flattening one’s back or pushing one’s vertebra into this position will eventually damage them. Plus you have to learn to CONTAIN YOUR MUSCLES, not force your vertebrae. There is a moment when the base of your ribs and your pelvic bone will feel like they are aligned in the front, like suspenders. Whatever curves are left over should remain.

Sometimes I do my supine abdominal work as well as strength training on a foam roller (pictured at right). This way there is no avoiding working in neutral spine. Plus, the foam roller will target the transverse abdominus as you are struggling to keep the foam roller still while performing exercises such as chest press, chest flies, overhead triceps, single and double leg lowers, etc.

Another bad habit that trainers and teachers tell their clients and students is to “sit on their hands” while performing exercises such as leg lowers. This is BAD for every reason. Your hands have small bones and veins which are easily damaged by sitting on them. Say you are 200+lbs, and you are putting all of your body weight on your hands! This is not good! I often joke and tell my students “I am a guitar player! I am not going to sit on my money makers!” Also, sitting on your hands again causes the pelvis to tuck, and the shoulders to protrude forward. By teaching this, you are telling your clients and students to “slouch”. You have not taught them how to gain strength by maintaining neutral spine. Third, more often than not, the reason the clients are feeling “pain” in their lower back is they are attempting to lower their legs beyond the range where the abdominals are effective. For me, about a 45 degree angle from the top is plenty of work. Attempting to lower one’s legs all the way to the floor and back will usually be out of the range of someone’s abdominal strength. Find a range of motion where the abdominal muscles fell the work, and the lower back is not effected. You can also put your client on the foam roller, or if you do not have a foam roller, place a thin towel under the sacrum to alleviate any pain the floor may be causing, as well as teach neutral spine.

For “plank”, I often joke (as I am a realtor as well) that “if the plank is not straight, I am returning it to aisle 4 in Home Depot”. People tend to hang their heads when something is difficult. I advocate looking a few floor boards ahead while performing plank, as well as push-ups, and to use a side mirror to check that the line of the head, shoulders, ribs and hips are aligned, while keeping the natural lumbar curve. Again, the ribs and hips should feel like suspenders. Push-ups are basically a “plank with an arm bend and straighten”. So it is important not to hang one’s head, especially when the floor is getting close :). (Planks pictured at right)

In closing, remember that you want to teach your students functional exercises that will help them out in the real world. Teaching neutral spine alignment is one of the most important ideas. You would never want to lift a box with a rounded, tucked spine, so why teach clients to “tuck their knees into their chest” while performing chest press? Sometimes it will take some time for a client to undo these bad habits, but in the end, clients will be stronger, and use the transverse abdomens vs poor alignment to perform daily tasks.

Photos courtesy of ANDREW MARK PHOTO.


Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, Pilates, Vinyasa Yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS.   You can order her new book, “Healthy Things You Can Do In Front of the TV”  on pre-sale on amazon.com, and it will soon be available on BN.com, and Kindle. Visit her website at bodyfriendlyoga.com