Healthy Weight DNA Insight Interpretation Guide

Healthy Weight DNA Insight Interpretation Guide Matching Diet Type There are four different matching diet types: Mediterranean (rich in MUFA and omega-3 PUFAs) 20% protein; 35% fat; 45% carbohydrate Encourages patients to focus on eating more healthy fats. Low Fat 20-25% protein; 20-25% fat; 50-55% carbohydrate Encourages patients to focus on eating slightly less fat. Not necessarily a low fat plan lower fat recommendation compared to the other three Low Carb 30% protein; 30% fat; 40% carbohydrate Encourages patients to focus on eating fewer carbohydrates. Balanced 20% protein; 25% fat; 55% carbohydrate Encourages patients to eat more of a balance of the three macronutrients. Provide the patient with the specific Mediterranean, low fat, low carb or balanced diet guidelines during, or after, the report review for general nutrition recommendations as well as specific meal and snack ideas. Help the patient determine the percentage of protein, fat, and carbohydrate dietary content by encouraging them to keep a specific food log for a week and entering it into an online food tracking program such as those found at MyFitnessPal.com, SparkPeople.com, Livestrong.com or FitDay.com. 1

Response to Monounsaturated Fats and Response to Polyunsaturated Fats When the result is Increased Benefit, encourage the patient to focus on including more of those types of fats in their diet. However, it doesn t mean that other types of fat should be avoided! Research suggests that consuming the fats that show an Increased Benefit has been linked to lower body weight; however, there are still other anti-inflammatory health benefits from consuming monounsaturated and polyunsaturated fats where the result is Neutral. Advise the patient to take notes as you go through the report so that they are taking an active role in the session. Using the guidance, the patient can develop a long-term wellness plan based on the results. Response to Monounsaturated Fat Comment only on the Increased Benefit result, as it is the outlier. Neutral no specific recommendations Increased Benefit (outlier) Focus on eating more avocados, olives, olive oil, and nuts most days of the week (look to the specific matching diet type guidelines for serving size and servings per day recommendations) versus eating saturated and trans or hydrogenated fats. Response to Polyunsaturated Fat Comment only on the Increased Benefit result, as it is the outlier. Neutral no specific recommendations Increased Benefit (outlier) There are two major types of polyunsaturated fats: omega-3 and omega-6 Focus on eating more omega-3 polyunsaturated fats, such as fish (e.g., salmon, herring, halibut, sardines, mackerel), flaxseed, flax meal, hemp seeds, walnuts, chia seeds and other types of seeds, most days of the week (look to the specific matching diet type guidelines for serving size and servings per day recommendations). Items such as these can be found at most health food stores and many chain grocery stores. Omega-6 fats tend to be high in the typical Western diet, so patients should monitor their intake of those types of fats. 2

Omega-6 and Omega-3 Levels Comment only on the Decreased result, as it is the outlier Typical no specific recommendations Decreased (outlier) Monitor intake of omega-6 fats Identify through the food log often found in processed foods and in healthy sources such as evening primrose and borage oils, olives, nuts, and poultry). Work to increase intake of omega-3 fats (sources outlined under Response to Polyunsaturated Fat section) if intake is low. Eating Behavior Traits Look for the outlying results Increased Difficulty Feeling Full More Likely When you see an outlier result, ask the patient, Do you find this to be true for yourself? This is a perfect lead-in to start talking about when and where this poor behavior trait may be occurring. Goals can be set around these situations. Even if the patient doesn t have a genetic predisposition to these eating behavior traits, some of these traits may still be true and should be addressed. The power of knowing that their eating behavior traits may be influenced by genetics takes some of the emotion and blame out of the eating behavior. Instead, these behaviors could be seen as predispositions that can be managed, opposed to weaknesses. This part of the report gives you an entrance into a powerful, rational coaching session or conversation to coach your patients on developing strategies for their poor eating behaviors and tendencies so they learn to put a positive spin on what might initially seem negative. Use this information to help your patients set specific, realistic, time-managed health- and wellness-related goals. Ask the patient, Do your current eating behavior traits align with your core health and wellness values and goals? 3

