You wouldn’t go on a road trip without a map. In the same way, when you’re leading your patients along the route to wellness, it’s best to know where you’re going and how to get there.
As a chiropractor, your understanding of the human body and the nervous system is the foundation of your art and science, but new tools are now available that may offer insights you never thought possible, thanks to genetic testing.
It was only as recently as 2003, upon the completion of the Human Genome Project (HGP), that we obtained the full genetic blueprint for building a human being.1 This was the culmination of a 13-year effort to sequence all 3 billion base pairs of the human genome.
As a result of the HGP, we discovered more than 1,800 disease genes, we now have more than 2,000 genetic tests for health conditions, and some 350 biotechnology-based products are currently in clinical trials. Progress in this area has been rapid and breathtaking.
When advanced technologies emerge from the laboratory, they are generally expensive and labor intensive—and genetic testing was no exception. Only recently have breakthroughs in science and laboratory equipment allowed for economies of scale to operate and bring this type of testing to the consumer level.
But while you can now easily offer genetic testing to your patients at a price they can afford, should you? What are the benefits for your patients and your practice? What do you need to know about this subject and what should you expect in terms of results?
From concept to reality
Today there are several companies that target the chiropractic market for DNA testing, mainly for gauging patients’ nutritional and fitness profiles. Rather than offering patients one-size-fits-all regimens, you can now provide more tailored, targeted, and effective advice.
Vince Pavelock is CEO and chairman of BodySync, a firm that offers nutrigenetic testing. “This journey began when we started developing, validating, and patenting proprietary genetic testing algorithms with application to customized nutrition, fitness, and wellness. We invented the first Web-based rules engine and computer-generated action plan in the genetics business,” he says.
Pavelock’s investments in nutrigenetic technology originally were aimed toward the development of a genetically guided nutrition and fitness program with a weight-management component. “We had made a strategic decision a couple years ago to build a nutrigenetic assessment for the practitioner market, find a reputable distribution partner expert in training health providers, and combine forces with them to touch and change as many lives as possible.”
Denise Blevins, speaking on behalf of genetic testing firm foru international, says her company’s decision to enter this field was the vision of Robert Ricciardi, PhD, a doctor of microbiology. “He developed one of the first gene-mapping technologies and also discovered the first viral activator proteins that turned on genes in human cells,” Blevins says, “leading to his becoming a ‘gene thermostat’ expert.”
Ricciardi then founded GeneLink in 1994 (the science company that provides foru’s secure DNA assessments and personalized nutrition and skincare). The Human Genome Project was well underway at this time and there was a surge in single-nucleotide polymorphism (SNP) association studies. “The question was whether SNP technology could be applied in a way to improve people’s lives,” Blevins says.
Disposition, not destiny
Before looking at how you might use this kind of tool in your practice, be clear on your objectives and the sorts of patients for whom it might be appropriate. Genetic data won’t supersede what you normally do as a clinician; rather, it can augment and amplify your efforts.
William Beakey, LAc, DOM, is director of Professional Co-op laboratory services, a firm offering physicians and DCs easy access to lab tests. He points out that genetic testing may be indicated for some cases, but it likely won’t be the first option for the practitioner.
“I like to do a lot of basic work first,” Beakey says. “A genetic test is going to tell you your predisposition. You might have a gene for something that may never be activated. I like to look at the phenotype first.”
Beakey sees a lot of DCs who are competent clinically as primary care physicians. And he notes that some tests can be performed in an office setting. “You could use a glucose testing kit—there are millions of people in the U.S. who aren’t diagnosed. You can do a urinalysis test right in the office.” Beakey finds that most people are more acidic than anything else. “Balancing a diet to get more alkalinity is a good thing to do.”
So where does genetic testing enter the picture?
Unlike direct-to-consumer genetic testing companies selling ancestry, paternity, or specific assessments on potential disease predispositions, emerging companies in the chiropractic space are focused on diet, supplementation, and physical activity levels.
“Early adopters have always been open to our technology,” Pavelock says. “Elite athletes have been excited about nutrigenetics and kinesiogenetics for some time now. While that’s still true, more and more people are curious about the genetics they’ve passed on to their children and are curious about how to use this knowledge proactively.”
People interested in genetic testing tend to be serious about personal wellness. Especially those individuals who have children where there might be a strategic wellness benefit that can guide the kinds of foods they’re eating.
In other words, as health-conscious people learn more about the meaning and application of the information available through DNA testing, more will be interested in obtaining it. “Everyone has genetic variances,” Blevins says, “and therefore is a prime candidate for wanting to look at their DNA and discover what they need to do to look and feel their best.”
