Webinar: The Science of Excellence, Part Two

Resilience, Stress, Genetics and Living Your Best Life

If you're a leader, you won't want to miss this webinar with Dr. Danny Meyersfeld. Hear him discuss how personalized genetic testing can help you become a resilient leader and effective role model to your teams.

Dr. Meyersfeld has a PhD in molecular biology and uses advancements in genetics to improve the overall health and wellness of his clients.

Webinar transcript:

Grant Robshaw: Thanks everyone for joining us this morning. Before we get started, I just want to say thank you to Muuvment and Core Benefits for putting on this webinar series. If you don't know about Muuvment yet, they're doing some really interesting things on using video to tell stories in order to drive behavior change - very cool stuff! So, check them out. Core benefits as well; Pascale at Core has been a real resource for us at NeuPath Health. So, I recommend that you connect with Pascale, a definitely valuable resource.

When I was thinking about what I was going to or how I was going to introduce Danny,I thought back to a study that I read. It was an analysis of statins. The analysis showed that the number needed to treat was 167 patients, and basically what that means is for this drug to prevent one death, 167 patients needed to take the drug for 4.1 years. Every life saved is valuable – that's not the point here. The point really is that 166 people who took that drug and best-case scenario, didn't see any benefit; worst case scenario saw some harm, due to side effects. Statins aren't benign, they do come with side effects and the challenge that we have, is that we don't know who that one person is versus the 166, and that's where Danny and his team come in. 

I was introduced to them by a couple of our physicians at NeuPath Health and we work a lot in musculoskeletal pain and they came to me and talked about this incredible company that was doing genetic testing and they had one test based on a single nucleotide polymorphism that showed whether codeine was valuable for patients or not – obviously, very important in the field of pain management – and that's really what got me hooked. And as I learned more about the work that Danny and his team are doing, I started to realize it was more than just about pharmacogenetic testing. It was really all-encompassing, so what they can do is work on the nutrigenomics side so they can look at your genetic makeup and determine what kind of foods you should and shouldn't be eating; look at your genetic makeup and determine what types of exercises you should be performing as well. If you could benefit from cardiovascular exercises, hit workouts, weight training. Really, it's a road map for living your best life and Danny is going to talk more about... Dr. Danny Meyersfeld, he's going to talk more about the genetic testing work that they're doing and really personalized medicine, and he's going to share some exciting news about a new resilience test that they've actually built, which I'm sure combines components of the pharmacogenetic, nutrigenomics and some of the exercise work as well. So, Danny, take it away.

Dr. Danny Meyersfeld: Thanks very much Grant; I was gonna say, Good evening, everybody, but it's good morning for most of you. I believe I'm talking to you from South Africa, it's about five in the evening here. Thanks Grant, for the introduction. You really encapsulated my entire talk in your introduction. I don't really need to say anything else because that is the essence of my talk this evening, which is this idea of that one person. That personalized medicine, were the one individual who will not benefit from the intervention. So, essentially, I'm picking up on some of the themes that were covered in Part One of this webinar series. We heard about the concept of resilience and the core biochemical pathways that underpin the trait of resilience.

And one of the key take-home messages from Richard Sutton's excellent talk last month was, how these key Biochemical pathways that underpin resilience are essentially encoded in our DNA. What I thought I would do this evening is pick up on that theme about DNA, and delve a little bit more deeply into what else can we establish, what else can we understand,and learn about ourselves and how we can empower ourselves and better ourselves – enhance our health; look after ourselves better – through an understanding of our DNA. Much of the output from the tests that we do from this knowledge is very much empowering. It's about taking more responsibility for our own health, not sitting back and relying on a healthcare system to look after us when we are sick, but very much being proactive and being predictive about our health and taking ownership of our health. So, this was essentially what Grant was speaking about, this idea of personalized medicine and this N equals 1. Who is that one person?

When a medication is effective for 99 percent of the population. Well, that's great for the 99, but it's not really great for the 1. How do we better understand, how do we better identify this individual, this single person who requires something that's going to be a little bit different? Personally, I think of personalized medicine: it's an acknowledgement from the healthcare practitioner that every patient walking into their rooms is an individual and is unique, and the intervention strategy or the healthcare strategy that works for one patient is not necessarily optimal for the next patient, and the responsibility for the healthcare practitioner now is to start understanding every patient at a unique genetic level in order to ensure that the intervention they propose for that person is indeed optimal for that person.

