Pharmacogenetics – What is It and Why You Need to Know!

Changing the Future of Health Care

When the human genetic code was cracked about 10 years ago,it brought with it the expectation of immediate application to human disease. Pronouncements that there would soon be a cure for cancer and heart diseaes, now that we knew the genes causing them were everywhere.

Integrative doctors advised a cautionary approach to the expectation that one gene can cause disease. We reminded our patients that any given disease is not caused by one gene. That there is no such thing as a “cancer gene” or a “heart disease gene.” That was not explained to us by the researchers who cracked the genetic code.

Over the last 10 years, it has come to public knowledge that genes do not necessarily have to express themselves. Integrative doctors have brought to our patients’ attention that genes are turned on or off by our environment. Our environment includes the food we eat, the nutritional supplements we take, the thoughts we have, the exercise we do. The science studying how genes are impacted by outside environmental influences is called Epigenetics. Epi means “above the gene”, and reflects our recognition that many factors affect the expression of our genes.

As most of my readers and patients know, I wrote a book about vitamin D several years ago. Vitamin D is one of mother nature’s strongest epigenetic molecules. It is not really a vitamin at all, but a type of hormone. Vitamin D is known to talk to over 250 and some say over 1000 genes directly. Vitamin D deficiency is associated with over 17 types of cancer. Men with significant vitamin D deficiency have a 200% higher risk of heart attack than men with a normal vitamin D level. That is the power of epigenetics.

And so, in spite of our disappointment that one gene does not cause one disease, several new genetic tests are becoming available that have immediate clinical application to daily medical care. One of the most powerful of these applications is in the field of Pharmacogenetics.

Pharmacogenetics, is the study of how genes affect a person’s response to drugs. This relatively new field allows us to combine pharmacology and genomics to develop effective and safe medication dosages which are specific to an individual’s DNA makeup. Wow!

This means minimizing side effects from the drugs! At present there are over 770,000 injuries or deaths due to drug reactions per year in the United States. Pharmacogentics gives us the promise of significantly lowering this number.

Pharmacogenetics is based on the understanding that all drugs are taken through several biochemical pathways to break them down after they are administered. The body needs to eliminate these drugs and does it by breaking them down through biochemical pathways. These pathways are explicitly outlined in the PDR for each and every pharmaceutical drug that is made. In fact, it is by law that pharmaceutical companies must pronounce the biochemical pathways through which their new drugs are broken down by our body.

These biochemical pathways to breakdown drugs are created by our genes. Remember from my previous articles, that our genes direct the making of the proteins that make the enzymes that break down chemicals and toxins in our body.But some of us have “mutations” which we call Polymorphisms (SNP’s) which either do not allow us to break down the drug or which break down the drug too fast, so it becomes less effective.

For people that cannot biochemically break down the drugs in a normal fashion the levels in their blood get very high and that contributes to bad side effects and even allergic reactions.

We now have companies that can analyze your DNA and see which of your biochemical pathways may be impaired, because you have a genetic polymorphism. They then cross-reference this with all the drugs that require that pathway to break them down.

The laboratories give us a beautiful spreadsheet-like chart that shows us which drugs your body is programmed to be able to break down in the normal fashion and which drugs you will not be able to break down in the normal fashion.

The companies do this for all categories of drugs including high blood pressure drugs, gastrointestinal drugs, urological drugs and even psychotropics and anti-anxiety drugs.

It’s probably been your experience that one of your friends or your family members has gotten a drug that didn’t agree with them or gave them significant side effects. One of the reasons for these problems is that the person does not have the genes that create the biochemical pathways to break down the medication.

This has application in all fields of medicine. For example a colleague of mine recently had a patient that was asking for more and more codeine to relieve their pain. We are taught in medical school that this is a sign of a malingering patient seeking narcotics. My doctor friend did the pharmacogenetics test on the patient, and it turned out that the patient was a fast metabolizer for codeine and he would break the codeine down within minutes of swallowing it and therefore would not be able to create the intermediate molecule that gives the pain relief. With this information, the doctor switched the patient to a different narcotic that the test showed he could metabolize and the patient got pain relief.

Imagine you have a friend who’s depressed and they need to go on a psychotropic drug. Wouldn’t it be nice to know if they have the pathways to break down Prozac or Wellbutrin or Lexapro? This is the power of pharmacogenetics.

I am very happy to let my patients know, that effective immediately we have this testing available at our office. For my readers, I will give you links below where you can research some of the labs that do this test and bring it to the attention of your doctor.

One of the nice things about this test is that it is a once-in-a-lifetime test. You don’t need to repeat it because it’s showing which drugs your genes can and cannot break down and that is based on your DNA.

