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HEALTHY
EATING

corporates clinicians, nutritionists, exercise The role of physical activity in metabolic include the rapidly emerging arena of
physiologists, food resource personnel and life balance is also axiomatic. Precision nutrition, metabolites of nutrients and the creation of
coaches, but much has been done. however, attempts to see beyond the obvious biomarkers to identify the impact of these
The bioinformatics pillars of precision nu- need for increasing the total level of METs. metabolites on the body's systems.
trition include genetics, dietary habits, food It attempts to arrive at the type and timing of From malabsorption syndromes to its im-
behavior, physical activity, metabolic variance physical activity and its relation to intake to pact on the immune system, gut microbiota
and the gut microbiota. The goal is the design achieve more metabolic bang for the exercise has seen an explosion in research. The precise
of tailored nutritional recommendations to buck. It also explores the phenomenon of interplay between food intake and its effects
prevent and treat. Although large design tri- epigenetics and the relationship between ex- on enteric microorganisms is further defined
als have been few in the field, they are not ercise, diet and the expression of multiple at- by studies that show specific dietary alter-
lacking, and much observational research has risk genes for obesity. ations changing the gut microbiome and
been collected. leading to disease. Therapeutics for these en-
Numerous genetic variants and polymor- tities have remained elusive.
phisms have been identified to be active in We live in an obesogenic society and
the heterogeneous metabolic response to nu- changing diet and lifestyle has proven chal-
trients and specific diets. With the explosion lenging for most of our patients. The wealth
of at-home genetic screening, many private of literature that speaks to vast improvements
sector laboratories offer customized dietary in outcomes with weight loss is an over-
recommendations based on genetic markers. whelming reminder to us that we are our pa-
While this approach is straightforward, it tients' advocates in the journey to health.
fails to recognize the complexity of the con- From Anesthesia to Vascular Surgery, all spe-
tributing factors to our variance in metabo- cialties have literature supporting this inter-
lism. The individual genome remains a target vention. Carry this with you—the loss of a
for personalized approaches to nutrition, but single Kg of weight decreases the relative risk
solutions based simply on genetic codes are of diabetes by 16%. It is possible to make that
few. The interplay between genetics and en- intervention with every patient at every visit
vironment is axiomatic. and not change anything but the course of a
Dietary habits may seem self-evident, but Deep phenotyping is de- human life.
for the discipline of precision nutrition, it fined as the precise and comprehen- As more is recognized about the benefits
refers to the quantity and variety of nutrients; sive analysis of phenotypic abnormalities in of dietary and lifestyle changes, the need for
macro- and micronutrients. Limitations of which the individual components of the an integrated, comprehensive approach uti-
quantification of intake have perplexed nu- phenotype are observed and described. As- lizing the multiple stakeholders in the field
tritionists for decades. Research instruments sessment of the impact of a given nutritional of nutrition science looms large. We rely on
are few and cumbersome and face the intervention requires accurate and well-de- our colleagues in nutrition, food resources,
dilemma of self-reporting bias. Similarly, ad- fined disease stratification. For instance, a personal training and life coaching to pro-
herence to dietary measures remains a diffi- trial looking at outcomes measuring only duce the outcomes long sought by a nation
cult-to-quantify behavior. the traditional risk factors of hypertension, suffering from an epidemic of obesity. Let us
If dietary habits are "what" we eat, then dyslipidemia, BMI and inflammatory mark- learn from our colleagues so that we can have
food behavior is "how" we eat. This field ers would be better defined if body compo- the true "stakeholders," our patients, achieve
looks at frequency, timing and relative pro- sition by DEXA, echocardiography, ocular the health outcomes they richly deserve.
portion of total intake over a given time pressures, fundus exam and spirometry were
cycle. It is also known as "food style monitor- also included. Tim Hlavinka, MD is a Urolo-
ing." Included in this field is the concept of Metabolic variance has on its surface the gist in San Antonio, and is Medical
Circadian rhythms and their impact on me- obvious reference to how and why individu- Director of Vidamor Medical in
tabolism, highlighted by the search for the als vary in their response to the same dietary Boerne. He is a member of the Bexar County
optimal manner of intermittent fasting. measures. However, the field goes beyond to Medical Society.

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