Imagine being told that everyone needs to wear one specific pair of low riding jeans at all times regardless of their age, body configuration, surroundings, or life situation. This could leave you with some images that you would want Brillo-padded from your mind. You’d probably also say that a “one-size-fits-all” solution wouldn’t work with clothes, that people are different. So why should it work with diets? Yet, how many times have you seen ads, books, podcasts, social media posts, TV and radio spots, and self-appointed nutrition gurus tell you that they have that one magical diet or that one “superfood” item that everyone should be consuming? Such folks have essentially been telling you what to eat when they don’t even really know that much about you. Instead, wouldn’t it make much more sense to take into account the great diversity that exists among different people and their situations? Well, precision nutrition would do precisely that. Precision nutrition is an emerging field that seeks to better tailor dietary recommendations and nutritional guidelines to different people’s characteristics and circumstances in a way that improves health.
Precision Nutrition is Part of An Overall Movement Towards Precision Health
Precision nutrition is part of a larger movement towards what’s being called precision health. Nutrition is certainly closely related to health because as the saying goes, you are what you eat. This doesn’t mean that you will suddenly become a long, pink, cylindrical object immediately after consuming a hot dog. However, over time, your diet can greatly affect your health in many different ways. In fact, according to the U.S. Food and Drug Administration (FDA), “each year, more than a million Americans die from diet-related diseases like cardiovascular disease, diabetes and certain forms of cancers.” And the Centers for Disease Control and Prevention (CDC) indicates on its website that “A healthy diet helps children grow and develop properly and reduces their risk of chronic diseases. Adults who eat a healthy diet live longer and have a lower risk of obesity, heart disease, type 2 diabetes, and certain cancers.” And even if you already have a chronic medical condition, the CDC emphasizes that healthy eating can still you “manage these conditions and avoid complications.”
Over the past decade, there’s been growing acknowledgement that “one-size-fits-all” approaches don’t work for health in general. When then-U.S. President Barack Obama announced the launch of the Precision Medicine Initiative in 2015, the White House called precision medicine “an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles.” In other words, when people and their surroundings are comprised of complex systems, treatments must account for that complexity. Note that “precision” is not exactly the same thing as “personalized.” Precision simply means more accurate or better tailored. This doesn’t necessarily mean custom-made for a specific person, such as custom tailored velour track suit, which is implied by the word personalized. Personalized is a subset of precision. For example, personalized medicine would be a super-tailored version of precision medicine.
Precision medicine is part of the broader term precision health, since the latter “includes precision medicine but also approaches that occur outside the setting of a doctor’s office or hospital, such as disease prevention and health promotion activities,” according to the Centers for Disease Control and Prevention (CDC) website. Unless you always dine on the examination table in your doctor’s office, the broader precision health term should include what you eat as well. With such increasing interest in better tailoring different health-related approaches to different people and their circumstances, it certainly makes sense to throw food and drink into this mix, so to speak. And that, kids, is how nutrition met precision health to form precision nutrition.
Your Body’s Biological Systems Change With Age and Different Life Events
Speaking of kids, you’d be kidding yourself if you believe that eating the exact same things throughout your entire life would be the way to go. You probably realize that you shouldn’t feed a newborn a whole flank steak or expect the person you met on Tinder to be happy with a all-baby food first date dinner. But these are only two examples of how the “right diet” changes with age. In the words of that Keane song, everybody’s changing. So much about your body and surroundings evolve with time. When you are in your 60’s, for example, your metabolism is probably not the same as when you were in your early 20’s and could eat an entire pizza as an hors d’oeuvre. The rate at which your stomach empties and your ability to recognize hunger or thirst may decrease with age as well. There’s also evidence that the your telomeres get shorter as you age and that your diet can affect this shortening rate. Your telomeres aren’t something that you can see in the mirror (at least, you shouldn’t be able to see them) but are super-small structures located at the end of your chromosomes, helping protect them.
Then there’s that city of bacteria and other microbes in your gastrointestinal tract called your microbiome. This city situation helps you digest, process, and absorb your food. Immediately after you are born, the reason why your poop don’t stink is that your intestines hasn’t yet been colonized with the bacteria that ends up giving your poop that oh-so-familiar odor. The composition of your microbiome continues to evolve depending on what you may consume and be exposed to over time.
Plus, your nutritional requirements may change rather substantially with different life events. For example, when you are pregnant, chances are you’ll eventually notice. That’s because your body and its functioning changes in many different ways. Not only might you start craving certain foods like pickles wrapped in prosciutto and prosciutto wrapped in pickles, you will likely have an increased need for more calories, micronutrients, and macronutrients. You are right when you tell your significant other that you are complex, you are a complex biological system.
Your Biological Systems Can Be Very Different from Other People’s
Even though some frustrated folks may say that all men are the same or all women are the same after a series of unsuccessful Tinder dates, they really aren’t. Your digestion, your microbiome, your absorption of nutrients, your processing of these nutrients, your metabolism, and many of your other biological can differ significantly from those of other people. Birth is not like a photocopy machine run. Not everyone starts off the same. And over time, what you do and what you are exposed to can in turn affect what’s inside you.