Another valuable part of getting this test done is that the last page has a summary of all your genetic polymorphisms i.e. which pathways work well genetically and which pathways don’t. If you are stuck in an emergency room, you can give this to the emergency doctor who could cross-reference it with drugs that would be appropriate for you in the ER.

To me, this is a very exciting development in medicine. In my practice, it is the first practical application of our cracking the human genome code that we have available for day-to-day use with patients.

The additional good thing is that insurance companies who pay for the drugs are starting to recognize these tests.(see video below). They will often pay for the test, because they realize that if they can prevent you from having side effects that require hospitalization, they will save money. Of course, you must check with your individual insurance company.

I am just so excited and delighted with this new technology I can offer my patients and my readers to bring to their own physicians so they can get the benefit of Pharmacogenetic testing.

The lab I have chosen to use for the pharmacogenetic testing of my patients, after much research, is Asperio laboratories. The high quality and reliability of their testing and easy to understand format of the results make this my choice.

Below are several videos which I know you will find interesting.

The first video is from a Asperio labs about the basics of pharmacogenetics testing. Here it is:

Here is a video from an insurance company explaing why they are excited about this testing:

And finally here is a longer video with the Medical Director of Asperio where he answers questions and explains the testing.


Asperio Labs – The lab I am using

Genomind – which does genetic testing just for all the psychotropics

Please let me know what you think about this exciting new field!

Dr. Soram

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Functional Medicine Now at the Cleveland Clinic!

By Soram Khalsa, M.D.

The Cleveland Clinic
The Cleveland Clinic

I am delighted to announce to my readers and patients that the world-famous Cleveland Clinic has opened a Center for Functional Medicine in Cleveland Ohio. My longtime friend and colleague Mark Hyman, M.D. is the director of the center. One of the patients who recently received tremendous benefit from the center, has already created an endowed chair for the center, which Mark Hyman sits in.

As most of my patients and readers know, functional medicine and integrative medicine are essentially synonymous.

The term functional medicine emphasizes that the goal of the physician is to restore proper organ function and a proper relationship of balance between all the organs in the body. This allows the patient to be brought back to health. As is commonly said functional medicine clinicians “think and link” instead of “naming and blaming”.

Remember that there is a weblike interaction between all the organs in the body. It is essential for a physician to look at the interactions between the different organ systems. Unfortunately, conventional medicine has broken organs into “silos”, where the doctor only knows about his or her silo. Attention is not paid to the interaction of that one organ system and the other systems of the body.

In creating this new Center, the Cleveland clinic is the first academic medical center in the United States to embrace functional medicine. Four research projects have already been started, comparing standard treatment for asthma, inflammatory bowel disease, type II diabetes, and migraine with functional medicine treatment. The results will be published in a major medical journal when the studies are finished.

Mark Hyman related at the recent Institute of Functional Medicine convention, that I attended, that Toby Cosgrove M.D., who is a 74-year-old cardiac surgeon, and the Head of the entire Cleveland clinic, came to him and invited Dr. Hyman to start this center as part of the Cleveland clinic.

Dr. Cosgrove was quoted as saying “We must consider new approaches to understanding and treating diseases”. He points out in his recent book the Cleveland Clinic Way, that chronic diseases “are now so prevalent and so costly that they’re threatening to destroy America’s broader economic health.”

My colleague Jeff Bland, who is the “father” of functional medicine is quoted as saying “In the last 40 years, a lot of progress has been made in defining the mechanisms that create disease. It’s different from the model that says, ‘here’s a pill for every ill’. It’s a systems approach to biology.”

He stated that the origins of disease can be found “in the interrelationship between environment and lifestyle and how those interact with a person’s genetic disposition.”

Dr Bland went on to say “At the turn of the last century, we started to understand the origins of infectious diseases.” Now, “we are sitting in a similarly exciting moment in time. We’re going to witness an unbelievable shift around noncommunicable diseases.”

The Cleveland clinic has long been on the cutting edge of medicine, setting standards for the future. The first blood transfusions were done at this hospital in the 1920s. Coronary angioplasty began there in the 1950s. In 2007, the hospital became the first to have a Chief Wellness Officer. And now they’ve created the Center for Functional medicine at the Cleveland Clinic.

Already physicians from multiple subspecialties within the clinic are coming up to Dr. Hyman to tell them that they want some of the principles that they are using in the Functional Medicine Clinic, to be able to use in their departments as well!

To me, these are exciting times! What my colleagues and I have been practicing for so many years, is now getting recognized at a major academic institution. I know the research they will be doing will revolutionize the approach to disease care in America.

Here is an interview with Mark Hyman M.D. and Patrick Hanway, M.D., the new Medical Director of the Cleveland Clinic for Functional Medicine.

And I will always continue to bring you the latest information on what is happening in functional medicine, the medicine of the future!

My next newsletter will be on Pharmacogenetics and how this will revolutionize the use of drugs in modern medicine.

