Introduction to Nutrigenomics
Nutrigenomics is an interdisciplinary field of study that investigates the relationship between nutrition, genes, and health. Derived from the words "nutrition" and "genomics," nutrigenomics seeks to understand how the foods we eat interact with our genetic makeup to influence our health positively or negatively. This is a departure from the traditional "one-size-fits-all" model of nutrition, where dietary recommendations are made for the population at large.
The importance of nutrigenomics extends beyond mere curiosity. Diseases such as diabetes, obesity, cardiovascular diseases, and even certain types of cancer have both genetic and nutritional factors that contribute to their onset and progression. By understanding how specific nutrients interact with particular genes, nutrigenomics has the potential to offer targeted prevention and treatment strategies. For instance, understanding which genes are influenced by certain dietary components can help in creating a nutrition plan that can either activate or deactivate these genes, affecting disease risk or progression.
How Nutrigenomics Offers a Personalized Approach to Nutrition
The central promise of nutrigenomics is personalization. The idea is not just to understand what foods may be generally good or bad for health, but to determine what foods are good or bad for your health based on your genetic makeup. With the advancement of genome sequencing technologies, it has become increasingly affordable and accessible to assess your genetic profile. This profile, combined with nutrigenomic research, can guide personalized dietary recommendations.
Imagine two individuals with a family history of breast cancer. One of them may have a genetic profile that suggests a faster rate of estrogen detoxification, while the other may not. Nutrigenomics can potentially offer each of them a personalized nutrition plan designed to either enhance or balance their natural estrogen detox capabilities, thereby affecting their overall breast cancer risk differently.
This personalized approach extends to micronutrients, macronutrients, and various food groups, allowing for diets to be tailored to individual metabolic types, health conditions, and even lifestyle factors. As a result, nutrigenomics transforms the act of eating from a general health practice to a targeted intervention, optimizing health outcomes at an individual level.
Understanding the Link Between Nutrigenomics and Breast Cancer Risk
The Genetic Factors That Increase Susceptibility to Breast Cancer
Breast cancer is a complex disease influenced by a variety of factors, including genetics. Certain genetic mutations, most notably the BRCA1 and BRCA2 genes, have been closely associated with a significantly higher risk of developing breast cancer. These mutations interfere with the cell's ability to repair damaged DNA, potentially leading to uncontrollable cell growth and cancer. However, it's important to note that having these mutations does not guarantee that one will develop breast cancer; it simply increases the risk.
Aside from BRCA mutations, other genetic markers, known as single nucleotide polymorphisms (SNPs), have been identified as less potent but still relevant factors that may influence breast cancer risk. These SNPs may play roles in hormone regulation, immune response, and cellular growth and repair mechanisms, among other functions.
Hormone Genetics and Breast Cancer
The following genes have a connection to both hormones and breast cancer increased risk:
AKR1C4: Involved in the metabolism of steroid hormones; mutations may result in altered hormone levels.
CYP17A1: Encodes an enzyme that is involved in the biosynthesis of steroid hormones; aberrant function can lead to hormonal imbalances.
GABRA2: Related to the neurotransmitter system that can interact with steroid hormones, affecting mood and stress, which indirectly might impact breast cancer risk.
HSD11B1: Helps convert inactive cortisone into active cortisol; imbalances can affect other hormones, including those related to breast cancer.
SRD5A2: Converts testosterone into the more potent androgen, dihydrotestosterone (DHT); altered function can disrupt hormone balance.
SULT2A1: Involved in sulfation, a phase II detoxification pathway for steroid hormones; anomalies can affect hormone detoxification.
COMT: Catalyzes the breakdown of catechol estrogens, which can contribute to breast cancer if not properly metabolized.
CYP1A1: Involved in phase I detoxification of estrogen; mutations may result in higher levels of harmful estrogen metabolites.
CYP1B1: Another enzyme involved in estrogen metabolism; specific variants have been associated with increased breast cancer risk.