Your Daily Behavioral Systems and Your Biological Systems Interact in Many Complex Ways
In fact, it’s a very vicey-versa situation: not only can what you do every day affect your biological systems, your biological systems can affect what you do every day. What you eat can in turn affect how your body handles food. And it’s not just what you eat but when and how you eat it. For example, eating a pizza at 12 noon may not be quite the same as eating one at 3 am. Eating a pizza over the course of an hour may not be the same as eating it over the course of a couple minutes.
Plus, you presumably do other things besides eat. Your physical activity level, your sleep schedule, your stress level, and the other things that you put into your body such as medications, supplements, and tobacco products can affect how your body works as well. In fact, your eating behaviors and physical activity levels can affect your microbiome and your sleep patterns. Your sleep patterns and physical activity levels can affect your stress levels. Your sleep patterns and eating behaviors can affect your physical activity levels. Your stress levels can affect your eating behaviors. In fact, all of these may affect each other in different ways and can in turn affect your metabolism, which can as a result affect what you do already. Simple, right? Well, this is only the tip of the iceberg lettuce when it comes to the complex systems involved.
The Systems Around You Can Affect Your Behaviors and Biology in Many Complex Ways
And if you think that you aren’t affected by what’s around you, you’ve got another thing coming, in the words of the hard rock group Judas Priest. It’s been said that you are the average of the five people you spend the most time with. Well, the same thing may apply to your diet. Think of your family, friends, and co-workers as walking, talking, and burping food items as they can influence what you eat. If everyone around you is eating chicken wings, take a wild guess as to what you may be more likely to eat. It’s probably not just vegetables unless you bring a fanny pack of kale to wing night. The people around you can affect many other things as well such as your stress levels, your sleep patterns, and your physical activity levels, which in turn can affect your metabolism and so forth.
Then there’s your environment and the complex systems that comprise your environment. This includes both the built environment, which is basically every human-made or human-modified structure around you, and the natural environment, which is essentially everything else surrounding you. Both environments can affect what you eat, how much physical activity you get, how much sleep you get, and a whole host of other behaviors. For example, it’s much harder to eat an all-kale lunch if none of the stores or restaurants even carry kale.
Economics matter too. It’s not as if you can walk into the local organic grocery market, grab whatever you want, point to some random dude, and say, “put it on that dude’s tab,” before making off with the food items. What you can afford affects what you eat and do. There are also cultural and political systems at play. Again, it’s a complex system of systems.
Various Systems Can Then Affect the Relationship Between Your Diet and Your Health
Ultimately, everything that you consume and how they are processed can affect your health in the short term as well as the long term. What makes it an even more complex system is the delay between your dietary intake and the health consequences. You are not like a giant latte machine where you can put in ingredients and churn out a health outcome relatively quickly. You are also not like a car where gasoline is the food and you can get a certain mileage as a result of guzzling it, meaning the food and not gas. Instead, lots of other things comprising a complex system can affect your health as well such as your genetics, your biology, your surroundings, and your other habits. For example, a smoker may have a greater risk of cardiovascular disease than a non-smoker, even though they have identical diets.
As you can see, things can get freaking complex. Too complex to be figured by just some dude hocking a diet on a YouTube channel by showing some supposed before and after pictures that look suspiciously like pictures of two different people. Or some dudette who happens to have written a book based on what she fed herself and her roommate for 30 days. Even some more established so-called diet gurus out there may not have done the work to elucidate all of the complexities.
In fact, many of the scientific studies to date haven’t been able to fully separate out the mechanisms involved. For example, there’s only so much you can get out of a large observational cohort study, you know the kind that follows thousands of people and compares what happened to people who had regular eaten or drunk something versus people who didn’t. I’ve covered previously for Forbes such studies that have led some people to prematurely conclude that coffee drinking may help you live longer. Alone such studies can only show some general possible associations and not prove cause-and-effect. And such associations or correlations can instead just be coincidences with many confounding factors. For example, you can draw a correlation between the decreasing number of pirates over the years and increases in global temperatures. But arrghh, that doesn’t necessarily mean that training more pirates would be the key to combatting climate change. Therefore, there is a need for more and a greater variety of scientific studies to better guide precision nutrition.
Studies will also need to use more systems approaches that account for and better elucidate the real systems at work. Too many studies to date have been like searching for someone on Tinder, focusing on superficial characteristics such as physical appearance rather than digging deeper to see what’s really affecting nutrition and health. For example, two people of different races or ethnicities can in actuality be a lot more similar than two people of the same race or ethnicity.
That’s why the National Institutes of Health (NIH) held a ”Precision Nutrition: Research Gaps and Opportunities Workshop” on January 11 and 12, 2021, to review what’s known about the complex system of factors affecting nutrition and health and what the current research gaps are. That’s also why the NIH launched the Nutrition for Precision Health (NPH) research program earlier this year. It’s stated goal is to “develop algorithms that predict individual responses to food and dietary patterns.” The NPH research program is not only using traditional nutrition research methods but also incorporating new ones such as artificial intelligence (AI) and other technology-enabled approaches.
Any precision nutrition research and resulting dietary approaches will have to take systems approaches to be successful. This means that they will have to account for all of the complex systems that affect nutrition and link nutrition with health. With both nutrition and health being affected by and affecting such complex systems, it’s going to take time and much more research to achieve true precision nutrition rather than we’ll-call-it-precision-nutrition-but-it-will-just-be-more-of-the-same. Trying to rush the work or coming up with some half-baked solutions could do more harm than good. It would result in overly-simplistic approaches to nutrition, which precisely has been the problem all these years.