Genomics testing
One thing doctors can do is to help people test their genes. Genomics testing tells you what genes you have. The Human Genome Project was recently completed and all 35,000 human genes have been identified. But, the key to genomics is the realization that genes just represent tendencies in most cases. Most people do not have a ‘‘breast cancer gene’’ or an ‘‘Alzheimer’s gene.’’ You may have a gene that increases your risk of breast cancer or Alzheimer’s disease, particularly if you make the wrong lifestyle choices. But you can often change this outcome by making proper lifestyle choices. But you won’t know what specific lifestyle choices to make unless you know what specific genes you have, and this is where genomics can provide critical information. Here are some practical examples of what genomics testing can tell you. The cytochrome P 450 (CYP 450) genes code for proteins that help the body detoxify toxins in the liver. One cytochrome P 450 gene is known as C17. Women who have a mutated C17 gene can have an increased risk of breast cancer or osteoporosis.26,27 If a woman performs genomics testing and finds she has mutated C17, she should avoid taking estrogen, since she would be at higher risk of developing breast cancer by doing so. Another CYP 450 gene is 1A1. Some mutations of this gene may render people much more susceptible to lung cancer. Individuals who have mutated CYP 1A1 should be especially careful not to smoke because they are at much higher risk of developing lung cancer. A mutated CYP 450 2E1 gene increases susceptibility to alcohol-related liver disease and cirrhosis.28 People with this mutation should be very careful with regard to alcohol consumption. So these are examples of how genomics testing can help you make specific lifestyle choices.
Early detection of cardiovascular disease and cancer Cardiovascular disease is the leading cause of death in many developed countries. Medical professionals can help their patients avoid heart disease with early detection. The usual blood tests that are used to determine risk of heart disease (cholesterol subfractions, triglycerides, etc.) are not adequate. Highly sensitive- CRP, homocysteine and lipoprotein (a) levels need to be checked as well. In addition, the ‘‘acceptable limits’’ given by many reference laboratories are also often inappropriate. As one example, the reference laboratory I use in my medical practice considers levels of homocysteine less than 15 as acceptable; yet risk of heart disease increases with levels greater than 7.0. Cholesterol levels under 200 are considered acceptable, but levels between 130–160 may be optimal. Specific cardiovascular-related genomics tests are available as well and can provide useful patient-specific information. Recently, non-invasive test for delineation of atherosclerosis have become available. Ultrafast CT scans can quantitate the amount of calcified plaque in the coronary arteries. Virtual angiograms and MRIs are becoming available in several metropolitan areas, obviating the need for invasive angiography.
Cancer is the second leading cause of death. Medical professionals can help with early detection and prevention of cancer. They can also suggest supplements like vitamin C, selenium, curcumin, fish oil, and folic acid. A diet rich in soy products and green tea is cancerprotective as well. It is important to make lifestyle choices including regular aerobic exercise and strict avoidance of smoking and exposure to passive cigarette smoke as well. These are proven methods of reducing cancer risk. Physicians can help detect cancer in the very earliest stages even before a detectable lesion is present by utilizing the DR-70 test which is undergoing FDA testing as a possible screening test for colorectal cancer.29 This blood test only requires a few cancer cells to be present in the body for detection. This can help detect cancer in a very early stage before it has had a chance to metastasize.
Hormone replacement
High hormone levels are a hallmark of youth, while declining hormone levels are characteristic of advancing age. At around 30 years of age an individual’s hormones begin to decrease, which then begins to accelerate the aging process. By restoring hormone levels to more youthful levels, people can often experience the benefits of higher hormone levels similar to what they had when they were younger. Antiaging hormones include estrogen, progesterone, testosterone, thyroid, melatonin and human growth hormone (hGH). The cornerstone of hormone replacement therapy, however, is to only replace hormones whose levels are low and for which there is a demonstrable deficiency. The indiscriminate prescribing of anabolic steroid hormones, such as human growth hormone for bodybuilders who merely wish to enhance the appearance of their physique, yet have adequate levels of hGH, is an inappropriate use of hormone replacement therapy and is not recommended.
Optimally one should use bio identical hormones, hormones which are chemically identical in their structure to those found naturally in the human body. For example when prescribing estrogen replacement for women, we want to use estriol, estrone and estradiol, which are the same estrogens found naturally in the body. Similarly, we prefer to use bio identical progesterone, not a progestin like medroxprogesterone (which is not progesterone at all, but a synthetic drug, which possesses progesterone-like activity). We use testosterone itself (not medroxytestosterone), which can improve muscle mass and sex drive in both men and women. Melatonin is useful in promoting deep sleep and also fights some cancers30 and, in certain cases of documented growth hormone deficiency, we have found the use of human growth injections of value.
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