CYP3A4: A broad-spectrum enzyme that metabolizes estrogens among other substrates; mutations can affect estrogen levels.
CYP19A1: Encodes aromatase, an enzyme that converts androgens to estrogens; overactivity can result in elevated estrogen levels.
DAO: Diamine oxidase gene; mutations may affect histamine metabolism, which is associated with inflammation—a factor that has been implicated in increased breast cancer risk.
ESR1 and ESR2: Estrogen receptor genes; mutations may affect how the body responds to estrogen.
MAO: Monoamine oxidase gene; mutations may affect how the body metabolizes neurotransmitters such as serotonin and dopamine, potentially influencing mood and stress levels, which are indirect factors associated with breast cancer risk.
MTHFR: Affects folate metabolism, which is essential for DNA repair; mutations may elevate breast cancer risk by impairing DNA repair.
NQO1: Involved in the detoxification of quinones, which can result from estrogen metabolism; mutations can affect detoxification efficiency.
ABCB1: A gene that encodes a transporter protein involved in moving toxins out of cells; variations can affect detox efficiency.
GSTM1 and GSTP1: Enzymes that participate in phase II detoxification; certain polymorphisms have been associated with increased breast cancer risk.
SULT1A1 and SULT1E1: Involved in sulfation of hormones and toxins; altered function can affect detoxification.
UGT1A1: Involved in glucuronidation, another phase II detoxification pathway; mutations can affect detox efficiency.
ADRB1 and ADRB2: Genes for beta-adrenergic receptors; they can affect stress response which indirectly may affect breast cancer risk.
FKBP5: Regulates cortisol receptor sensitivity; mutations can affect stress response.
MTNR1B: Involved in melatonin signaling; melatonin may have protective effects against breast cancer.
OPRM1 and TCF7L2: Involved in stress and metabolic response; may indirectly impact breast cancer risk.
grFAAH: Involved in endocannabinoid metabolism; can influence hormonal balance and stress response, which might indirectly affect breast cancer risk.
Each of these genes has a specific role in hormone metabolism, detoxification, or stress response, and understanding their function can provide insights into individualized breast cancer risk. However, it's important to note that having a variant in any of these genes is not a definitive predictor of disease but rather a factor that may contribute to overall risk. It's also essential to consider how these genes interact with each other and with environmental factors like diet.
How Nutrition Interacts With These Genetic Factors
The growing field of nutrigenomics offers intriguing insights into how nutrition can interact with these genetic factors. Certain nutrients have been shown to influence gene expression, either activating or deactivating genes that are linked to breast cancer.
For instance, nutrients like folate, found in almonds and avocados, may interact with genes involved in DNA repair. Omega-3 fatty acids from flaxseeds may play a role in downregulating genes associated with inflammation, which is a known contributor to cancer progression. On the flip side, high intake of processed foods has been linked to the activation of genes that promote inflammation and tumor growth.
Additionally, nutrients like indole-3-carbinol found in cruciferous vegetables (e.g., broccoli, cauliflower) may play a role in estrogen metabolism, aiding in the detoxification and removal of harmful estrogen metabolites from the body. The "hack and hold" method is a simple technique used to increase the sulforaphane content in broccoli and other cruciferous vegetables. Sulforaphane is a compound with potent antioxidant and anti-cancer properties, and it's one of the reasons why cruciferous vegetables are often recommended for their health benefits.
The method involves "hacking" or chopping the broccoli into smaller pieces and then letting it sit ("hold") for a period before cooking it. Here's a step-by-step guide to using the hack and hold technique:
Wash the Broccoli: Wash the broccoli thoroughly to remove any dirt or pesticides.
Chop the Broccoli: Cut the broccoli into florets or smaller pieces as you usually would. This action breaks the cell walls and starts a chemical reaction between an enzyme called myrosinase and a glucosinolate called glucoraphanin, both naturally occurring in broccoli. When these two compounds come into contact, they produce sulforaphane.