Snacking Typical no specific recommendations Increased (outlier) Determine the trigger, or cue, for the snacking. Can that cue be avoided or altered? What kind of reminders can be set/displayed to help the patient stay on track with their values and goals? Can an accountability partner help keep them on track? Divide calories between three meals and two snacks that are spread evenly throughout the day. Do not go more than 4 to 5 hours without a meal or snack. Plan out the day: include meal and snack times, as well as snack options. Remember the saying, If you fail to plan, you plan to fail. Keep emergency food with you. Drink water or green tea before eating. Use smaller plates and serving containers. Utilize the genetically appropriate diet guideline handouts for snack ideas ( Mediterranean, Low Fat, Low Carb, or Balanced ). Slow down while eating! Take at least 20 to 30 minutes to eat a meal. Adequately chew food before swallowing. Put down the utensil between bites. Use the less dominant hand to eat. Sites such as: MyFitnessPal.com, SparkPeople.com and Livestrong.com provide tools to assist with tracking and managing the points above. 4

Satiety Feeling Full Typical no specific recommendations Difficulty feeling full (outlier) Identify times of day when difficulty feeling full may be more common than others and what is happening before and during those times. Slow down while eating! Take at least 20 to 30 minutes to eat a meal. Adequately chew food before swallowing. Put down the utensil between bites. Use the less dominant hand to eat. Drink water between meals: carry a water bottle all day. Set a goal to drink at least 2 to 3 cups of water between meals. Increase fiber in meals and snacks up to 50 grams per day (adding no more than 5 grams per day at a time) as fiber intake increases, so should water intake. Eat more non-starchy vegetables: Spinach, broccoli, cucumbers, asparagus, kale, lettuce, red peppers, eggplant, onions, radishes, Brussels sprouts, mushrooms, and leeks. Eat protein and healthy fat at each meal (look to diet guidelines for recommended serving sizes and servings per day). Get 7 to 9 hours of sleep. Keep a food journal To help improve brain chemistry, do something every day that brings happiness. Advise patients to be aware of external cues that tell them to eat faster/slower/more/less than normal. 5

Eating Disinhibition Definition: a tendency to eat more than usual in response to a stimulus such as the availability of tasty foods that are not common at regular meals Less Likely no specific recommendations More Likely (outlier) Help the patient identify situations that they feel are triggers and make a plan to avoid those situations, or come prepared with a strong game plan. Obtain an accountability partner. Avoid buffets and situations where it s easy to get seconds. Banish the enemy from the table (chips and salsa, bread basket, etc.). Become familiar with proper serving sizes of foods (found in diet guidelines). Brush teeth after eating or have a mint. Keep a food journal. Food desire Definition: drive to obtain one s favorite foods. In other words a patient may feel more reward or positive reinforcement from obtaining that food. Typical no specific recommendations Increased (outlier) Identify situations/patterns where issues with food desires are the strongest and most problematic and become aware of the types of things that are happening before and during the strong food desires. If the foods tend to find their way into the house, get the enemy out of the house and keep them out! Find alternative pleasurable activities (make a list of things they like to do and/or healthy foods they like to eat). Keep a food journal Plan out the day: include meal and snack times, as well as snack options. Do not go more than 4 to 5 hours without a meal or snack. Eat a genetically appropriate balance of complex carbohydrates, lean proteins, and healthy fats. Obtain an accountability partner. To help improve brain chemistry, do something every day that brings happiness. 6