It was said much better than me back in 2015 by President Obama - what if figuring out the right dose of medicine was as simple as taking our temperature, that is the promise of precision medicine: delivering the right treatment at the right time, every time, to the right person. And he fully understood the value of practicing this type of medicine both from a perspective of patient outcomes as well as the broader health economics perspective across a population. So, essentially what is personalized medicine? It's a practice of medicine that uses an individual's genetic profile to guide the prevention, diagnosis and treatment of disease.

We firmly believe that the future of health and wellness lies in the personalization of diet, lifestyle, supplement and pharmaceutical recommendations according to individual requirements. In this way, healthcare will become and really has become predictive, preventive and personalized. And just a graphic demonstration of what I'm saying, we take this middle consumer group, a whole bunch of different individuals and in this consumer group, based on our genetics can be stratified into different cohorts.

On the left, in this case, we're talking about a particular dietary regime – it might be a low fat, it might be a Keto diet. In this case, it's going to be particularly beneficial; these guys are going to benefit from that intervention, it could be a medication, as Grant alluded to with codeine. And then you get the other cohort where the dietary regime is not only not beneficial but may in fact be harmful. And the answer to this question and the mechanism by which we can identify whether it's going to be beneficial or harmful is now simply in our DNA.

What this understanding of genetics does is it allows us to understand and respond to the underlying causes rather than treating purely the symptoms. If you see this very nice image on the left of my screen which looks at the key factors at the bottom of this genetic predisposition which is being influenced by lifestyle such as sleep and relaxation, exercise and movement, nutrition, stress, relationships, trauma. All of these things in our daily lives - so much of it we can take control of. We can modify these things ourselves. These are the choices that we make, the environment in which we put ourselves, the stresses that we choose to manage, the amount of sleep we are able to get, the supplements we take, the diet we partake of. All of these things, act in our genetic predisposition to ultimately create triggers or mediators, and eventually, as you move up the tree, signs and symptoms of disease. Personalized medicine is taking us to the root cause of the eventual manifestation of these diseases.

To better understand how this all works, we need to take a step back a couple of years back to Grade 10 Biology and just delve into a little bit more detail about the DNA molecule just to understand how this all works at a practical level.

So hopefully, this image is very familiar to most of you listening. This is the very fascinating as well as the famous double helix structure of DNA, comprised of these four chemical-based pairs: adenine, thymine, guanine, and cytosine. The two pairs always pair with each other, so, an adenine will always pair with a thymine and guanine always with a cytosine. We call them ATC and G for short, and it is this base pairing along with the sugar phosphate backbone that creates this helical structure that is the famous structure of the DNA molecule.

The DNA strands are tightly wrapped into these packaged units called chromosomes. Each chromosome sits in the nucleus of our cell and the total genetic complement of the human is approximately three billion of these base pairs of DNA, so every one of our cells, except for our sex cells, which are half, every one of these cells in our body, would contain three billion base pairs of DNA. The central dogma of biology (this took me years of study; I'm going to put it across to you in about 30 seconds) in a nutshell: DNA, this double-stranded structure, through a process of transcription, is copied into a single strand of mRNA; the "m" stands for message, and that mRNA is then, for a process of translation made into proteins. Each combination of the three bases that I showed you previously would tie specifically to a unique amino acid and so the chain of bases along the mRNA strand would correspond to the amino acids that combine to form a protein structure. And that is really a key aspect of personalized medicine: it  is this DNA to RNA to protein dogma of Biology.

Now, the list of DNA molecules are not too dissimilar to the letters of the English alphabet. In English, we have 26 letters; in the language of DNA, we have 4 letters. But the key aspect, the key similarity is that a change of one letter can make a profound difference. In English, changing a letter makes a profound difference to the meaning of a word.

You're not going to tell your wife that she's looking, well, you're going to tell her she's looking "fit" and you hope you don't misspell it. The exact same principle applies to the DNA molecule, where if you look at the double-stranded structure at the top there's two different options as you go down the image. On the left side which we call genotype A, there's a G and a C pairing at a given position on the strand, and on the right that G is now replaced by an A, and that is a simple spelling change in the same way as "fit" changes to "fat", we've got a G changing to an A. Now, if we go back to the left side to genotype A. As I mentioned, the combination of nucleotides forms a chain of amino acids. Those amino acids form a particular structure called "enzyme form A", in this case, and the enzyme will perform a function in your body: in this case, it's the efficient removal of toxins from a cell. That is the critical metabolic activity that that particular enzyme is responsible for within your cell.

Genotype B – we've got this change in a letter from a G to an A. This means that the chain of amino acids is now slightly different. There's a different amino acid, because of that spelling change in the DNA. This creates "enzyme form B". The structure of the enzyme is slightly different.