Let it Sit: Allow the chopped broccoli to sit at room temperature for about 30-40 minutes. During this time, the myrosinase enzyme interacts with glucoraphanin, leading to higher sulforaphane levels.
Cook as Desired: After the waiting period, you can proceed to cook the broccoli any way you like. The formation of sulforaphane during the "hold" period allows the compound to remain in the vegetable even when heat is applied, although some of it will inevitably be lost during cooking.
Optional: To boost sulforaphane content further, you can add a source of myrosinase like mustard seed powder or radish to the cooked broccoli. This additional myrosinase can help convert any remaining glucoraphanin into sulforaphane.
The hack and hold technique takes advantage of the natural enzymatic process in broccoli to maximize the production of sulforaphane, which has been researched for its potential health benefits, including anti-inflammatory, anti-cancer, and antioxidant properties. This is especially relevant for estrogen-receptor-positive breast cancer, where estrogen plays a significant role in cancer growth.
It's worth noting that this method can also be applied to other cruciferous vegetables like Brussels sprouts, cabbage, and cauliflower, though the amount of sulforaphane produced can vary depending on the vegetable.
Diving Deep: Nutrigenomics and Hormone Detox
The Role of Genes in Hormone Production, Regulation, and Detox
Hormones like estrogen play a critical role in various bodily functions, from reproductive health to bone density. However, an imbalance in hormone levels or their metabolism can lead to a variety of health problems, including breast cancer. Genes have a significant influence on how hormones are produced, regulated, and detoxified in the body.
Hormone Production: Certain genes are responsible for the biosynthesis of hormones like estrogen. For example, the aromatase gene (CYP19A1) plays a crucial role in converting androgens into estrogens.
Hormone Regulation: Genes like the estrogen receptor genes (ER-alpha and ER-beta) regulate how the body responds to estrogen. Mutations or variations in these genes can impact sensitivity to the hormone, potentially affecting breast cancer risk.
Hormone Detox: Genes related to liver enzymes play a vital role in hormone detoxification. These include the cytochrome P450 family of genes, which help convert active forms of estrogen into less active forms that can be easily excreted from the body.
The Significance of Estrogen Detoxification in Breast Cancer Risk
Understanding Estrogen Detoxification
Estrogen detoxification is the metabolic process by which the liver transforms estrogen into less potent metabolites for excretion. This detox pathway is crucial for maintaining hormonal balance and reducing the risk of estrogen-sensitive cancers, such as breast cancer. While the liver is the primary site for estrogen detox, its metabolites are ultimately excreted through urine and feces.
Estrogen detoxification is particularly significant in the context of breast cancer because many breast cancers are estrogen-receptor-positive, meaning they grow in response to estrogen. Inadequate detoxification can lead to a buildup of harmful estrogen metabolites that can bind to these receptors and promote tumor growth.
Additionally, specific genetic profiles may either speed up or slow down the rate of estrogen detoxification, which can be a pivotal factor in breast cancer risk. For individuals with a slower detoxification rate, implementing nutritional strategies to enhance this process may be particularly beneficial. For those with a faster rate, balancing out estrogen levels to avoid detrimental low levels may be more appropriate (1).
Nutrigenomics can provide insights into which nutritional strategies may be most effective for enhancing or balancing estrogen detoxification, based on one's genetic makeup. By understanding these mechanisms, individuals can take proactive steps in their diets to mitigate breast cancer risk effectively.
The Role of Diet in Estrogen Detox
Nutrition can be a double-edged sword when it comes to hormone detoxification. While some foods and nutrients actively support this process, others can be counterproductive.
Supportive Foods and Nutrients
Cruciferous Vegetables: Foods like broccoli and Brussels sprouts contain compounds like indole-3-carbinol and sulforaphane, which aid in metabolizing estrogen into less potent forms.
Fiber: Integral for hormone regulation, fiber helps in the elimination of estrogen by binding it in the digestive tract.
Omega-3 Fatty Acids: Found in fatty fish, these fats may reduce inflammation, thus supporting hormone balance.