Sweet Tooth Typical no specific recommendations Increased (outlier) Identify situations where sweets are being eaten, specifically how often, how much, where they are consumed, and the triggers. Brainstorm relevant positive activities to replace eating sweets. Find fruits that satisfy, but be aware of portion sizes as outlined in the diet guidelines. If unwilling to eliminate sugar, consider replacing with an appropriate substitute. Use cinnamon and vanilla extract, if medically appropriate. Keep blood sugar balanced by consuming: - Adequate fiber (assess current intake and slowly increase) - Genetically appropriate balance of macronutrients (adequate protein and healthy fat at meals and snacks) Get 7 to 9 hours of sleep. Identify stressors and develop coping skills and tools. Nutritional Needs Certain genotypes are associated with lower blood levels of different vitamins or require more of a certain vitamin for optimal health. There can be numerous reasons the body might be predisposed to decreased vitamin levels, for example, reduced absorption capabilities in the gut, faster than normal clearance of the vitamin from the bloodstream and impaired conversion of one nutrient to another. Our test only looks at the genetic predispositions of nutrient deficiencies. If a patient is feeling run-down, lacking energy, or eats an unbalanced diet it may be beneficial to have a vitamin and mineral blood panel done. An age and gender-specific multi-vitamin may also be a good safety net for certain patients. Create a personalized super food list for the patient based on all of the foods listed on those pages. Challenge the patient to find a recipe containing two to three foods from that list and prepare it for breakfast, lunch, dinner or a snack! Patients may also benefit from taking a supplement if their blood levels of certain vitamins are low. 7

Dietary Sources Vitamin B2 Fortified cereal, milk, dried ancho chili peppers, paprika, parsley, almonds, edamame, mackerel, wild salmon, trout, sun-dried tomatoes Vitamin B6 Chickpeas, tuna, salmon, chicken breast, fortified breakfast cereals, potatoes, turkey, banana, lean ground beef, bulgur, cottage cheese, winter squash Vitamin B12 Clams, fortified breakfast cereals, wild rainbow trout, sockeye salmon, tuna, haddock, low-fat milk, low-fat yogurt Folic Acid Spinach, black eyed peas, fortified breakfast cereal, asparagus, Brussels sprouts, romaine lettuce, avocado, broccoli, kidney beans Vitamin A Sweet potatoes, spinach, carrots, pumpkin, cantaloupe, red peppers, mango, black-eyed peas, apricots, broccoli, part skim ricotta cheese, tomato juice Vitamin C Red pepper, orange, grapefruit, kiwifruit, green pepper, broccoli, strawberries, Brussels sprouts, tomato juice, cantaloupe, cabbage, cauliflower Vitamin D Cod liver oil, swordfish, sockeye salmon, tuna, Vitamin D-fortified milk or yogurt Vitamin E Wheat germ oil, sunflower seeds, almonds, hazelnuts, peanut butter, peanuts, boiled spinach, kiwifruit, mango For vitamins with a result listed as Stay Balanced, it is still important to consume foods containing these nutrients. Vitamin deficiencies are still quite possible. Exerc ise: 8

Exercise Endurance Training and Strength Training: We all know that exercise is important. However, genetically speaking, it may be more metabolically beneficial for some patients to focus more time on endurance training while others should focus more time on strength training. Look at the results for endurance training and strength training to see where they have a result of Enhanced Benefit and/or Beneficial. Help the patient focus exercise time on the types of exercise where they may see these more positive results. Find out what the patient is currently doing for exercise being as specific as possible so you can help them set goals from there. Endurance Training Enhanced Benefit Encourage patient to incorporate more endurance training (exercise that is done for a longer duration with moderate intensity; cardiovascular-based exercise) into workout regimens by adding an extra endurance workout per week or adding time to the current duration of the workouts. Help them set a specific exercise goal: 1) How many times per week they will work out? 2) How long will the session be? 3) At what intensity will they be working? 4) Options for activities? Example: If they have an Enhanced Benefit result for Endurance Training and Less Beneficial for Strength Training, and they plan to workout 6 hours per week, perhaps 4 hours could be spent doing endurance training and 2 hours spent strength training. Options: walking, jogging, running, swimming, elliptical, Zumba, aerobics classes, spin class, riding a bike, burst style training, etc. Keep in mind the exercise recommendations above are just suggestions. If the patient has found a plan that is working well, feel free to continue the current plan. Encourage the patient to keep an exercise log to track time spent and what was done. Encourage patient to work with a personal trainer to help give them ideas of things to do and to keep them challenged (even if it s only once per month). Normal Benefit Discuss endurance types of exercise that the patient likes to do. Encourage patient to do endurance training at least two times per week. See list above for goal setting. *Zumba is a registered trademark of Zumba Fitness, LLC. 9