Links for more information on the Cleveland Clinic Center for Functional Medicine:

Cleveland Clinic to open Center for Functional Medicine

Cleveland Clinic’s Center for Functional Medicine: A Test Kitchen for Healthcare’s Future

Pathways to Healing Article (PDF)

Investing in ‘functional medicine’ to cure disease, not soothe symptoms, for patients

To your good health!

Dr Soram

Dr. Khalsa’s Just Back From My Conference on the “Omics” Revolution

I am just back from Austin Texas, where I attended the annual international conference sponsored by the Institute of Functional Medicine. As I’ve told you many times in my writings and in my lectures, functional medicine places an emphasis on how our organs function, and how to improve our organ function to lead to better health. This is of necessity includes the use of diet, lifestyle, and nutrition to improve organ function.

This year the conference was titled the Omics” Revolution: Nature and Nurture.

Genomics is the study of our genes and how they express themselves to contribute to making us who we are. The function of the genes is to make proteins which then create our metabolism, which detemines our health and even we are finding, our mental makeup.

The study of the proteins of the body and how they make us into who we are is called Proteomics.

These proteins then create our metabolism. The study of how these proteins interface with our metabolism to create who we are is called Metabolomics. Our metabolism then cretes how we look, how we digest our food, whether we are fat or skinny, and all aspects of our health.

This conference emphasized, more than ever, that our genes are “Not written in stone.” We are now learning that our diet, our lifestyle, our thought patterns and our emotional patterns are able to directly impact our genes and thereby their expression of proteins which turn into our metabolism which creates who we are.

As my colleague Jeffrey Bland PhD, has said “There are many “you’s” within you.” This is good news! We are able to control the expression of our genes by what we eat, how we think how we exercise and how we live. Our food and our thoughts talk directly to our genes!

I am happy to present this video of my colleague Dr Jeffrey Bland, who explains this idea of Omics very clearly. When you watch this short video, you will see why the Omics revolution is such an exciting thing to me as a functional medicine doctor.

What is the “Omics” Revolution? from The Institute for Functional Med on Vimeo.

In my next blog post I will talk about some of the specific things that were discussed at the conference.

Remember to follow me on Twitter and Like me Facebook where you can leave me questions and comments.

Do You Eat a Lot of Cooked Food? Why Adding More Raw Foods to Your Diet is a Smart Move

Asking most people whether they eat a lot of cooked food may sound like a silly question. After all, we’re conditioned to cook all of our meat thoroughly to avoid bacteria and parasites, and even our dairy products and juices are pasteurized.

For many, raw food in their diet consists of an occasional salad or piece of fruit, as even most veggies on Americans’ dinner plates are of the cooked variety.

So what’s the problem, you may now be wondering?

Raw plant and animal foods (such as raw milk) are loaded with beneficial enzymes for your body. (Enzymes are actually special proteins that act as catalysts for the chemical reactions that occur to keep your body functioning.) However, enzymes begin to be destroyed at temperatures above 110-115 degrees. So if your food is cooked, pasteurized or processed, it will contain no enzymes whatsoever.

Click here to read more.

Probiotics: What Are They and Are You Getting Enough?

Probiotics, which mean “for life,’ are beneficial bacteria that can assist your body with digestion and help protect you from harmful bacteria.

There are, in fact, trillions of bacteria in your digestive tract, but not all of them are good for you. One reason why probiotics are so important is because they help keep the balance of good vs. bad bacteria in check. Without them, bad bacteria would overwhelm your system, causing your cells to miss out on important nutrients and function poorly.

As written in the book “Digestive Wellness”, probiotics lower the pH of your colon and kill disease-causing microbes. They also produce vitamins A, B and K, protect you from illness, enhance peristalsis, and make lactase for milk digestion. Probiotics also ferment dietary fiber, producing important short-chained fatty acids, such as butyric acid, which in low levels has been associated with ulcerative colitis, colon cancer, active colitis and inflammatory bowel disease.

Click here to read more.

The Environment and Our Health

By Soram Khalsa, M.D.

There is an ongoing dialogue between the Paleo-diet people and the Vegan people of our country. The paleo people say the more meat that you eat, the healthier you will be. They will have bone broth and beef liver for dinner.

The vegans say “meat is bad for you”, and they will serve meals with sprouts and beands and say this is the best for you.

Most likely the answer will be somewhere in between. And there will be an ongoing dialogue between the two camps for a long time to come.

However recently a most powerful movie has come out called cowspiracy. I just watched it over this holiday weekend and it really change my perspective on the Paleo diet. What will happen to our planet and our children if we keep eating lots of meat?

It turns out that farmed animals consume a much greater supply of the available water than humans do. In addition the digestive gasses the animals produce are a much bigger part of pollution on our planet than gasoline.

