From treatment to prevention: The future of personalised supplementation

Scientific breakthroughs and epidemiological findings have given us the tools to dramatically improve health outcomes for a wider population, he told an audience at the Future of Nutrition Summit at Vitafoods Europe 2023.

Tracking the history of personalised supplementation

Berk pointed to the first US dietary guidance recommendation, which came out in 1941, and recommended just eight micronutrients. Even then, the need to personalise was recognised; there were different needs for women, men, and children, as well as the recognition of pregnancy.

Of course, current recommendations demonstrate a shift towards greater personalisation: we now appreciate that ageing adults have different requirements, for example, and that pregnancy and breastfeeding affect an individual’s needs.

Berk said this also represented a paradigm shift, starting in the 1970 and 80s, from thinking about disease treatment to its prevention. In the past, dietary recommendations focused on treating specific deficiencies, such as scurvy or rickets; now, the emphasis is on overall health.

Vitamin C is recognised for its role in supporting the immune system, while vitamin D has implications for immune and metabolic health. There has also been a shift towards benefit-focused supplementation, where specific needs of different populations, such as women's health, are addressed.

But what will the next stage of personalisation look like?

The role of epidemiological data in personalisation

Berk made reference to the Dutch famine study, which gives valuable insights into how prenatal nutrition affects long-term health outcomes.

“Towards the end of World War Two, the Netherlands experienced a severe famine because of the weather conditions, in parallel to the food rations that were occurring as a result of the war,” he explained.

The Dutch health ministry’s medical records show the weights of all the children who were born before, during, and after the famine. Looking at what trimester the mothers were in during their pregnancy gives insight into prenatal nutrition intervention requirements.

The study showed that individuals who were exposed to famine early in the womb experienced more health complications later in life, despite having normal birth weights. These included increased prevalence of cardiovascular disease and increased glucose intolerance.

“All these children, whether they were exposed to famine or not, or when they were exposed to famine, all had normal birth weights, but there's going to be some epigenetic programming that's really going to put them at risk for disease later on,” Berk said. “And this is why we need to understand this so that we can have better supplementation of pregnant women and their babies for later on.”

Folate metabolism: A case study

Berk gave the example of folate supplementation, which we now know to be imperative during pregnancy for the prevention of neural tube defects. The current recommendations are set at 400 micrograms per day, but are these levels correct for everyone?

Looking at folate metabolism, there is a “very common” polymorphism for the methyl-tetrahydrofolate receptor: as many as 60-70% of the population in Australia has one of the variants for this, Berk said. However, despite this, the prevalence of neural tube defects is not very high in Australia, with one in 1,000 babies at risk.

“Where does that leave us from a supplementation perspective?” he asked.

In some cases, there may be a need for supplementation with a higher dose. But those giving recommendations today will be looking at serum folate levels, said Berk, and will see that the individual is taking 400 micrograms and recommend they continue like that.

“I think five years from now, 10 years from now, when we know a little bit more, you might start to see some of this personalised supplementation,” he added.

Lessons for a long life: Using epidemiological data to define healthy ageing

The field of healthy ageing offers opportunities to explore the factors that contribute to longevity. Studies of centenarians in regions known as “blue zones”, regions of the world where people not only live long lives but ones of high quality, indicate that diet plays a crucial role.

Epidemiological data from countries such as Japan, Greece, Italy, and Costa Rica show that social connection is also key; however, genetics and other lifestyle factors also contribute.

Mitochondrial function, for instance, declines with age, and nutritional supplementation can support mitochondrial health, which is associated with overall longevity. By understanding the effect of nutrients on mitochondria, we can look at how to promote healthy ageing on an individual level.

Berk gave the example of continuous glucose monitoring technology as something that was originally created for people with diabetes, to allow them to ensure that they stay in an optimal range, “but that technology is getting shifted down across the continuum … from the people with diabetes to athletes wanting to know how they can maximise their performance and maybe have that competitive advantage”.

From there, the next group is the “nutritional biohackers” – those people who “really just want to understand everything about their body and maximise health for optimal performance”, Berk said, before uptake by the general population.

The power of polymorphisms: Harnessing insights on metabolism

Berk used vitamin D as an example of an area where the literature on supplementation and metabolism was “mixed”.

Despite initial excitement relating to epidemiological research, he said randomised controlled trials found that supplementation with vitamin D didn’t necessarily lead to a reduction in risk of diabetes or cancer; the findings were not clear-cut.

However, the results of a more recent, “really groundbreaking” study, where the researchers supplemented vitamin D based on individuals’ baseline levels and receptor status, showed the benefit of knowing about, and adjusting for, polymorphisms.

“If we can think about that and really start to show us how we can use polymorphisms, this will really guide how we do vitamin D supplementation for an individual level,” said Berk. “We know vitamin D can play a role in bone density, insulin resistance, and immune function, and I think this is one of the more exciting areas in the space because we're almost there.

“We know that there could be a benefit – we have to just do a little bit more research and figure out how we're going to take all that information, and then how can we get it to individuals along the way.”