The functioning of the enzyme is therefore slightly different, and, in this case, we now have inefficient removal of toxins from the cell. So, in essence, this single nucleotide polymorphism, or SNP – a single, simple change in our DNA sequence – can have a profound effect on the ability of our cells to perform the functions that we are required to perform. Why is this important? Because these enzymes are responsible for all of these metabolic processes happening in our cells. Whether it's elements of gut health, the critical process of inflammation, mental health, skin aging, blood clotting, weight management... I can go across the list. These are all the different aspects of nutrigenomics tests that are covered in our particular list of tests with: the requirements that we have for certain vitamins; our athletic potential; prescription medications... An understanding of our genetic code will give us insight into the functioning of the enzymes involved in all of these different processes in the cell. And so you can immediately start to see the value of understanding what is going on in an individual or in a patient at a genetic level: where their genetic predispositions for risk might lie; understanding how certain enzymes may or may not be functioning based on the spelling changes in the DNA; and, most importantly, what we can do to circumvent these changes in enzyme activity.

How can we bypass these defective enzymes in order to ensure that the outcome, the eventual functioning, is optimal even though we've got a deficient enzyme in the pathway somewhere? So, it's about how can we intervene in order to bypass any negative influences of the DNA. So, Grant mentioned earlier this concept of nutrigenomics, which is personalized gene-based nutrition. And this is the core basis of nutritional genetics: it is that our phenotype, which is the eventual physical manifestation of who we are, whether it's a factor like high cholesterol or overweight or whatever particular characteristic it is that we might be looking at. That eventual phenotype is a combination of the genotype, which is the genes that we are born with, as well as the lifestyle that we choose to lead. So, the genotype becomes our non-modifiable risk factors; our lifestyle is very much our modifiable risk factors; we can be responsible about the choices we make based on an understanding of the genetic risks that we have. And it's a two-way street, in that genes dictate responses to environmental factors, and environmental factors also impact gene expression. 

So, the genes that we carry are impacting how we respond to different environments, to different nutrients, to different vitamins, and the environment in which we place ourselves can affect the way our genes are expressed. You can have a genetic predisposition for a certain trait that never manifests because you've put yourself in the right environment that prevents the manifestation of that particular disease or that particular outcome. Understanding these risks allows us to act preemptively to manage those risks. Take a very simple example, and before the webinar started Grant was very happily sipping away in his morning cup of coffee – not sure if it is first or second – but let's just look for a second at the nutrigenetics of caffeine metabolism. So coffee is a major source of caffeine, which is metabolized by... (don't worry about that name) ...it's a CYP1A2 is the name of the enzyme; it's one of our P450 enzymes.

Individuals who carry the AA version of the CYP1A2 enzyme are what we call rapid caffeine metabolizers, and those who have the C version (in other words, the letter A has changed to a C in some individuals) so those who have the C version are slow caffeine metabolizers. Now in a significant study that was done, a high intake of coffee was associated with an increased risk of Nonfatal Myocardial Infarction, only among individuals with slow caffeine metabolism. Intake of coffee or caffeine was associated with increasing blood pressure, again, only among individuals who are slow caffeine metabolizers. So, if you're one of those people who works long hours, having six, eight, ten coffees a day and you are a slow metabolizer of caffeine, it can be really detrimental to your health, and it's very useful information to have. This is another practical example of nutrigenetics in practice where a large study – there was I think it was about 1200 participants, yeah – they did a study to ascertain whether individuals who were with TT or CC version of the APOA2 gene were more likely to have a higher BMI. And over the course of five years, as you can see from this graph, there's very very little difference between these individuals depending on their genotype. So for the TT and the TC individuals or the CC individuals: no statistical difference, or statistically significant difference, in their risk for high BMI. However, when they brought in the environmental interaction (and if we just ignore the middle two lines for now just to simplify things) the top line with the black squares: those were CC individuals who had a high fat intake of more than 22 grams a day. And the CC individuals with less than 22 grams a day is the clear white squares at the bottom. So even though on a random diet with no nutrient interaction, there was very little difference in BMI, suddenly, when bringing in the nutrigenetic interaction, which was saturated fat intake, the interaction was actually quite significant. 

There was a very different responsiveness of these individuals to the dietary intake. So if you're one of those people who has tried different diets or wonder which diet type is right for you – is it a low-fat diet? is it a low carb diet? – this is an interesting study which shows, you know, what we probably all know anecdotally which is that there's no one right diet type that is going to work for everybody. So the idea of nutrigenetics and a nutrigenetics test is to skip the guesswork, is to move away from the one-size-fits-all trial-and-error approach to, in this case, weight loss. Understand your genetics, understand how you're processing these different nutrients or these different fats and carbohydrates and get onto the right diet type from the get-go, and that aids generally in compliance and improves dietary outcomes for individuals who use this information to guide their dietary intervention.