Here are a few quotes from the movie:

“Animal agriculture is responsible for 18 percent of greenhouse gas emissions, more than the combined exhaust from all transportation.” [1]

“Livestock is responsible for 65% of all emissions of nitrous oxide – a greenhouse gas 296x more destructive than carbon dioxide and which stays in the atmosphere for 150 years.”


And these 2 quotes are the ones that really shocked me the most.

“Agriculture is responsible for 80–90% of US water consumption.” [3]

“2,500 gallons of water are needed to produce 1 pound of beef”

[4][5] Why is California telling us not to shower or water our lawns?

Here are 3 previews of the movie. I urge you to go to the website and pay to watch the full movie. You can find it HERE!

I look forward to staying in touch with you about Integrative Medicine and the health of our people and the health of the planet.

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Back to Writing my own Articles for you

I’m delighted to be back writing my own integrative medicine newsletter article for all of my patients and readers.

So many advances are occurring in the field of integrative medicine. Increasingly, conventional medicine and integrative medicine are coming closer and closer together. Just witness the new conversations about probiotics that we integrative practitioners have been talking about for decades. Now it is part of mainstream medicine.

The role of environmental medicine in everything from autoimmune disease to cancer is being discussed on a large forum internationally.

The role of stimulating the immune system for people with cancer is another example of this coming together of integrative medicine and traditional medicine. Traditional oncologists are now looking at vaccines to boost the immune system of the patient against their malignancy.

And so over the months ahead either on a monthly or sometimes weekly basis I will write my own “Integrative Medicine Update”. Most of these updates will be short articles with my comments linking you to the major article and all of its findings. Everybody now has Internet access and it is easy to send you to these links where you can read the full article yourself.

I will appreciate your comments and conversation about the articles that I write. I look forward to being in dialogue with you about it.

Dr. Soram

The Benefits of Giving to Charity: What to Teach Children (and Refresh Yourself On)

donatingWith finances tight for many in the United States, giving to charity may not be at the top of your list of places your money needs to go. Yet, while giving to charity is always an optional thing, doing so on a regular basis can have very real benefits for you and your family.

Teaching Your Children About Charity

Why would your children need to know about charity? Well, it’s one of the key ways that you can help your children develop into caring, well-rounded people when they get older. And in a world so full of violence and apathy, raising concerned, empathetic children is a necessity for the future.

Children, in fact, are naturally caring. One study found that children as young as 21 months show signs of empathy when their parents are upset (crying or arguing). Another study, this one published in the American Psychological Association’s (APA) Developmental Psychology journal, found that even young children who are aggressive and disruptive show “concern for the welfare of others.” However, the startling finding is that this concern can decrease as children reach school age.

Click here to read more.

Climate Change Causing “Increases in Tick-Borne Diseases …” What You Need to Know Before Venturing Outside This Spring and Summer

Dog ticks, which are mainly a threat during the spring into summer, do not usually bite people, but that appears to be changing. When the ticks are exposed to higher temperatures, such as may occur as the global climate warms, they appear to acquire a taste for human flesh, a change that could cause an increase in dangerous tick-borne diseases.

According to research by Didier Raoult, a professor at the University of Marseille School of Medicine in France, hot weather may be making dog ticks turn on humans. They decided to investigate after a series of unusual outbreaks in humans occurred.

Raoult and colleagues incubated 500 brown dog ticks at 77 degrees Fahrenheit and 500 at 104 degrees Fahrenheit. They then placed the ticks on their own arms. After 1.5 hours, about half of the ticks kept at 104 degrees had tried to burrow in, compared to none of those at 77 degrees.

“From a global perspective, we predict that as a result of globalization and warming, more pathogens transmitted by the brown dog tick may emerge in the future,” the researchers wrote in PLOS Neglected Tropical Diseases.

Click here to read more.


TMJ and TMD: Natural Options for Treating and Healing This Common Source of Jaw Pain

Does this sound familiar?

“My jaws are so sore and I have sharp pains running through the joints. I feel a clicking, popping and a grinding sensation anytime I move my jaw to talk or eat. Even my ears have a ringing and buzzing in them. I’m constantly fighting stiffness and pain in my neck and shoulders, plus my hands feel numbness in them. I can’t sleep from all the pain I’m experiencing, and I feel like I’m falling into a depression. What is wrong with me?”

If you are experiencing symptoms like the ones above, you may have temporomandibular joint dysfunction (TMJ/TMD). The disorder was first discovered in 1934 by an otolaryngologist named J.B. Costen, and currently estimates suggest that anywhere from 60 million to over 175 million Americans may suffer from TMD – so if you’re one of them, you’re not alone!

In fact, according to John D. Laughlin III, president of the Holistic Dental Association, 70 to 80 percent of the United States population may have some form of TMD!

Click here to read more.