HDL (Good) Cholesterol Response to Exercise Enhanced Benefit (outlier) Incorporating more endurance-type of activities (using the recommendations under the Endurance Training section to help set specific exercise goals) and following the proper genetically-based exercise guidelines can help improve and increase HDL cholesterol levels more so than the Normal Benefit group. Normal Benefit Incorporating more endurance-type activities and following the proper genetically-based exercise guidelines may improve HDL cholesterol levels, but perhaps not to the same degree as the Enhanced Benefit group. Insulin Sensitivity Response to Exercise Enhanced Benefit (outlier) Incorporating more endurance-type activities (using the recommendations under the Endurance Training section to help set specific exercise goals) and following the proper genetically-based exercise program can help this patient become more sensitive to insulin. This can help to clear sugar from the blood more efficiently and potentially decrease the risk of type 2 diabetes. Normal Benefit Incorporating more endurance-type activities and following the proper genetically-based exercise program may not help this patient become as insulin sensitive as the Enhanced Benefit group but it still remains important in many other aspects of health. 10

Your Body and Weight This section can help to show the patient s propensity to being obese, the likelihood of regaining weight after weight loss, how fast their metabolism may work, as well as insight into how efficiently this person may lose fat when they start a weight loss program. Obesity Above Average Average Higher than average genetic likelihood for a high BMI May have higher than average hunger (see recommendations under Eating Behavior Traits for Hunger) It is well-documented that genetics accounts for 40 to 70% of a person s predisposition to obesity. As long as this patient is following a genetically appropriate diet, and is conscious of poor eating behavior traits, food reactions and nutritional needs, as well as following a genetically-based exercise program, the patient may be able to overcome this genetic predisposition! May still be overweight and have a high BMI Although genetics can account for 40 to 70% of a person s predisposition to obesity, lifestyle factors can account for a large portion as well! Encourage the patient to follow a genetically appropriate diet, help the patient become conscious of poor eating behavior traits, food reactions and nutritional needs, as well as ensure that the patient is following a genetically-based exercise program to achieve, or maintain, a healthy weight. Weight Loss-Regain More Likely to Gain Weight Back (outlier) Patient may have difficulty keeping weight off after losing it Have the patient take a realistic and analytical look at all the recommendations from the goal-setting session so far. Help the patient to pick two to three specific goals to focus on in the short-term that were discussed during previous sections of the report. Encourage follow-up as often as possible. In an ideal situation, schedule a weekly weigh-in and monitor weight management progress. Have the patient keep a food and exercise log to track progress. Weight Loss Maintained Since lifestyle can greatly affect body weight, it is still important this patient is following a genetically-based diet, and is conscious of poor eating behavior traits, food reactions and nutritional needs, as well as following a genetically appropriate exercise program. 11

Metabolism Fast Normal Tend to have an increased resting metabolism Still need to be eating and exercising in a genetically appropriate way for optimal health Encourage patients to: Eat within an hour of waking up in the morning. Follow a genetically appropriate diet and exercise plan. Be conscious of poor eating behavior traits that may sabotage metabolism. Ensure adequate vitamin and mineral intake. Do resistance training and burst style training. Drink green tea and adequate water throughout the day. Drink a moderate amount of caffeine. Eat protein at each meal. Adiponectin Levels Definition: a hormone produced by fat cells which functions in the body to trigger the liver and muscles to get energy from fat. Higher levels are considered good for weight loss and health. Possibly Low Typical Losing weight may help increase adiponectin levels No specific recommendations 12