Then another practical example is the fascinating field of pharmacogenomics which, for me, now refreshes the cornerstone of precision medicine. It's such a massively valuable bit of information to carry. When you look at the statistics on adverse drug reactions and the cost to the healthcare system around the world of adverse drug reactions, it's a wonder that Pharmacogenomics hasn't moved a lot further down the line than where it currently is and moved a lot quicker than what it has. Essentially, we're taking the principles of nutrigenomics and applying it now to drug response and to making better drug therapy decisions. So, pharmacogenetics, the principle is that there is significant inter-patient variability in drug response largely attributed to innate differences among individuals in their capacity to process and react to drugs. The goal is to identify genetic markers affecting drug response and use them to make better drug therapy decisions. This is just a very rough illustration of what optimal drug metabolism would look like in an individual. A certain amount of drug is administered, the enzyme that is responsible for breaking down that drug: does it work? ... and you end up with a certain amount of metabolite. Normal levels of enzyme convert the drug into active metabolites that you want to be at the appropriate level in the blood in order to be therapeutic.

With the genetic variation, in some cases you're going to get enhanced enzyme activity which leads to greater concentrations of active metabolites, and in many cases that can cause adverse reactions or side effect. Alternatively, a genetic variation can cause decreased enzyme activity. This leads to insufficient active metabolites in the bloodstream, and in this case the particular medication would be ineffective for the person that it's given to.

A classic example is the drug codeine and this looks like a complicated pathway, we're not going to go through it, essentially what this is showing is codeine, in the blue square at the top, is broken down by CYP2D6, is the name of the enzyme, and the active ingredient for codeine is a drug that I'm sure you've all heard of called morphine. And morphine, it's really important to have morphine at the right level in the blood because too much morphine can have severe adverse effects including death in some cases.The genetics of the CYP2D6 enzyme is pretty complicated; there are many different variations and mutations and genetic changes within the CYP2D6 gene including, in some cases, that there are multiple copies of the genes. Some people will actually have more than two copies of the CYP2D6 gene; those people are termed ultra-rapid metabolizers.

On the other side of the scale, you've got the poor metabolizers based on one or two mutant alleles, and then you've got your extensive metabolizers for your average metabolism - the people who are processing the drug normally. The way this was identified is that enzyme's metabolic activity was assessed by administration of a probe substrate and the measurement of urinary formation of the metabolite. Based on this study, these different metabolizer statuses were identified and what is quite interesting is the extent of these different metabolizer statuses in the general population. If you look at the coloured bars, the yellow, the green, and the blue bars; these are the ultra-rapid metabolizers or the intermediate and poor metabolizers. And that makes up combined 22% of the population, which in essence means that 1 in 5, more than 1 in 5 individuals who are prescribed codeine will be either ultra-rapid metabolizers, who are potentially metabolizing it too quickly or they will be non-responders and it will be having very little effect. And again this is one of those conversations most people have had anecdotally where they talk about a drug and, you know, for one person it has no effect and, for another person, it puts them to sleep. This is the exact principle of pharmacogenomics: that we all break down these drugs at different speeds and metabolize the drugs differently, and we end up with different amounts of the active ingredient in our bloodstream.

So who can benefit from something like a Pharmacogenomics test? Well really, anyone experiencing side effects to specific medications, anyone who's taking a medication that they're not responding to, anyone requiring doses outside of a recommended range, or anyone planning to start a new medication for the first time. And particularly relevant groups of patients would be geriatric patients who are taking often multiple combinations of drugs, mental health patients... I think that psychiatry is one of the hardest fields to optimize the therapeutic intervention for patients. Often the strategy is simply to prescribe the drug and go back six weeks later in order to see whether that drug is having any effect.

Metabolic syndrome patients: often many of the symptoms associated with metabolic syndrome are: they don't make you feel bad, you don't know that they're there until they manifest in a significant way. And your chronic or acute pain patients, who are often being prescribed medication that is simply not effective for them. And I think in many cases, the complaints are put down to the fact that people are not taking the medication or they're not taking it as they should, or they're just complaining because they're in the habit of complaining. The idea that the medication is simply not working is something that is only recently being acknowledged as a possibility.

I alluded to this a little bit earlier: why prescribing the right medication matters. It has been estimated that 10% of all National Health Service bed days are used by patients with adverse drug reactions. These result in the need for the equivalent of 15 to 20 400 bed hospitals, and costs approximately 380 million pounds a year. So there is a massive expense on treating and managing patients with adverse drug reactions and something that is imminently avoidable with the advent of pharmacogenetics.