Folate: Rich in leafy greens, folate is essential for DNA methylation, a crucial process in hormone detoxification.
Hindering Foods and Nutrients
High Sugar and Processed Foods: These can induce inflammation and hormone imbalance.
Excessive Alcohol: It impairs the liver’s detoxifying capabilities.
Red Meat: Particularly when processed or cooked at high temperatures, red meat can disrupt hormone balance (3).
Other Notable Foods and Nutrients That Can Aid in Hormone Balance and Detox
Green Tea: Rich in antioxidants like epigallocatechin gallate (EGCG), green tea has been studied for its potential role in inhibiting breast cancer growth.
Seeds: Seeds like chia and pumpkin are high in zinc and other nutrients that support hormone balance and immune function.
Nuts: Almonds and walnuts contain healthy fats and antioxidants that may help in hormone regulation.
Herbs and Spices: Turmeric contains curcumin, which has anti-inflammatory properties, and rosemary has antioxidants that may support liver function, a key organ for hormone detoxification.
Quality Proteins: Lean meats like poultry, fish, and plant-based proteins like legumes can provide essential amino acids that are crucial for hormone synthesis and detoxification.
Phytoestrogens: Foods like flaxseeds and soy can offer a balanced estrogenic activity, potentially reducing breast cancer risk when consumed as part of a well-rounded diet (2).
The Importance of Hormonal Balance
While it's vital to detoxify excess estrogen, let's not forget that estrogen itself is not the enemy. It has crucial roles in bone maintenance, skin health, and reproductive functions among others. An imbalance in either direction—excess or deficiency—can lead to health issues. High levels can risk hormone-sensitive cancers, while low levels can affect bone density and cardiovascular health.
Tailoring Diet to Genetic Make-up: A Nutrigenomic Approach
Understanding your genetic makeup can further refine your dietary approach. This personalized strategy enables a nuanced approach to hormone balance and breast cancer risk reduction.
Advantages of a Nutrigenomic Approach
Precision: Nutrigenomics allows for personalized nutrition, which is far more precise than generalized dietary guidelines.
Risk Mitigation: Understanding your genetic predispositions can help you make dietary choices that actively mitigate your risks for conditions like breast cancer.
Holistic Well-being: Beyond breast cancer risk reduction, a personalized diet can also contribute to overall well-being by reducing inflammation, improving gut health, and optimizing nutrient absorption.
Key Nutritional Strategies for Breast Cancer Prevention
The role of diet in managing health risks, including those related to breast cancer, is gaining increased attention. Here are five key nutritional takeaways to consider for a more effective approach to hormone balance and breast cancer risk reduction.
1. Embrace Cruciferous Vegetables
These vegetables, including broccoli, cauliflower, and Brussels sprouts, are packed with compounds like indole-3-carbinol that support your body's detoxification pathways, particularly those related to estrogen. Aim to incorporate a variety of these vegetables into your meals several times a week.
2. Prioritize Dietary Fiber
Fiber-rich foods like whole grains, fruits, and vegetables play a significant role in hormone regulation. Dietary fiber helps in the binding and excretion of hormones such as estrogen, effectively preventing their reabsorption into the bloodstream. Aim for at least 25 grams of fiber per day for optimal benefits.
3. Consider Phytoestrogens
Certain foods, such as flaxseeds and soy products, contain phytoestrogens, which are plant-based compounds that mimic estrogen to some extent. While their role in breast cancer prevention is still a topic of research, they can offer a balanced estrogenic activity. This is particularly important for those who may be at risk due to elevated levels of estrogen.
4. Limit Inflammatory Foods
High-sugar and processed foods can exacerbate inflammation and disrupt hormonal balance. These factors can indirectly contribute to an increased risk of hormone-sensitive cancers like breast cancer. Choose anti-inflammatory foods like berries, nuts, and fatty fish to support your body’s natural detoxification processes.
