Are we ready for Personalised medical treatment?

Physicians have always treated disease after their onset. But the sheer increasing number of disease and the escalating costs of treatment has made many think about ways to prevent disease before they occur. Disease prevention is thought of as Primary Prevention when preventive steps are taken before the first episode of the illness itself. It would require the treatment of risk factors that if left uncorrected would lead on to disease. For e.g., treatment of Hypertension, Diabetes and Dyslipidaemia before the onset of Cardiovascular diseases such as Heart Attacks and Strokes. Secondary Prevention are steps and treatments that are given to prevent the second episode of a disease. This would be the medical treatment of Cardiovascular disease with anti platelet drugs such as Aspirin, Statins etc. Primordial prevention refers to correction of lifestyle abnormalities at a very young age much before the onset of even the risk factors for the disease. These would include regular exercise, maintenance of ideal body weight, adequate sleep, intake of a well balanced diet and dietary supplementation.


Although most doctors have focussed their efforts on treating already established disease, it is becoming increasingly clearer that adopting preventing strategies may be the need of the hour. While recommendation exist from world bodies such as the WHO, the questions many physicians are asking is if medical therapy can be individualised and personalised. Is there a way to identify the risk for disease even before disease onset? Would genetic test be of any help in identifying risks of Non Communicable diseases (NCD – heart and vascular disease, Kidney failure, Cancer etc)? Can they be used to guide personalised recommendations for disease prevention?


Genetic tests have been used to predict risks for Breast and Colonic cancer and those with high risk are also advised an option of surgery to reduce that risk. Pharmacogenomics and Neutrigenomics are terms that are used to describe the prescription of pharmaceutical agents and nutritional supplements to reduce the risks of cancer/disease. This field, although in its infancy provides hope of big achievements in personalised Primordial preventive strategies.


A recent article in an International Medical journal  discussed the effectiveness of genetic testing to suggest disease susceptibility and to suggest preventive measures in an attempt at primary prevention of diseases.Their findings suggested that genetic testing had a 25% sensitivity only of predicting future events and that current evidence isn’t enough to suggest widespread screening using these tests. The low sensitivity (accuracy) of these tests could be explained by the observations that the genes that confer risk are multiple, the interaction with each other and with lifestyle factors complex and our understanding of them rudimentary at present!


Although very attractive, the concept of Personalised Preventive Medicine is a long way off and for now would only interest researchers or those who are simply curious to know what their genes may be saying. Even if the sensitivity of genetic testing is low, it might give the curious an insight into their disease susceptibility risks and suggest ways to modify their lifestyles to prevent disease in the future.


Genetic testing isn’t very expensive and can be done at Chennai for Rs. 20000/- The tests include identification of genes predicting Non communicable diseases, genes for drug allergies and for prediction of drug interactions.

Benefits of a high Fibre diet

Fibre or roughage refers to the undigested vegetable matter containing substances like cellulose, lignin and pectin which are not completely broken down and digested by the intestines. Most of the fibre is removed from cereals when they are processed and polished. Good carbs refer to carbohydrate foods that are high in fibre and not in sugar. High fibre and whole-grain intake have been shown to significantly reduce mortality and chronic illnesses. It has been estimated that the average dietary fibre intake in adult American men and women is 18gms and 15gms (when the recommendation is 33.6gms and 28gms per day). Given below are some of the benefits of a high fibre diet:

– 15-30% reduction in all cause and cardiovascular mortality including the incidence of heart attacks, strokes, diabetes and colon cancer.

– High fibre reduces body weight, blood pressure and total cholesterol.

– Decreased body weight in turn reduces risk of diabetes, cardiovascular disease and many cancers.

– Fibre reduces intestinal transit time by bulking up the stools and improving the emptying of the colon. The higher incidence of colon cancer in Western society is attributed to the lack of adequate dietary fibre. In contrast, rural African communities consuming traditional meals of high fibre, low meat and low fat have very low colon cancer rates.

– High fibre cereal intake is associated with improved insulin sensitivity, lipid profile, endothelial function and reduces inflammation.

– High fibre intake has been shown to reduce the incidence of prostate, lung, colorectal and ovarian (PLCO) cancer and has an inverse relationship with cancers of the head and neck region, especially oral cavity and pharyngeal cancers. This happens independent of whether they are smokers and alcohol drinkers or not.

– The benefits of fibre are not only due to the fibre itself but also due to the other nutrients accompanying it. Metabolites of fibre, particularly butyrate can prevent cancer in any part of the body. Phyto-nutrients that accompany dietary fibre in food have additional health benefits. People who eat a high-fibre diet tend to be more health conscious and have a better life style.

– It is believed that fibre in any form (even as a pill) is good for health.

– Fibre rich foods are wholegrains, green vegetables, legumes, whole fruit with skin, etc.

Author’s note:

You would do very well to incorporate a salad with every meal.

Eating Patterns and Risks of Heart Attack and Death

Does Eating Late Dinners and Skipping Breakfast increase the risk of Death and recurrent Heart Attacks?

A recent study published in the European Journal of Preventive Cardiology (April 17,2019)says exactly this. In this study of 113 patients admitted to the ICU after a major Heart attack, they were individually asked about their eating habits with a questionnaire. Skipping breakfast was defined as NOT eating until lunch (excluding Coffee and water) for at least 3 days a week. Late dinners were defined as dinners (and not snacks) that were eaten less than 2 hrs before going to bed atleast 3 times a week.

They found that 23% of the study population suffered from the primary end point ie death (5.3%)or readmission for reinfarction or recurring Chest pain(17.7%) after the first Heart Attack.

Many of us have heard that you have to Breakfast like a King to stay healthy. It is recommended that Breakfast provides 35% of the total calories consumed through the day. The stress of modern living along with greater distances travelled to work returning home late is forcing people to eat their dinners late and skip Breakfast daily as a habit. They may sleep late, wake up late in the morning and consequently skip their breakfast in their hurry to reach their Office.

The authors feel that eating late and skipping breakfast, although a part of cluster of bad habits of modern living independently contributed to adverse Cardiovascular outcomes especially after the first Heart Attack. They hypothesise that these habits increase inflammation, oxidative stress and endothelial dysfunction that may contribute to the poorer Cardiovascular outcomes.

This study is interesting for me because it provides some evidence to suggest that our Old Grandmas were probably right after all!