And again, I showed a similar image earlier, but this is the same principle with pharmacogenetics, is this patient group who are given the same prescription based on the same diagnosis and in this case, they're 4 different cohorts that can be identified. If we just go clockwise around, the effective and unsafe dose where the drug is not effective and not safe. The group that we all want to be in with a drug is effective and has no side effects, alternatively where it's not effective but it's still having no side effects, and that would essentially be equivalent to taking a placebo. So, the goal of pharmacogenetics is really to get people into this bottom-right group in as short a period of time as possible: make sure the medication that they're taking is having an effect and minimizing or completely eliminating any risk of side effects.

This is an example of what a pharmacogenetics report would look like. In this case, the existing patient medications are highlighted up front. This particular person is taking a statin; they're taking amitriptyline, as well as codeine. These three drugs have come up as being contraindicated. The report explains why: in this case, for codeine, this person is that ultra-rapid metabolizer that I was talking about, and so the report tells you what to do and how to adjust the dosing if that information is available. And the level of evidence behind it is also defined and in this case, all of these bits of information are actionable within clinical factors.

In some cases, the evidence is not quite as high in which case it's classified as being informative and then it's left a little bit more to the doctor's discretion how to apply the information: whether they still want to use the drug and monitor the patient a little bit more closely or whether they prefer to try a different drug. The value of pharmacogenetics is that it has lifetime value. It's doing a test once that can form part of an electronic health record and be part of the information that your doctor has at his or her fingertips for the rest of your life. So, a single test now, even though we might report on the drugs of interest up front, we are also covering over 200 different prescription medications that may be relevant at some point in the future, from anti-cancer agents, cardiovascular, diabetes, pain medications, a lot of psychotropic medications such as antidepressants, antipsychotics... many manydrugs that have... over 200 drugs where the label of the medication includes FDA  recommendation for a genetic test to help guide the dosage. So the science and the research, the evidence underpinning the pharmacogenetics tests are very strong and very well established.

So, just to sum up some of what the talk has been and to sort of give you that take home message. Genes are not your destiny. We do have the ability to control our gene expression. We have the ability to make the right lifestyle choices. We can modify the gene variants through the appropriate intervention. The goal is ultimately to empower the end user to be more proactive about their health, and we all firmly believe that genetic testing should not stand alone. It does not replace conventional medical investigations or assessments. It's an additional tool for the doctor to have at their disposal to better understand the risk and health outcomes of their patients. Thank you again, to Pascale and the organizers, and I'm happy to take any questions.

Grant Robshaw: Thanks Danny…Given how new this field is and not just for the general public, but for healthcare practitioners as well – I'm assuming that there's a lot of education that goes  into really getting healthcare practitioners up to speed – How has uptake been in the healthcare community? 

Dr. Danny Meyersfeld: Yeah, its a great question! This nutrigenomics has it's kind of been an interesting journey from the early days which sort of takes us back to about 2003, when the first draft of the human genome was published, and what happened was very quickly, a whole bunch of companies sort of sprang up offering direct-to-consumer genetic tests. At the time, there was very little or no effort on behalf of those companies to involve the doctors or the healthcare practitioners in the process. It was testing done online, sold to the consumers who were then left to decipher their own reports. I think, what that did, unfortunately, was it gave nutrigenomics a bit of a bad name. There was a lot of criticism around the test, about the lack of evidence, about the lack of clinical value, about the quality of evidence behind the claims that were being made.

There were some dubious companies that were offering the services and a lot of the criticism around the test in those early days was very justified. When I set up my company, the core value was that there's hugely valuable information sitting in genetics, but it's not everything. You know, it's a valuable piece of the clinical puzzle but it's not everything and if you look at the genetics by itself it's maybe giving you 50% of the picture, you need that other 50% which the healthcare practitioner brings, and similarly the clinician and investigation without the genetics is 50% of the pictures. So the idea is to put the genetics into clinical practice. Yes! you're right, it was an immense effort to embark on education strategies to upskill practitioners in the use of genetic tests. As you've seen from this talk, there's a whole language associated with genetics and we're talking about SNPs, polymorphisms, and heterozygotes, and homozygotes, and things that doctors simply had not learned about at university when they studied.

