Genomics is defined as the science of our genes and their influence on our health.
I use Genomic testing for mental health to help us understand:
- How our personalities interact with and are influenced by our early life experiences
- Cultural and ethnic diversity and the dynamic interactions that result from intergenerational influences
- How we digest food, and what foods “fuel our engine”
- What medications might help (or hurt) us
- What nutrients we need more of, and which ones we can’t use very easily
- And so much more!
Personalized Nutrition and Mental Health Care
Personalized mental health (also called precision mental health) focuses on using an individual’s genetics to determine drugs and their doses. Applying this lens helps us decide whether a specific psychotropic medication should be used or avoided, and it recognizes the diversity of possible responses. Personalized methods focus on helping the individual, not on the dis‑ease per se. These methods suggest that there may be many causes and many treatments for the same dis‑ease, and they require deep inquiry from a whole-system lens with each person.
Personalized nutrition is defined by where our ancestors evolved and flourished, how we carry that history in our bodies, minds, and genes, and how we nourish ourselves optimally.
Nutrigenomics is the study of how foods interact with our genes. It explains our individual genetic differences—each of us may require different amounts of vitamins, minerals, and food compounds. Our genetic individuality determines how we absorb, metabolize, and detoxify. Foods we choose to eat can trigger epigenetic changes.
Epigenetics refers to chemical tags that attach to the exterior of the genome. This changes how your cells respond to and express your genes. The difference between DNA and epigenetics is like the difference between nature and nurture. DNA is your roadmap, not your final destination (or destiny). Genes are our nature and do not change, even with social or epigenetic influences.
However, food, stress, psychosocial status, sleep patterns, environmental exposures, exercise, and other aspects of our lives affect how our genes act. This gives us the power to influence many responses in the body and mind.
Genomic Testing
The same medicine may have very different effects on different people. Genomic testing has confirmed that genetic variations affect both the efficacy and adverse effects of psychotropic medications in children and adults alike. I always suggest Pharmacogenomic testing when someone is considering any pharmacotherapy. Note that while some insurance companies cover this testing, others do not. The prescriber should be able to make the order.
Pharmacogenomics testing provides information about how our genes affect our drug response. Testing is used in both integrative and conventional psychiatry. It may give genetic predictions about drug response and help explain a failure to respond. Some of this information is well-established—for example, the cohort of nonresponders to statins or those who may react adversely to certain antibiotics.
Genetic responses to SSRIs, tricyclic antidepressants, and antipsychotics are the focus of Current mental health genomics drug tests. Such tests can assess efficacy and adverse reactions, such as the propensity for weight gain or tardive dyskinesia.
Genetic responses to pain and pain medications are well-established. Tests that identify pain sensitivity and the potential for efficacy or adverse reactions to different pain medications, including NSAIDs and opiates, also provide insight into the best approaches to managing chronic pain.
The Genomic tests will also reveal strengths and vulnerabilities in the liver’s detoxification process. Of particular importance is the role of detoxification enzymes in the liver and their effects on medications. Some people may process and eliminate medications very quickly or very slowly. Understanding this function is essential when considering the use of herbal supplements, including berberine, Oregon grape root, and goldenseal, as these especially affect enzymes that help the liver detoxify.
What Are Some Common Genetic Markers to Test For?
Understanding clients’ genetic markers can inform personalized nutritional, supplemental, and exercise routines. Here are a few key markers for reference:
- APOE: Involved in clearing harmful plaques that form around nerve cells. These plaques are a hallmark of Alzheimer’s disease and consist of damaged proteins called amyloid ß, which stick together to form the toxic plaques. There are at least three slightly different versions (alleles) of the APOE gene: E2, E3, and E4.
- COMT (Val158Met): Central to dopamine metabolism and highly associated with a propensity for worry. It is a possible risk factor for bipolar disorder, panic disorder, anxiety, obsessive-compulsive disorder (OCD), eating disorders, and attention-deficit/hyperactivity disorder (ADHD). It also affects morphine dosage requirements and perceptions of pain.
- MTHFR (C677T, A1298C): Needed to maintain levels of activated folate, which may aid in preventing depression.
- Vitamin B12 (FUT2): Affects optimal B12 levels; deficiency is a depression risk factor.
- Vitamin D (GC, NADSYN1/DHCR7, CYP2R1): Levels are highly heritable. We obtain vitamin D (which is really a neurohormone) from sun exposure and through food and supplementation. These gene SNPs (single nucleotide polymorphisms) may contribute to the need for more supplementation.
Note that COMT, MTHFR, and vitamin markers can explain present symptoms, while APOE can explain future risks. But all these markers can inform our lifestyle choices.
Can I Order Genetics Tests for My Clients?
There is no simple answer to this question; it depends on variables such as your license, the type of test, the lab you select, and the state in which you practice. Some large test consolidators make this easier for you by having a physician on hand to sign for the tests. This enables practitioners and clients alike to order tests directly. Some states, like New York, prohibit direct access testing.
Which Labs Offer Genetic Tests?
I shopped around and used a variety of tests before I settled on 3×4 Genetics. They offer a comprehensive Genomics test. I love their webinars and they have excellent support for the clinician and wonderful webinars. Let them know I sent you (for extra special treatment!)
For a self-order Pharmacogenomics test, I use Kashi Labs.
Ordering other pharmacogenomic tests may require a prescriber order based on the state and location of the clinician and the lab.
She served as a Fulbright scholar on traditional medicine, a Clinical Fellow at Harvard Medical School, and a National Institutes of Health-funded research scientist in mind/body medicine.
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