A few years ago, Ashley Besecker, RDN, CD had her genes sequenced in search of information about her body and potential health risks. Among other things, her results confirmed she is a carrier of APOE4—the gene associated with an elevated risk for Alzheimer’s disease. While that might seem like a frightening piece of news to receive, Besecker was empowered by it.
She is confident that by knowing her unique risks, she can put in place a highly effective plan (based on individualized nutritional and lifestyle factors) to prevent the disease known for causing cognitive decline. In some cases, diet and lifestyle changes can even reverse the active disease.
Although helpful for that reason alone, Besecker says the kind of genetic testing she works with reaches much further than evaluating risk of Alzheimer’s disease or other chronic conditions such as diabetes and heart disease. From telling musculature information to the resiliency of patients’ cartilage to how they process starches, the options are seemingly limitless. They can also simply help with weight loss and health optimization.
“When talking about health these days you can’t ignore genetics. Genetics aren’t necessarily prescriptive, but they are predictive, and they are the future of medicine,” she says. “It’s all about knowing your individual risks. Nutrition comes into play because it’s a large part of how you mitigate those risks. That and lifestyle.”
Besecker, age 33, is a registered dietitian and owner of Crave Heath, a private practice in Bellevue that specializes in the intersection of nutrition, genetics and personalized medicine. She is also endlessly fascinated by the biochemistry of the human body and always has been.
Born in Woodinville, Besecker showed an early interest in science. “I’ve always asked way too many questions. I want to know why something works and how it works. Medicine is a natural career for someone like that. In college, [at Pepperdine University] I was planning to major in sports medicine. But then I took a sports nutrition class and fell in love with the science of eating—how food actually interacts with the body.”
After Pepperdine, Besecker completed a residency at Vanderbilt University Medical Center, where she continued to develop her passion. Although eventually offered a job there, she was called back to her Pacific Northwest roots, where she got a job as the nutritional director of an eating disorder and addiction center. Ultimately, she knew she wanted to run her own practice, and in January of 2009 she opened the doors of Crave Health.
But she wanted to offer more to her clients more than broad nutritional counseling and meal plan designing. She wanted to educate her patients on what exactly goes on in their bodies.
“There is so much misinformation out there with nutrition, so I’m very passionate about scientific literacy. I want people to be critical thinkers,” she says. “Anyone can use a bunch of big words or cite one study, but I want my patients to be able to think through things logically, scientifically—just be savvy enough that you can spot the people pulling one over on you.”
Which bring ups the actual tests Besecker uses with her patients. As a baseline, she recommends two things: DNA testing (which points out a patient’s potential risks) and micronutrient deficiency testing.
Besecker understands why some people hesitate to test their genetics; she says many people don’t want to know if they are carriers of genes for the more threatening diseases, so she likes to emphasize that people can customize the information they receive and only get results on actionable precautions if they want.
“There’s this whole subset of lifestyle genes that tell you so much. Like CYP1A2, which indicates how you process things out of your body, including caffeine,” she explains. “That’s a major one for a lot of clients. If you have a broken copy of that gene, caffeine will sit in your system for a longer period of time, making you more prone to cardiovascular disease. But that doesn’t mean you can’t have coffee. It just points out that you shouldn’t overdo it. For those people, keeping their coffee intake to two cups or less reduces your risk by roughly one-third —one-third, that’s huge!
“It comes back to critically thinking about what works for you, and how you function well, even though it might sound wacky to someone else,” she says.
For her, after she found out she was at risk for Alzheimer’s, she was able to make a lifestyle change that holds a lot of promise for many like her.
“Some of the lifestyle changes I suggest for those who have copies of the APOE4 gene are very specific, like overnight fasting,” she explains. “Overnight fasting is when you don’t eat for a period of 12 to 14 hours (i.e., from 8:00 p.m. to 8:00 or 9:00 a.m.) at night. The idea is you’re giving your body a larger window of time for repair, which helps clear problematic proteins and plaques that can build up in the brain. It’s a pretty simple lifestyle change.”
The other tools she relies on deal directly with nutrition and how patients’ bodies are dealing with and processing foods, supplements and chemicals. The most important one, she says, is the micronutrient test (think: vitamin D, folic acid, magnesium, etc.). She explains that even when people are supplementing these things their genetics can, unknowingly, be preventing them from actually absorbing or utilizing them. This leaves nutritional holes, which can cause certain systems in the body to function less than optimally and therefore allow for the potential to become diseased.
Additionally, Besecker might use a food sensitivity test to determine foods that are causing inflammation in the body (a major contributor to most chronic diseases). The test she uses (called an ALCAT test) looks for very a specific reaction from the red and white blood cells.
“This is why diet trends drive me crazy because nutritional optimization should be targeted on an individual and what they were designed to eat. When a diet says everyone should do this, I immediately know it’s not focused on the right things. For example, people process saturated fats very differently. Some people can eat saturated fats all day long. For others, that’s terrible for them,” she says.
Besecker, who is currently finishing a certificate in genetics and genomics from Stanford to further her education, says this is only the tip of the iceberg when it comes to using genetics-based nutritional therapies. “I’m very excited for the future of this kind of medicine because you can be so specific.”
→ For more information visit crave-health.com