Opinion, South Africa

Dr Yael Joffe: On the Science of Functional Medicine

Director of the CTG, Dr Yael Joffe, talks about the value of gene-based personalised health and nutrition interventions in managing chronic illness.

Yael Joffe - EHN

Translational Nutrigenomics Expert and Director of the Centre for Translational Genomics (CTG), Dr Yael Joffe, talks about the value of gene-based personalised health and nutrition interventions in managing chronic illness and lifestyle disease.

Tell us about the work you are doing at CTG, especially in terms of personalised medicine.

There are two main areas that I work in, the first, which has been my core expertise for the last 17 years, is Nutrigenomics – the practice of using genetics and nutrition to best treat an individual patient. While one of our specialities at the CTG is helping patients with their weight, we are more concerned with chronic fatigue, autoimmune disorders, cancer and spectrum disorders like ADHD – because those are some of the conditions of a new health epidemic. I opened CTG to offer genetic testing and to translate it in a way that is clinically useful to our patients. In other words, using information about your genes to help you choose a diet and lifestyle that allows you to reach your health potential.

The other half of my work is personalised medicine or functional medicine, which is a different paradigm for traditional medicine. Instead of disease-based medicine, we’re interested in the original dysfunction that happens at a metabolic level and over time manifests as disease such as diabetes, hypertension or even Alzheimer’s. We want to take a broader view than the current healthcare system that focuses on individual episodes and symptoms and use medicine to treat those symptoms. And while we’re not against medicine in any way, as a system we’re waiting for symptoms to appear and then trying to treat those symptoms. But at CTG we want to deal with the dysfunction to prevent or manage disease.

How long has functional medicine been around?

Functional medicine is a spectacular paradigm of medicine that has been going on for at least 15 years. Its home is essentially at the Institute for Functional Medicine in the US, which has close to 20,000 members from all over the world. To become a functional medicine practitioner you first need to become a qualified doctor, dietician or medical professional and it’s also very biochemistry-based, which is much tougher to understand than the traditional approach of treating or medicating symptoms of a disease.

What’s the difference between functional medicine and preventive medicine? 

Preventative medicine is an element of functional medicine. Obviously, in functional medicine we want to prevent everyone from getting sick, but you can also use functional medicine to treat disease. It’s not so much differentiating between preventative and functional, it’s differentiating between acute care and chronic care. We don’t treat colds and coughs and day to day stuff – or acute medicine. Our focus is on prevention, optimal health and/or chronic disease. As an example, most diseases take decades to manifest. So if you have been suffering from chronic fatigue for the last ten years and no one has been able to help you outside of telling you that it’s a virus and to go lie down, then we are the people that can help.

What is your vision for the clinic?

I’ve partnered with Dr Anne Lannoye, a functional medicine doctor from Belgium who specialises in functional neurology – the brain, the gut and the immune system, which are all very closely related. We met in Denmark when she attended one of my trainings in genetics, and we realised that we had exactly the same vision: we want to offer an alternative healthcare to our patients that really impacts their health. We want to help prevent diseases like Alzheimer’s or cancer from manifesting and also treat patients whose diseases were already manifesting.

I already had the CTG open for a year and a half, but with Anne on board we’ve gone from being a nutrition-based centre to becoming a medical nutrition centre. We want to take our shared vision to turn the clinic into a Centre of Excellence for precision medicine. We’re using the work we’re doing in Cape Town as a pilot to test the client journey and to write protocols and programmes, and to learn all the lessons that we need to learn to be able to scale and export a profitable model. Our dream is to have clinics all over the world that offer the same client journey.

You’ve talked about using genetic information to understand a patient at a biochemical level. Let’s talk about chronic disease or lifestyle diseases that cover obesity, diabetes and hypertension. What’s the impact of genes on lifestyle choice?

There are those who will attribute disease to genetics, like your parents and grandparents had it and there are others who will support the idea that if you fix your diet and change your lifestyle you will be fine. And obviously neither of those is the right answer because we have a genetic blueprint that you were born with and can’t get away from, but what’s interesting for us is how that blueprint expresses itself.

There are two key components to my field of expertise, one is called Nutrigenetics and one is Nutrigenomics. In Nutrigenetics, we look at your DNA sequence, the actual code and we look for changes in the code that would give us information about how things are working in your metabolism. But it doesn’t tell us exactly what’s going on; it just gives us a clue about how that marker may behave itself and it’s usually a manifestation of lifestyle choices.