5. Opt for Healthy Fats
Omega-3 fatty acids found in fatty fish like salmon, flaxseeds, and walnuts can aid in reducing inflammation. Reduced inflammation can support better hormone regulation and detoxification, making Omega-3s a worthwhile addition to your diet. By understanding the importance of estrogen detoxification, hormone balance, and how diet can influence them, you're taking proactive steps toward a balanced hormonal profile and reduced risk of breast cancer. As research in the field of nutrigenomics evolves, the possibility for even more personalized, effective dietary strategies becomes increasingly likely.
Real-world Case Studies and Examples
Several research studies and clinical trials are delving into the potential of personalized nutrition in cancer prevention. One notable study found that women with certain genetic profiles responded differently to a diet rich in cruciferous vegetables, showing variations in estrogen metabolism rates (4). Another study demonstrated that individuals with specific SNPs showed a more significant reduction in inflammatory markers when following a Mediterranean diet compared to a standard Western diet (5).
Sara, a 40-year-old woman with a family history of breast cancer was concerned about her risk. She decided to consult with her healthcare provider, who recommended undergoing genetic testing focused on nutrigenomics, as well as the DUTCH test which, in addition to 18-hour tissue exposure to hormones, takes an in-depth look at hormone metabolites and how they are used, processed, and excreted from the body. The testing included evaluating specific genetic markers known to be associated with a higher risk for developing breast cancer, such as mutations in the BRCA1 and BRCA2 genes, as well as markers related to nutrient metabolism, inflammation, and hormone regulation.
After receiving her results, Sara learned that she carries a genetic variant that suggests she might not metabolize folate efficiently, a nutrient essential for DNA repair. Her report also indicates that she has a gene that may result in more aggressive metabolism of estrogen, and her DUTCH test showed elevated levels of more harmful estrogen metabolites. These insights put her at a potentially higher risk for estrogen-receptor-positive breast cancer.
Armed with this personalized data, her healthcare provider suggests a tailored nutrition plan. Sara was advised to include more foods rich in natural folate like leafy greens, legumes, and supplements to support optimal DNA repair. She's also recommended a diet rich in cruciferous vegetables like broccoli and Brussels sprouts, which can promote healthier estrogen metabolism. In addition, her provider suggested incorporating more fiber-rich foods and omega-3 fatty acids to support overall hormone balance and inflammation control.
After six months of following the personalized dietary recommendations, Sara completed additional testing that showed improvement in key health metrics, including hormonal profiles and markers of inflammation. Her DUTCH test showed lower levels of harmful estrogen metabolites, and her levels of oxidative stress appeared to be lower. She also reports feeling more energetic and seeing improvements in her overall well-being.
This example demonstrates how nutrigenomic testing can offer actionable insights into one's health risks and pave the way for personalized interventions. For Sara , understanding her genetic predispositions empowered her to make dietary changes that could significantly reduce her breast cancer risk.
The Broader Implications of Nutrigenomics in Health and Disease
How the Principles of Nutrigenomics Can Be Applied to Other Diseases
While this blog post has focused on the role of nutrigenomics in breast cancer risk and estrogen detoxification, the implications of this field extend much further.
Cardiovascular Disease: Just as specific nutrients can influence estrogen metabolism, others can impact lipid metabolism, inflammation, and oxidative stress—all factors in cardiovascular disease. For example, polymorphisms in genes affecting cholesterol metabolism can indicate how an individual might respond to a diet high in saturated fats (6).
Diabetes: Nutrigenomics can help clarify how specific dietary components affect insulin sensitivity and glucose metabolism. For individuals with a genetic predisposition for insulin resistance, certain diets may be more effective in preventing or managing type 2 diabetes (7).
Obesity: Genetic markers can indicate predispositions for slower metabolic rates or tendencies to store fat more efficiently, providing guidance for personalized weight management strategies (8).
Mental Health: There’s growing evidence that nutrition can impact mental health through mechanisms like inflammation and oxidative stress. Personalized nutritional strategies may offer adjunctive treatments for conditions like depression and anxiety (9).