On the other hand, Beakey thinks you might turn to this kind of test when you’re unsure about a particular patient’s condition: “I would say it’s more for the head-scratcher cases. What do you not know about this patient that’s holding back their success?”
Pavelock also stresses that practitioners may find that genetic testing helps them identify wellness opportunities that may never have been revealed based on standard blood tests or phenotypical assessments. Nutrigenetic testing can help practitioners build a more targeted and logical platform for guiding a patient: “It takes some of the guesswork out of where to start, such as whether or not there’s a potential vitamin deficiency.”
Start smart
Our experts agree that before you consider employing any kind of lab testing in your office, you need to be clinically competent to apply it, interpret the results, and counsel patients about the data obtained. Genetic testing is a fairly complex subject, so educating yourself first is essential.
Beakey points to the many highly educated researchers who lecture and give seminars on these topics. “There are courses you can take on genetics. The University of Maryland offers a certification. The University of Toronto has a very advanced program,” he says, and also notes the usefulness of the lectures by Amy Yasko, PhD, which explain the process of DNA methylation.2
In Pavelock’s opinion, it’s important to have an expert who can help patients understand and calibrate the impact of the whole-health picture. “This shouldn’t be a standalone test. It’s just a part of helping the practitioner design a personalized road map to health and optimize what a patient is (or isn’t) doing. It takes away the guessing game.”
In addition, it can also boost compliance. “Genetic testing is a targeted technology. We have conducted studies in which we have seen personal genetics enhance compliance on nutritional and fitness regimens,” Pavelock says.
For her part, Blevins agrees that it’s always helpful to have a professional walk through the assessment to guide a patient’s understanding of their results.
“That’s always the case,” Beakey observes. “That’s what physicians do. A lot of them don’t know much about genetic testing. It’s daunting, humbling, and exciting at the same time. The patient should always try to work with a competent physician who can help interpret the results, as it can be a little scary once you’re past the ancestry part of it.”
Pavelock also finds that certain DNA tests can generate data that can confuse or leave a patient with more questions than answers. “A trained practitioner who uses genetic testing to provide a context for practical nutrition and fitness recommendations essentially gets a game plan on how to deal with a patient. It’s information with interventation possibilities behind it,” he says.
In practice
Those in the chiropractic industry who have already incorporated genetic testing into their practices find that many patients are naturally interested in removing some of the guesswork from their wellness goals by having a professional guide them through a test’s implications.
Kelly Miller, DC, offers genetic testing and personalized health plans to patients at his practice in Temple Terrace, Florida. A 59-year-old baby boomer, Miller says he had a vested interest in learning about aging and regenerative medicine and embarked on a course of study in Brazil to expand his knowledge.
After selling his multidisciplinary practice in 2013, he now works solo at an operation that focuses on functional aging and regenerative medicine. These subjects intertwine with his longtime interest and research in the field of nutrition.
Miller offers testing to detect SNPs related to weight management, vitamin deficiencies, heart health, and inflammation as well as bone health. He views the chiropractic industry as well-suited to offer DNA testing that can unlock key information about a patient’s profile. “I really think this is a missing link,” Miller says. “This is a huge market for chiropractic from a nutrition and aging standpoint.” In addition to overseeing the test, chiropractors can assist patients with compounding issues such as back or knee problems which, without remedy, can inhibit patients from achieving the recommended forms of diet and exercise.
Chad McKernan, DC and owner of a practice in Shelby Township, Michigan, offers advanced gene sequencing assessments to ascertain patients’ targeted exercise regimen, ideal diet, and optimized health and recovery through nutraceutical supplementation. “When I first started doing DNA assessments, most of the patients were baby boomers looking to live a longer and healthier life,” he says. “Then I noticed more and more geriatric patients coming in for testing. Really, it’s across the board. Just about anyone who has passion for a wellness lifestyle seems to be interested in it.”
Developing a program
Although some patients may already be familiar with genetic testing, others will have either never heard of it or thought about it as an option. Miller often brings up the topic as he discusses patients’ medical histories. “For the average chiropractor looking at this, we have an aging population,” Miller says. “You’ve got huge area that you can address with genetic testing and talking about family history to get people more proactive.” To develop a program at your practice, Miller recommends employing a symptom survey and talking to patients who might benefit most from targeted nutrition about the possibility of taking a test.
Before McKernan began offering genetic testing at his practice, his patients had been asking him questions about it, or telling him that they were getting tested. “Sometimes it would be by a reputable doctor and other times it would be by some fly-by-night website they found on Google,” he says. “I was afraid that my patients were looking at price only, and not doing the test that would best suit their needs.”