Genes are the gun and environment pulls the trigger. Genes can switch on and off, they can go up and down, they can become silent or they can talk very loudly. And why genes do that is a combination of changes in the DNA sequence and changes in the environment – diet, nutrition, exposure to toxins, exercise and stress. So everything that we do and how we do it impacts gene expression. But the exciting thing that we are learning, which is what makes our work very unique, is that you can use diet and lifestyle to change expression.

In general if you visit a dietician, they will give you advice based on whatever is the current standard of dietary guidelines such as carbohydrate exchanges or saturated fats. But what is happening is they’re taking population health information about what is good nutrition and packaging it to match you. They are adapting that information to your preferences, but not to your biochemistry.

On the other hand, we look at your genes to get some good clues about what’s going on in your body, we know whether a certain gene needs to increase expression so it can protect you against disease or if other genes need to down regulate because they are causing inflammation. And we use nutrition and lifestyle to make those changes. So we practice nutrition in a very non-dietetic way, we are using nutrients to change gene expression as opposed to population-based nutrition.

Talk us through the patient journey at CTG. How does it differ from what most of us are familiar with when visiting our GP?

It’s important to keep in mind that acute care is focused and chronic care is very broad. When a patient comes to our centre we don’t only ask them about their symptoms today, we go into a thorough and detailed history with the patient to capture the clinical and more nuanced information that will help us put all the pieces of an individual’s health together.

We see ourselves as detectives in that we have all this information from genetic and biochemistry tests, as well as information about their history and current symptoms, and then take all that information and put together the puzzle and find the missing pieces.

So, understanding the patient is the first part of the process in the centre. The second part of the process is to understand what we think is happening, which is usually quite complex, and how we are going to treat it. Obviously we use a lot of nutrition, but we also use medicine when we need to, including herbal medicine. So from there a doctor and a functional nutritionist comes together to set a treatment plan.

Once we work out what’s wrong with you, we assign you a health coach to help you change your behaviour. We use an app called Nudge Coach that allows you to track your nutrition and also be in touch with your health coach 24/7. So if, for example, you are food shopping and don’t know what to cook for dinner, within minutes your health coach can send you a recipe and tell you where to find the ingredients. Or if you wake up with no energy and you can’t get out of bed, you can connect with your health coach for advice, and if they think something serious is happening they can organise for you to see one of our doctors.

So the health coach engages and connects with the individual on a regular basis, every two weeks at a face-to-face meeting and on the app outside of that. After a month the patient will meet with the medical team again to review and tweak. Because we’re dealing with different people who respond differently to interventions, we structure treatment according to your needs. So if you come to us and you are really ill you’ll need to come in more often to see us and the doctor. If you have come to us with either a weight management issue or a fatigue or detox issue, you won’t have to come back so much. So through our service you’re getting 24 hour care, a full assessment, feedback, education and a community. It’s engaged, managed care.

Mental health has received a lot of attention in the last couple of years, both to reduce the social stigma but also because it’s prevalent and a major contributor to overall health and lifestyle. What role does mental health play when you’re consulting with a patient?

A number of patients that we are attracting to the centre present with ADHD, autism and other spectrum disorders. It’s very interesting because our gut, brain and immune system are all linked, so you cannot treat mental health without treating the gut and the immune system, and you cannot treat the immune system without treating the brain.

We’re seeing a huge prevalence of children with ADHD, and while that may be driven physiologically, a large part of it is our diet. For example, some of us are more susceptible to sugar and refined carbohydrates and pesticides, this may create a brain fog and eating wheat and dairy both create something called exhorphines. We all know about endorphins – our feel-good hormones, but exhorphines attach themselves to exactly the same receptors in the brain that endorphins do. So what happens is that when you eat a pizza you get a load of exhorphines being generated by the body that will go and attach themselves to the receptors and as a result leave no room for endorphins. So you will feel tired, have brain fog, feel depressed and feel flat; it’s all a physiological response. People think that if you eat gluten and you don’t get diarrhoea or tummy cramps you must be fine, but gluten affects mental health because it attaches itself to these receptors and blocks our endorphins. This is often the case for kids at school who can’t concentrate and who are distracted.

That’s just one example of how nutrition can change brain function. 80% of your immune system is in your gut, so if your gut is not absolutely optimal you will never get off your meds. And that’s where the difference comes in, we use clinical information together with an in-depth understanding of the individual to create nuanced treatment plans to give patients back their health and quality of life.

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