Metabolic Health Factors This section will help practitioners gain insight into the patient s metabolic health forecast and give guidance for suggested recommendations if the patient does not have the optimal diet and lifestyle factors in place. Look for the results where it says High or Above Average, which are results that may be the most concerning for the patient and are areas where the patient may need to make some specific diet and lifestyle-related changes to help combat this result. Use this section as reinforcement to help the patient follow through with the previous goals you have discussed, and help motivate the patient to make longterm changes. Elevated LDL Cholesterol High or Above Average (outliers) Routine screening for blood cholesterol levels should be performed at appropriate ages, as recommended by the U.S. Preventive Services Task Force and other groups. Diet and lifestyle play an important role in LDL levels. Processed foods and foods high in trans fat (e.g., foods such as fried foods, cookies, crackers, and snack cakes) can contribute to elevated LDL levels. Encourage patients to: Eat a more plant-based diet that includes non-starchy vegetables, legumes, whole grains, as well as high-fiber, low glycemic fruits such as berries. Eat more foods high in soluble fiber such as oatmeal, beans and barley. Choose foods rich in omega-3 fatty acids such as wild salmon, cod, mackerel, walnuts, flaxseeds, flaxseed oil, walnut oil and chia seeds. Maintain a healthy weight. Get more physical activity: target at least 150 minutes per week to help boost HDL levels and improve total cholesterol makeup. Quit smoking, if the patient is a smoker! Average, Below Average or Low Routine screening for blood cholesterol levels should be performed at appropriate ages, as recommended by the U.S. Preventive Services Task Force and other groups. Since diet and lifestyle can play such an important role in LDL levels, it is still important for patients with average, below average or low results to focus on reducing or eliminating processed foods and foods high in trans fat (e.g., foods such as fried foods, cookies, crackers, and snack cakes) from their diets. Encourage patients to: Eat a more plant-based diet that includes non-starchy vegetables, legumes, whole grains, as well as high-fiber, low glycemic fruits such as berries. 13

Eat more foods high in soluble fiber such as oatmeal, beans and barley. Choose foods rich in omega-3 fatty acids such as wild salmon, cod, mackerel, walnuts, flaxseeds, flaxseed oil, walnut oil and chia seeds. Maintain a healthy weight. Get more physical activity: target at least 150 minutes per week to help boost HDL levels and improve total cholesterol makeup. Quit smoking, if the patient is a smoker! Decreased HDL Cholesterol High or Above Average (outliers) Encourage patients to: Follow a genetically-based exercise program on a consistent basis and target 150 minutes per week of physical activity. Keep an exercise log. Average, Below Average or Low For optimal HDL levels and optimal health, following a genetically-based exercise program on a consistent basis, targeting 150 minutes per week of physical activity, and keeping an exercise log are still recommended. Elevated Triglycerides: May put patient at increased risk for coronary artery disease and type 2 diabetes High or Above Average (outliers) Encourage patients to: Limit intake of refined carbohydrates and sugar, especially fruit juice, soda, candy, and too much fruit (identify these foods in the patient s food log). Discuss the quantities of the refined carbohydrates and trans fats (e.g., foods such as fried foods, cookies, crackers, and snack cakes) in their diets and work with them to reduce intake or eliminate completely. Follow their genetically appropriate diet. Choose foods rich in omega-3 fatty acids such as wild salmon, cod, mackerel, walnuts, flaxseeds, flaxseed oil, walnut oil and chia seeds. Get more physical activity: target at least 150 minutes per week, or five or more days of physical activity per week. Limit alcohol consumption to recommended levels, as mentioned earlier. Quit smoking, if the patient is a smoker! Maintain a normal body weight. Average, Below Average or Low Although this patient may not have a genetic predisposition to elevated triglycerides, it is still beneficial for overall health to follow the recommendations listed above for High or Above Average results. 14