Research supports the notion that a consumer’s perception of personalized nutrition does significantly improve with the involvement of a healthcare professional, according to a 2014 study in the Journal of Nutrigenetics and Nutrigenomics.3 “The community is looking for practitioners to do this type of testing, and our profession is a perfect fit to offer it to them,” McKernan says. Both McKernan and Miller have information about the tests they offer on their websites, which drives curious individuals to their office doors.
Stay in scope
The kinds of tests available to DCs from the handful of companies offering them usually produce a results report. This will explain the findings in terms a patient can readily grasp, and suggest possible health effects of the SNPs examined. As long as you aren’t diagnosing an illness or predicting a certain outcome based on the test results, you should be safely within your scope of practice.
Any lab you are working with should adhere to the Dietary Supplement Health and Education Act of 1994 (DSHEA), which is the FDA response to dietary supplements, Blevins says. “This simply means we do not diagnose, treat, or prevent any illnesses. We are not a medical device or a drug and therefore have not been approved by the FDA.”
This should be integral to the type of test you are ordering. “The beauty of the action plan—or report—is that it focuses on unique wellness opportunities that may never have been identified by other means,” Pavelock says. “And this is a cheek swab rather than a blood draw. It shouldn’t pull the doctor into the wrong arena.” The results of the test and the process of conducting it are thus in the doctor of chiropractic’s scope, and the report won’t make any correlations between a deficiency and a disease.
“You’re talking about how this shows that you may have an increased propensity, likelihood, increased risk factor for these things,” Miller says. “You’re evaluating the absence, the deficiency, or inefficiency; we’re not going to cure. It’s a risk-benefit analysis.”
McKernan makes the boundaries clear with patients in writing: “The type of testing I am doing is preventative. It is not designed to look for genetic variation related to diseases, pathological states, or conditions. I actually have a waiver that I make them sign that states they understand this,” he says.
One test, a lifetime of change
Of course, receiving the test results is only the beginning of the process. With a simple cheek swab, patients can hold in their hands a compass pointing to improved health—but they have to choose to walk in that direction. You can help keep them on track. One of the most crucial components of your involvement in genetic testing is overseeing patient compliance of the plan you help craft.
Here, McKernan sees the crossroads of chiropractic and genetic testing working together in harmony, with another opportunity to educate: “Not only are [patients] getting great DNA testing, we can also teach them how to eat, exercise, and supplement their daily routines.”
Miller finds that getting to the root of patients’ health goals can help solidify their adherence to a new lifestyle. “You always have to relate it to ‘what’s my motivation to do this,’ ” he says. “What do they envision their 50s and 60s looking like? Their 60s and 70s? Do they want to be here around 100? You have to relate it on a very personal level.”
This type of motivational interviewing is influential in other methods of chiropractic care and can be transferred to the genetic testing realm. When a patient is advised all at once to supplement with nutraceuticals, maintain a completely revised diet of 40 percent protein, and increase exercise levels, a healthcare practitioner can ensure the driving force for wellness goals isn’t lost within the packet of paperwork.
Advances yet to come
We also wanted to know what the future has in store for this modality, given how new this technology is. According to our experts, medically directed and guided weight management should be a major outcome of this science. We’re only at the leading edge of our understanding of the genes that control the body’s nutritional needs and responses.
Also expect to hear more about epigenetics. While we know that some genes can be activated in response to external triggers, our ability to test how they are responding to interventional strategies is still a few years off.
“The more we understand about a person’s genetic potential and ability to absorb and process things will allow for better healthcare,” Beakey says. “Genetics is more than just eye and hair color.”
Physician, heal thyself, goes the adage. If you’re curious about genetic testing, consider testing yourself first before committing to adding it to your practice. The results you obtain can help you decide if this level of personalized healthcare is appropriate for your client base.
Daniel Sosnoski (far left) is the editor of Chiropractic Economics. He can be reached at 904-567-1539, dsosnoski@chiroeco.com, or through Chiroeco.com. Caroline Feeney (immediate left) is the associate editor of Chiropractic Economics. She can be reached at cfeeney@chiroeco.com, 904-567-1559, or through Chiroeco.com.
References
1 National Human Genome Research Institute. “All About the Human Genome Project (HGP).” http://www.genome.gov/10001772. Accessed Jan 2, 2015.
2 Yasko A. “The Methylation Cycle.” Dr. Amy. http://www.dramyyasko.com/our-unique-approach/methylation-cycle/. Accessed Dec. 2, 2015.
3 Nielsen DE, Shih S, El-Sohemy A. Perceptions of Genetic Testing for Personalized Nutrition: A Randomized Trial of DNA-Based Dietary Advice. J Nutrigenet Nutrigenomics. 2014;7(2):94-104.
