Dr. Robyn Murphy is a Lifestyle Genetics Advisor at DNALAbs and a naturopathic doctor working at Ace sports clinic, a holistic clinic for integrated medicine based in Canada. In this interview, she discusses the insights that DNA testing can bring to one’s health, and how they can be leveraged to achieve better results when treating patients.
Please introduce yourself and your background.
Since the inception of my medical career, I have been involved with lifestyle genetics and pharmacogenomics. I’m a Lifestyle Genetics Advisor and naturopathic doctor. Working in an integrated clinic with medical doctors and other health care practitioners has given me the practical experience to appreciate personalized care.
This experience has been integral in the clinical applications of genetic testing: what are the particular biomarkers, signs, and symptoms that we can identify to understand how genetics is affecting our health, and what are the evidence-based strategies that we can utilize in order to compensate for those genetic variances.
What are the current considerations that doctors take when making a treatment plan or prescribing medication, and how can that be enhanced by DNA testing and analysis?
Many of the treatment considerations have to do with objective data to identify what is happening within the body, to validate signs and symptoms, and understand the underlying causes. We look for a treatment strategy that’s going to be effective and reliable while reducing any side effects that may occur. Genetic testing is helping us to identify some of those underlying causes: biochemical nuances that can alter the dosing strategy, minimize side effects, and personalize the treatment strategy.
Clearly, this is a very individualized approach, so rather than following generalized guidelines and giving every single patient with depression, for example, the exact same dose of supplements and medications, we’re now utilizing some of this objective data to try and predict the patient’s specific requirements and dosing strategy to maximize effectiveness and minimize negative side effects.
What are the long term benefits and implications of taking genetic tests at birth?
Depending on what branch of genetic testing you’re looking at, there can be some really exciting revelations about someone’s health early on.
For example, about 1-2% of Canadians suffer from Celiac disease, however, if someone is susceptible to this disease, it’s dependent on their environment as to whether or not the gene and the disease itself are going to be expressed.
We know that when it comes to Celiac disease, the history of gastroenteritis or other intestinal infections; the presence of another autoimmune disease or a first-degree relative having Celiac disease; the amount of gluten that is introduced into the diet and timing; All of these can have an impact on whether or not the disease gets expressed.
Therefore, knowing the genetic predispositions at an early age can help determine environmental changes to help reduce the probability that the disease is going to develop. Early surveillance and identification are also informed to ensure early intervention.
Using the example of Celiac disease, a lot of patients are not diagnosed until their 20s, sometimes in their 60s, and they can be suffering from chronic digestive complaints or extraintestinal complaints for many years. That’s one example of the benefits that you can get with early testing.
When we look at pharmacogenomics, looking at medication use, predicting what is the appropriate medication, what is the appropriate dose, avoiding any medications where there’s a high risk of side effects. All of this can help with treatment as far as timing.
Particularly, looking at mental health and depression, it can be a very long process for people to identify with their doctor what is the appropriate medication. Sometimes it can take years of trial and error, often leading to the heartache and suffering that can occur with someone who’s dealing with depression. Looking for the right medication while having to manage and deal with possible side effects as well.
I believe that the earlier you implement genetic testing, the more information you have about your health. This can help make informed choices of appropriate lifestyle, dietary, nutritional, or pharmaceuticals interventions.
What kind of data do you collect in your work, and what are you hoping to achieve from it?
There are two main tests that we look at: lifestyle genetic testing and pharmacogenetics. We’re looking at several different genetic variations including single nucleotide polymorphisms insertions and deletions, and copy number variation.
Genetic variants included within the panel are chosen according to research that confirms clinical effect, which leads to biochemical changes that are measurable and modifiable by interventions. By looking at this information, we identify individual-based strategies for lifestyle, nutrition, exercise, and disease prevention.
DNA samples are collected using a buccal swab, which contains the complete human genome. The de-identified samples are sent to the lab for analysis and results are accessed through a HIPPA- and PIPEDA-compliant platform.
Which trends or technologies do you find to be particularly interesting these days around your line of work?
What I find interesting is the advances in data processing and computing power that allow for the synthesis and analysis of huge amounts of biological data, including genomics, metabolomics and proteomics, and how this is changing our approach to health.
We’re examining not just the genetic information but the markers that reflect how the body is functioning in real-time. Synthesizing all of these parameters gives an accurate reflection of how the genes are influencing health.
What would it take to standardize DNA testing and analysis into our healthcare systems?
For widespread clinical application, we require standardized genetic panels to be established according to clinical requirements.
In a clinic that is focusing on general health, lifestyle and nutrition, it is extremely adventitious to utilize genetic information to predict response to dietary interventions and inform individual dosing and surveillance strategies.
When it comes to hospitals and medical offices, pharmacogenetic testing will help to individualize treatment and reduce the risk of side-effects from medications, particularly related to treatments for cancer, cardiovascular, and metabolic disease.
DNALabs is working with hospitals to offer exactly that type of testing. On a small scale, more and more clinics are starting to implement and integrate genetic testing into treatment strategies for chronic disease, which is paving the way for standardization of care, on a large scale.
How do you envision the future of your industry?
In regards to genetic testing, we’ve seen a trend towards increased public interest. Individuals are becoming more familiar with genetic testing and seeking out these types of tests directly. Direct-to-consumer testing is now a billion-dollar industry. As public education and research into the implications of genetic variations become more widespread, this number is expected to grow to over 3.8 billion in the next decade.
Health care is changing, patients are becoming more interested in preventative medicine and are influencing the available types of treatment, including testing strategies to individualize care.