Autoimmune Diseases: Genetic factors can indicate a predisposition to certain autoimmune diseases like rheumatoid arthritis or celiac disease. Nutrigenomics can guide dietary interventions to manage symptoms or potentially even reduce disease risk (10).
The Potential Future of Personalized Diet Plans Based on Genetic Testing
Tailored Nutrition Plans: As genetic testing becomes more accessible and affordable, the prospect of creating highly personalized nutrition plans based on one's unique genetic makeup is increasingly feasible. These plans could be as specific as dictating optimal macronutrient ratios, suitable types of exercise, and even ideal meal timing, all based on one's genetic predispositions.
Integration with Health Care: Nutrigenomic data could eventually be integrated into healthcare records, allowing for more holistic and targeted care. Doctors could consult this data when prescribing medications or recommending lifestyle changes, thus improving the efficacy and reducing potential side-effects or contraindications.
Predictive and Preventative Medicine: Nutrigenomics fits well within the growing trend towards predictive and preventative medicine. By understanding the genetic predispositions to various conditions, individuals can take proactive steps to mitigate risks through dietary and lifestyle adjustments.
Ethical Considerations: As with any genetic information, there will be ethical considerations, such as data privacy and potential discrimination based on genetic predispositions. However, with appropriate safeguards, the benefits could outweigh the risks.
Public Health Implications: On a broader scale, understanding how genes interact with nutrients could inform public health guidelines, making them more nuanced and effective at a population level.
Nutrigenomics has broad-reaching implications for the future of healthcare and disease prevention. Its principles can be applied to a variety of health conditions beyond breast cancer, opening the door for more personalized, effective treatments. As genetic testing becomes more mainstream, the possibility of creating highly individualized healthcare plans becomes more real, marking a significant step forward in the evolution of medicine.
Where do we go from here? Future Direction and an Action Plan
As we've journeyed through the complexities of nutrigenomics, estrogen detox, and their implications for breast cancer risk and overall health, it becomes abundantly clear that this growing field offers promising avenues for personalized healthcare. Nutrigenomics is not just a scientific buzzword; it's an evolving discipline with the potential to revolutionize the way we think about health, disease prevention, and treatment.
Knowledge is power, especially when it comes to understanding how your genes can influence your health risks and how you can modify those risks through diet. If you're curious about your genetic predispositions, consider undergoing genetic testing from a reputable source. This can provide you with invaluable insights into how your body metabolizes specific nutrients, responds to certain foods, and even how it detoxifies hormones like estrogen. Armed with this information, you can make more informed decisions about your diet and lifestyle.
The Potential Benefits of a Diet Tailored to Individual Genetic Profiles
Targeted Disease Prevention: As we've discussed, a personalized diet based on your genetic profile can help mitigate the risks of diseases like breast cancer, cardiovascular disease, diabetes, and more.
Optimized Nutrient Absorption: You could discover that your body is more efficient at utilizing certain nutrients over others, allowing you to focus on foods that provide the most benefit.
Reduced Side Effects: Tailoring your diet to your genetic profile could minimize the side effects associated with certain foods or nutrients, such as gastrointestinal discomfort, allergic reactions, or nutrient imbalances.
Improved Quality of Life: Overall, a diet tailored to your genetic makeup can result in better energy levels, improved mental clarity, and a more balanced emotional state.
A Reminder of the Interconnectedness of Diet, Genes, and Health
In an age where healthcare is often reactive rather than proactive, nutrigenomics offers a way to flip the script. It serves as a poignant reminder that our genes, diet, and overall health are intricately connected in a delicate balance. By understanding this interconnectedness, we can seize the reins of our own health destiny, making choices that are not just good but optimal for our individual genetic makeup.
So, what can you do right now? Start by educating yourself. Read studies, consult experts, and if possible, get your genetic testing done. The next step is to apply this knowledge practically—adapt your diet, consult healthcare providers for personalized advice, and monitor your health metrics. Share this information with your family, as genetic predispositions are often shared among relatives. Lastly, engage with communities and platforms that are proactive about personalized healthcare and disease prevention.