In fact, there's still today very few universities offering courses or degrees in Nutrigenetics. Unfortunately, it's taken a lot longer than should have to make its way into mainstream academia. That being said, the uptake from doctors especially over the last handful of years, probably last 3 or 4 years, has been massively increased. We've got doctors coming to us all the time: When is the next training? How do I get trained? I think it's become so much more commonplace to be working with genetic testing and almost mainstream in terms of the types of doctors that are wanting to work with tests. We've had well over 5,000 practitioners go through our training over the last five - six years. There's a definite thirst for information from the practitioners, and there's an understanding now from them that they want to work with genetics but they don't necessarily know where to start or how to start. That's the role that we're trying to play to get them to a point where they feel comfortable and responsible in the way they're disseminating the genetic information. And I'd say that the job is getting easier. As genetics, becomes more and more mainstream, as more and more people are talking about it, the demand for it increases, so the doctors are taking it upon themselves to better understand what is a complex but exciting field. We've seen good uptake, but obviously it's a daunting word for any doctor to travel to try and incorporate this type of testing into their practice.

Grant Robshaw: Okay, and, building on that, we have a question about accessibility: "How accessible are your tests and where would somebody go, as a starting point to learn more about pharmacogenomic and nutrigenomic testing?"

Dr. Danny Meyersfeld: To learn more about the testing, I mean, there's any number of online resources on pharmacogenetics, especially the CPRC guidelines – the CPRC website is an excellent website – the FDA, have a lot of good information on their website on pharmacogenetics. In terms of accessibility, we don't sell the test online, we work through our healthcare practitioners network but we could very easily connect people with our healthcare practitioners. We've got doctors in probably 60 countries around the world. Pascale has the tests available through her channel, through her website. So the tests are really easy to access and are done by means of a cheek swab.It's non-invasive. You're looking at a less than two weeks turnaround time. So it's becoming more and more accessible.

Grant Robshaw: Okay. We have a question about genetic e-cards, and how far we are from actually having genetic e-cards and using them in day-to-day practice and how costly would sequencing of the individual's entire genome be.

Dr. Danny Meyersfeld: I don't know how far we are from the e-cards. I would imagine that was some way away from that still. And the cost of sequencing has come down massively; it's come down from the approximately 15 billion dollars that the human genome cost to sequence to I think it can be done now for probably under a thousand dollars. But a thousand dollars is still quite significant for that sequence and it's a huge amount of data, so the data storage and the utility of that data becomes the question of how relevant is the vast majority of that sequence information and what are we really going to do with it. So, I think there's a lot of ethical questions when it comes to DNA around the data protection, around privacy, around ownership, health insurance – all sorts of questions that pop up when you start talking about genetics and DNA testing.

A lot of the concerns from the early days of testing which revolved around the health ownership and the risk for prejudice within a health insurance space; a lot of those have been proven to not materialize that there really is no risk at this point for any adverse selection or prejudice based on your genetics. In fact, it's not legal to use it to prejudice. One of the CEOs (I love this quote) one of the CEOs of one of the large American Insurance companies, when asked about the value of nutrigenomics testing within the insurance space, he said that, he's far more interested in the fact that somebody's prepared to pay to do the test to have that information about  themselves than he is in the results of the test.

And you know, he said that because he knows these results are empowering, they do motivate behavior change, which ultimately is what all these guys are trying to do: is motivate the right behaviors. Somebody's prepared to do the test, just sit with the practitioner to have a consultation, to make certain changes to their lifestyle based on the results of the test; that's generally far more interesting to the insurers than what the test itself is showing.

Grant Robshaw: Okay... I'm gonna be selfish here and I'm gonna ask a question with my CEO hat. As somebody who leads an organization, how can I enhance the performance of my team? Specifically, what steps would I take? How would your resilience testing fit into that?

Dr. Danny Meyersfeld: I think so much now, there's an acknowledgment of the value of health and nutrition and lifestyle in the performance that we put in at work. I think the two are inextricably linked. So if we look across the spectrum of tests, if you look at the nutrition side and understanding how people should be eating, what sort of nutritional supplements they should be taking, looking after their health, you're going to see improved performance at work, be it the way they manage stress, their time away from work. There's so much that we can do, and this brings us to the resilience test that Richard spoke about last time, and how these different biochemical pathways underpin our performance and how we manage stressful situations. Understanding where your employees are and how they respond to these different situations or rather helping them to understand, it's not necessarily that that you as the CEO would have the knowledge, but that they would have the knowledge and work with a coach to make the necessary changes in order to manage their stress. You're going to see improved performance, you're going to see reduced absenteeism, and healthier, happier workforces are going to be more productive. These tests are becoming more and more popular within that corporate executive wellness environment, and I think there's a massive opportunity for the tests in that space, because employers are realizing the value of their employees, the intellectual capital that sits within the executives of these big companies is enormous. And so one's investment in genetic testing as a means of enhancing their health outcomes and enhancing their stress management and their performance: in the long term it is not a significant investment.

