Academic Integrative Medicine at the Marcus Institute uses precision medicine in its assessments to get at the route of dysfunction and better understand the unique biology of each patient they serve. The advantage of this approach within an integrative health environment is that the options for recovery and prevention are directly connected to the precision assessments. Hence, specific lifestyle therapies, medications, nutrients, etc. are now more scientifically guided than ever before.
What is precision medicine?
Precision medicine refers to the practice of creating highly personalized treatment regimens for disease prevention, diagnosis, and treatment, as well as optimal well-being and longevity. Precision medicine begins with mapping a specific blueprint of a person’s health using assessment tools such as:
- Genomic/genetic testing
- Current diet and nutrition
- Biomarker testing, including blood and urine tests
- Wearable devices that monitor data such as glucose function, sleep, and heart rate variability (HRV)
- Cognitive evaluations
- Cardiovascular fitness testing, such as VO2 Max, which measures how efficiently you are using oxygen while exercising
From there, precision medicine physicians synthesize the information in a way that is actionable, creating a fully personalized treatment regimen.
Precision Medicine: Real Patient Case Study
In the above video, Dr. Dan Monti interviews Dr. Nathan Handley, the Co-Director of Precision Medicine at Thomas Jefferson University. Dr. Handley describes how he used precision medicine to treat a patient complaining of fatigue. The patient noticed that he tended to be more anxious, as well, and had been on antidepressants in the past.
Dr. Handley’s team performed genetic testing, and found that this patient had an MTHFR gene that put him at higher risk for developing deficiencies in folate—a key nutrient for neurological function. Specifically, he had a gene variant that reduced his body’s efficiency in metabolizing folate, or putting folate to use. Folate is important for the process of methylation, which basically allows all cells in the body to function optimally, like the oil in the engine.
When people have MTHFR variants, Dr. Handley runs bloodwork to see if the gene’s effects are showing up for that specific patient (if a patient has a genetic predisposition, it does not automatically mean that the problem will automatically manifest). To test it, Dr. Handley checks to see if homocysteine is elevated, which is an indication that methylation could be a concern.
In this patient, homocysteine was indeed elevated, so the care team decided to focus on the methylation pathway using targeted supplementation. They prescribed the patient specific forms of B vitamins and folate—methylfolate, an already-methylated form of folate, so the body does not need to methylate it. This supplementation worked for this patient, improving his symptoms of fatigue and anxiety.
Note: This does not mean to imply that B vitamins and methylfolate are the ideal treatment for every, or even many, patients with fatigue and anxiety. This is a precision medicine technique and it would not work for everyone with fatigue—it works because it precisely targets the underlying issue that this particular patient had.
Precision medicine techniques we use at The Marcus Institute of Integrative Health
At the Marcus Institute of Integrative Health, we use many research-driven precision medicine strategies to target our patients’ unique needs.
Diagnostic testing with PET-MRI
We utilize the region’s only state-of-the-art, PET-MRI scanner for adults to get a full picture of individual patients’ bodies and brains. The PET-MRI scanner’s uniquely combined functionality provides unprecedented insight into the body’s health and functionality, making it one of the most advanced diagnostic tools in the world.
We use this tool for both Total Body Imaging and Advanced Brain Imaging as part of our services like Executive Health, which helps busy professionals proactively manage their health, and Optimal Brain Health, which may support those who have experienced cognitive decline, injury, or other conditions.
We also use the PET-MRI hybrid in our research at The Marcus Institute, looking to determine structural and functional changes that can be associated with our integrative treatment methods for conditions such as irritable bowel syndrome (IBS), cancer, and neurological and psychiatric conditions.
Hormonal analysis and treatment
Throughout our lives, hormones can play a significant role in our well-being. We routinely test hormone levels in the blood and prescribe a customized lifestyle program to adjust hormones when they are out of balance.
Further, on a case-by-case basis, we may also prescribe bioidentical hormone replacement therapy (BHRT) to balance the hormones using formulas that are structurally identical to the natural hormones that are shown to be missing from the body. We base this treatment process on a communicative, understanding, physician-patient relationship to develop a highly customized treatment plan tuned to relieving your symptoms.
Deep phenotypic testing to assess current biological age and function
Also as part of our Executive Health program (and for any individuals who are simply interested in this service), we used the highly personalized precision medicine technique of testing an individual phenotype to uncover genetic predispositions and patterns.
Community & social factors
We know from research into the Blue Zones that one’s community is critical in their longevity and well-being; social isolation and loneliness promote inflammation in the body due to the stress they induce. Part of treating patients with an integrative approach includes looking at an individual’s social support system and community in order to better understand the full picture of their health, as this is key to providing personalized care.
Targeted micronutrient therapies
For many patients, we prescribe a personalized oral supplement regimen based on everything else we know about their health. Further, highly precise, targeted high-dose therapies may be incorporated into treatment regimens at The Marcus Institute. High-dose Vitamin C, or ascorbic acid, is one targeted therapy we have offered to patients after cancer recovery, for example.
We are also continually studying the effects of treating patients with other targeted therapies—most recently, high doses of intravenous N-Acetyl Cysteine (NAC), a supplement available over-the-counter. Early studies show promise in the molecule’s ability to improve cognitive function, and we continue to research NAC to better understand its applications.
References »
Delpierre C, Lefèvre T. Precision and personalized medicine: What their current definition says and silences about the model of health they promote. Implication for the development of personalized health. Front Sociol. 2023 Feb 21;8:1112159. doi: 10.3389/fsoc.2023.1112159.
Buettner D, Skemp S. Blue Zones: Lessons From the World’s Longest Lived. Am J Lifestyle Med. 2016 Jul 7;10(5):318-321. doi: 10.1177/1559827616637066.
What is Precision Medicine? UC Davis Health.
Precision Medicine. National Human Genome Research Institute.
About Dr. Monti
Dr. Daniel Monti is an integrative medicine doctor and neuroscientist on the leading edge of research and innovation in integrative healthcare. He is the founder and CEO of the Marcus Institute of Integrative Health, as well as founding Chair of the Department of Integrative Medicine and Nutritional Sciences at Sidney Kimmel Medical College, Thomas Jefferson