Take the first step toward a healthier, more informed you. Your genes might not change, but how you nourish them can—and that can make all the difference.
References
1. Longcope C. Relationships of estrogen to breast cancer, of diet to breast cancer, and of diet to estradiol metabolism. J Natl Cancer Inst. 1990;82(11):896-7. doi: 10.1093/jnci/82.11.896. PubMed PMID: 2342120.
2. Dikshit A, Hales K, Hales DB. Whole flaxseed diet alters estrogen metabolism to promote 2-methoxtestradiol-induced apoptosis in hen ovarian cancer. J Nutr Biochem. 2017;42:117-25. Epub 20170123. doi: 10.1016/j.jnutbio.2017.01.002. PubMed PMID: 28178600; PubMed Central PMCID: PMC5360509.
3. Longcope C, Gorbach S, Goldin B, Woods M, Dwyer J, Morrill A, et al. The effect of a low fat diet on estrogen metabolism. J Clin Endocrinol Metab. 1987;64(6):1246-50. doi: 10.1210/jcem-64-6-1246. PubMed PMID: 3571427.
4. Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002;7(2):112-29. PubMed PMID: 11991791.
5. Coughlin SS, Stewart J, Williams LB. A review of adherence to the Mediterranean diet and breast cancer risk according to estrogen- and progesterone-receptor status and HER2 oncogene expression. Ann Epidemiol Public Health. 2018;1. Epub 20180316. doi: 10.33582/2639-4391/1002. PubMed PMID: 31008451; PubMed Central PMCID: PMC6474371.
6. Li J, Tang X, Xu J, Liu R, Jiang L, Xu L, et al. HMGCR gene polymorphism is associated with residual cholesterol risk in premature triple-vessel disease patients treated with moderate-intensity statins. BMC Cardiovasc Disord. 2023;23(1):317. Epub 20230624. doi: 10.1186/s12872-023-03285-w. PubMed PMID: 37355634; PubMed Central PMCID: PMC10290797.
7. Karimi E, Tondkar P, Sotoudeh G, Qorbani M, Rafiee M, Koohdani F. A personalized diet study: The interaction between ApoA2 -265T > C polymorphism and dietary inflammatory index on oxidative and inflammatory markers and lipid profile in patients with type 2 diabetes mellitus: A cross-sectional study. Int J Clin Pract. 2021;75(7):e14178. Epub 20210501. doi: 10.1111/ijcp.14178. PubMed PMID: 33759320.
8. damska-Patruno E, Bauer W, Bielska D, Fiedorczuk J, Moroz M, Krasowska U, et al. An Association between Diet and MC4R Genetic Polymorphism, in Relation to Obesity and Metabolic Parameters-A Cross Sectional Population-Based Study. Int J Mol Sci. 2021;22(21). Epub 20211107. doi: 10.3390/ijms222112044. PubMed PMID: 34769477; PubMed Central PMCID: PMC8584592.
9. Yubero-Serrano EM, Gonzalez-Guardia L, Rangel-Zuniga O, Delgado-Lista J, Gutierrez-Mariscal FM, Perez-Martinez P, et al. Mediterranean diet supplemented with coenzyme Q10 modifies the expression of proinflammatory and endoplasmic reticulum stress-related genes in elderly men and women. J Gerontol A Biol Sci Med Sci. 2012;67(1):3-10. Epub 20111020. doi: 10.1093/gerona/glr167. PubMed PMID: 22016358
10. Strickland FM, Hewagama A, Wu A, Sawalha AH, Delaney C, Hoeltzel MF, et al. Diet influences expression of autoimmune-associated genes and disease severity by epigenetic mechanisms in a transgenic mouse model of lupus. Arthritis Rheum. 2013;65(7):1872-81. doi: 10.1002/art.37967. PubMed PMID: 23576011; PubMed Central PMCID: PMC3735138.