Grant Robshaw: Great! You've mentioned SNPs a couple times and there was a question around sequencing of the entire human genome. How do you identify relevant SNPs? I assume that your testing, your panels change; you're adding SNPs over time. How do you identify relevant SNPs and add?

Dr. Danny Meyersfeld: Yeah, I spoke about the values – when I set up the company – one of those being the healthcare practitioner approach, the other being that we want to limit our test panels only to the most relevant actionable SNPs to make things simpler for the doctor. There's a perception amongst some people that the more SNPs you're looking at, the better the test must be, and we really take the opposite approach. As you start looking at more and more and more SNPs, there's so much potential for contradictory information to come through in a report. If the practitioners don't understand that the SNPs have different weighting and different roles in different biochemical pathways, that their significance is not always the same. So, we've got an extensive literature review process that our tests continually undergo where there needs to be at least three peer-reviewed articles, three articles and peer-reviewed journals showing the association between a SNP and a particular outcome, and we also wherever possible try and ensure that there is an intervention in order to manage the effect of that SNP. And that for us is absolutely key.

There's a big, well, there was in the past a big "so what" message around genetic testing. I have a genetic test, I've got this information, this genetics information: now what do I do with it? And we really set out to solve that "what if" question, that the information is powerful, the information is useful, if you are given the tools to act on it. So, I'll test and constantly update; we constantly got new panels that we are rolling out as the science advances. And I think what's important is we are humble enough to acknowledge that we don't know everything, there are still people who are critical of the test and say we don't know enough, and we'll stand up say look, we don't know everything, there's a huge amount that we still do need to learn. But we also do have a vast amount of knowledge and the idea is to use the information that we have, to the extent that we can affect patients health drive improved outcomes, help doctors understand their patients better. 

Let's use the information that we have and let's constantly update our tests as new information becomes available. And that's a big part of what we do, is the literature review, updating of SNPs, validating of SNPs – "is there enough evidence?"At which point do we say: "Right, now we can include the SNP in the test and put our name to it and we are happy to stand up and defend it based on the science that is available." So, there's a process that we're constantly undertaking. To give you an example, when we launched  our diet test back in 2010, I think it consisted of eight SNPs and we're now sitting in about 22 or 23. It's not a massive number but it's a small number of highly relevant, well-researched, good evidence SNPs that have interventions and actionable insights for the  patient.

Grant Robshaw: Great! I'm gonna jump back to  a more selfish question: as I'm thinking about how we could implement genetic testing within our organization to drive and enhance performance and resilience, I think about employee concerns around privacy, providing access to their genetic information, how does DNA Life safeguard that?

Dr. Danny Meyersfeld: Yeah, that's a point I alluded to earlier, which is that the employee has access to the information and not the employer. We firmly believe that genetic individual owns their own results; sorry, the individual owns their own genetic results. All our tests and the data transfer, the way the reports are sent, the online system that we have is all GDPR compliant. Results are sent exclusively to the doctor that orders the test. They will then share the report with their patient. There's strict confidentiality around the testing, around the results.

We're not one of these companies who uses the data for further research or sells the data on to pharma or anybody else. Our key core fundamental business is to try and improve the way healthcare is practiced. And then our primary concern is for the health of the individual. The genetics results are shared exclusively with the doctor who then act accordingly in consultation with the patient.

Grant Robshaw: Okay, and you mentioned it being shared directly with a healthcare practitioner. Does that  have to be a doctor? Are there are other providers that I could go to or my employees could go to?

Dr. Danny Meyersfeld: Yeah, we've got quite a large range of practitioners, I say doctors just as a generic term but we've got a lot of dieticians, we've got a lot of nutritionists, and a lot of allied health practitioners, we've got doctors, physicians; we've got a whole host of different practitioner types, all of whom have gone through our training. Based on their background and their specialty and their training prior to the DNA training, they will maybe use the information slightly differently or their methods, their interventions might be different depending on their own specialty but they would all be proficient in the genetic test itself based on the training that they've done with us.

Grant Robshaw: That's great! One thing that really struck me when our doctors or my doctors came to me to introduce DNA Life was – you alluded to other genetic tests on the market – we won't mention any names, but our doctors really liked the fact that you only include in your testing SNPs where outcomes can be changed by changes to lifestyle versus your increased risk based on your genetic makeup, you're at increased risk for this disease, nothing you can do, can you talk a little bit about that?

