…article continued:
Research is also working to identify metabolomic markers that can objectively assess nutrient status, food intake, and the biological effects of foods. As noted, an issue of concern has been the recommendation of nutrients based on urine testing. Overall, many nutrients lack an ideal or consensus biomarker for deficiency diagnosis. Evaluation of organic acids primarily highlights that there may be a nutrient need or other issue impacting a metabolic pathway. Though not generally diagnostic, functional medicine testing may identify areas of concern. All laboratory assessments should be evaluated in the context of a full medical history and exam, and other contributing factors.
Applied Metabolomics Going Forward
While conventional medicine has largely ignored urine metabolites outside of serious inborn errors of metabolism (i.e., PKU, MSUD, etc.) or a few single markers, functional medicine or integrative nutrition has certainly been ahead of the curve in its excitement and interest in using metabolomics, specifically urine organic acids. Functional medicine has laid significant groundwork for providing a format for applying metabolomics, though it has not fully kept up with current research and accepted standards. Applied Metabolomics, as it currently stands, offers patients insight and additional information on their metabolic status. Though certainly, some criticism may be that it lacks clinically applied evidence, it is important to remember that in functional medicine it is primarily being used to adjust lifestyle, exercise, diet, or guide supplementation of nutrients or botanicals, and not to determine the use of interventions that carry with them a significant risk of harm, such as pharmaceutical agents. Patients have control over these extrinsic factors, making changes personalized and participatory. At the same time, clinicians and integrative and functional medicine organizations should be transparent in identifying the support, or lack thereof, for the information they are presenting to justify their suggested treatment plans. Support of a single study cannot override consensus science.
Another exciting advancement in the utilization of metabolomics data is the evolution of machine learning and artificial intelligence informatics platforms. As metabolome databases become more robust and standardized, the use of advanced analytical technology will likely allow for more comprehensive pattern analysis and clinical contextualization of the data set generated when a metabolomics test is performed, providing more evidence-based recommendations based on the subject’s data and, ultimately, more impactful and efficacious therapeutic interventional options for the treating clinician to consider.
Metabolomics is improving our understanding of physiology, what is normal, what is normal for each individual, and what may identify impairments. It can characterize key markers in specific processes and pathways, physiology, impact of diet and microbiome metabolism, etc., all helping to identify a client’s individual metabolism and better personalize treatments. While conventional medicine has primarily looked at laboratory markers that provide a diagnosis, functional medicine has looked at a broader picture of function. Metabolomics offers a pathway to move forward in the quest for truly precise and personalized medicine.
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David M. Brady, ND, DC, CCN, DACBN, IFMCP, FACN has 30 years of experience as an integrative practitioner and over 25 years in health sciences academia. He is a licensed naturopathic medical physician in Connecticut and Vermont, is board certified in functional medicine and clinical nutrition, a fellow of the American College of Nutrition, and completed his initial clinical training as a doctor of chiropractic. Dr. Brady has been the chief medical officer of Designs for Health, Inc. for 17 years. He is also one of the founders of Diagnostic Solutions Labs and serves as the chief medical officer for the lab. He was the long-time vice president for health sciences and director of the Human Nutrition Institute and continues to serve as an associate professor of clinical sciences at the University of Bridgeport in Connecticut. He has appeared on the plenary speaking panel of some of the largest and most prestigious conferences in the field, including IFM, ACAM, A4M, ACN, IHS, AANP, AIHM and many more. He is in clinical practice at Whole Body Medicine in Fairfield, CT, specializing in functional, nutritional, and metabolic medicine.
Betsy Redmond, PhD, MMSc, RDN has worked in laboratory content development and research for more than 15 years and also runs a private practice nutrition and consulting business. She holds a Masters in Clinical Nutrition from Emory University and PhD in nutrition from the University of Georgia. Additionally, she is a co-developer of the Academy of Nutrition and Dietetic’s Integrative and Functional Medical Nutrition Therapy (IFMNT) Radial, that was recently published in the textbook Integrative and Functional Medical Nutrition Therapy (2020). Her focus has been on evaluating evidence and literature support for IFMNT claims. betsy.redmond@diagnosticsolutionslab.com