Dr. Danny Meyersfeld: Yeah, well that's exactly the principle that we want to embark on. We don't quantify disease risk. We're not one of these companies that says you've got a 1.5 times increased risk as compared to the general population of developing cancer: "Good luck with that". It's really about looking at the way the pathways are functioning  within the cell. Defective or deficient activity of these enzymes and all of these metabolic processes ultimately are risk factors for chronic diseases of lifestyle: cardiovascular disease, cancers, diabetes. But, as I said, for us it's critical that there's an intervention, that the doctor can say, "Okay, we've now identified these risks and this is what we can do to try and reduce the risk." That's why I said right at the beginning of the talk that these tests are empowering because we were born with our genetic code and that code doesn't change throughout our life, which means from the day we're born, we're sitting with these genetic risk factors. They're there whether we know about them or not. The only way we can act on them and reduce our risk is if we have the knowledge. It's a cliché that knowledge is power but in this case, it's very much true that knowledge of our DNA code gives us the power to identify where our risks are and what we can best do to bring those risks down. I think it gets a bit more specific and a bit more personal than "eat more broccoli and smoking is bad". We know smoking is bad and we know broccoli is good, but for some people smoking is particularly bad and for some people eating good quantity of cruciferous vegetable is particularly important.

It comes down to small margins, there's not going to be any earth shattering information that comes out of a genetic report that you've never heard anywhere else before, but what you will know definitively from the genetic report is that the information you're given is right for you, for that n=1 as opposed to hearing a whole bunch of general health recommendations and assuming that everything you hear is the thing that you must do. Often it's easier to focus on some very small specific changes. If you're going to start making changes to your diet, your lifestyle, hone in on those one or two things that are unique to you or priority for you in order to ensure you take control of your own health. 

Grant Robshaw: Okay, and you shared some data around diet and improvements based on knowledge from genetic testing. Do you have any other good patient stories that you could share? It doesn't necessarily have to be a study, but n=1 is good too.

Dr. Danny Meyersfeld: Well Grant, funnily enough you mentioned one right at the beginning: we had a psychiatrist that we went to speak to about our pharmacogenetics test and he was always a little bit skeptical until we actually insisted he did the test himself. And in fact this happened with two separate psychiatrists: one was a psychiatrist and one was a cardiologist. The psychiatrist was taking statin chronically and the report showed that he was likely to have side effects from that particular statin. He came to me a month later and he said the test has changed his life because all he did was change from statin A to statin B and the side effects have gone the muscle pain that he'd come to accept as something he just had to put up with for the rest of his life – and this is a guy in his 50s – he was fully prepared to sit through the side effect and assume it was just there and there's nothing he can do about it. 

And all of a sudden he was pain-free for the first time since he had his first 'script. So he refers to that as a life-changing moment, in simply doing the test and understanding that that particular statin wasn't right for him and previously it had never crossed his mind. Then the other doctor was a cardiologist. It's quite ironic that, and it worked out great for us, that the report showed this but this is a cardiologist who's prescribing Plavix to his patients a lot of the time, and he said it hadn't for once struck him that then Plavix might not be working for some of his patients, until his own report showed him to be non-responsive. So he's one of the 10% of the population who'd be completely non-responsive to taking Plavix as a drug to prevent a cardiovascular event.

This is something that you don't know you're not responding to the drug until you have an MI or a heart attack or something, so that again just made him realize the value of having that knowledge for his patients when prescribing medication in the future, so that one turned out quite well in the sense that, we got the result for him that helped us.

Grant Robshaw: That's great! I'm aware that it's much later in South Africa than it is here in North America. We don't want to keep you up much later. Really appreciate your time, Danny. It's always fascinating for me to learn more about the work that you're doing at DNA Life and, for everybody who attended, I just want to mention two things: one is that the DNA Life and Core Benefits and Muuvment have arranged for a couple of free genetic ... genetic tests around resilience. It's a brand new test that the DNA Life has put together. I believe you're going to receive an email around feedback and the organizers are going to choose a couple people to take that test. 

Really exciting!!! I haven't even seen that test yet, so it's definitely worthwhile. 

The second piece, is there's a third webinar coming up, it's the last Wednesday in May at 10:00 AM, and it's near and dear to my heart. It's one of NeuPath's doctors: he's done a lot of work around stem cells, it fits with the theme here. We're really talking about the future of medicine, we talk about pharmacogenetic testing and personalized and stem cells. This doctor, Riam Shammaa, he's done a lot of work around the benefits of stem cell therapies for conditions of Osteoarthritis and Degenerative disk disease where there really, up until now, hasn't been a good prognosis. It's really been more about palliative care, how can we make your life more comfortable and he actually has some scans that I've seen that show disk regeneration, which is very cool.

That's the last Wednesday in May at 10:00 AM.

Thank you everybody for attending today. Thanks again, Danny.

Dr. Danny Meyersfeld: Thanks, thanks so much Grant.