Welcome to the Evolution of Medicine podcast! On this episode, James Maskell sits down with Yael Joffe RD, PhD, to talk about the kickoff for 2021, the year of re-invention. They discuss genetics and genomics, and how they could change the profession of nutrition. Yael shares her insight as a dietician on powerful strategies for nutritionists and dieticians within functional medicine. If you are interested in nutrition and want to get in a new mindset for 2021, then this podcast episode is for you!

Highlights include:

  • The hierarchy within medicine and how the meetup groups are there for everyone to share and discuss their practices together
  • Looking deeper into nutrigenetics: How do my genes behave?
  • Discussing what “new nutrition” is and how it is more accurate than just looking at genetics
  • And so much more!

Resources mentioned in this episode:

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

James Maskell: Hello, and welcome to the podcast. This week, I’m super excited to kick off our conversations about 2021, the year of re-invention. And we are going to talk about genetics and genomics and how it could change the profession of nutrition. Ultimately, we’re going to start with the profession of dietetics and where it came from and why it hasn’t really lived up to its potential.

James Maskell: We’re also going to really understand what it takes to unleash the potential of genomics into the industry and some of my pet peeves with genetic testing. And then we’re going to find out a little bit more how every practitioner in our community can get on the bandwagon for 2021 and really play a part in the re-invention of medicine via genomics. So it’s a really interesting 45 minutes.

James Maskell: Dr. Yael Joffe is just as passionate as I am about this transformation, healthcare, a joy. So welcome back to the podcast, Dr. Yael Joffe. Welcome doc.

Yael Joffe: Thanks James. Great to be here.

James Maskell: Really excited to have you here. I guess I just wanted to follow on last week. I did a conversation with Dr. Jeffrey Bland about medical nutrition therapy and the changing healthcare landscape. And I guess, medical nutrition therapy when he started in the realms of dietetics. And I know that’s where you started as well. So why don’t we just start there, what is dietetics and has it lived up to its potential in achieving its goals?

Yael Joffe: Thanks James. That’s a great place to start. So I almost feel like I’m talking about dietetics is talking about the elephant in the room. So let me start out with the caveat that there are some outstanding dieticians out in the healthcare industry, really outstanding, but let’s talk about dietetics as a profession.

Yael Joffe: And the interesting thing is when you look at dietetics and look where it came from, it actually grew out of two emerging themes. So one is folklore. So if we go back to the Greeks and the Romans, they had stories about if you eat this, it will do that. But the real profession came out of home economics.

Yael Joffe: And the reason they did that is during the Second World War, when all the men had gone off to war, and the woman left their homes to go out into the marketplace to work, they took the skills that they had from her, and that was sewing, knitting, cooking, housekeeping and they created this profession called home economics.

Yael Joffe: When home economics wasn’t needed anymore and the men came back from war, they professionalized the home economics. And they also took it into a more scientific realm. So it was this home economics, so this is all for the why we are seeing 99.9% of dietitians are women is because of where it came from, which in my opinion is a great loss.

Yael Joffe: And the other thing is that they took something that was inheriting from housekeeping and they made it in to a science and a profession. And that’s why a couple of things go wrong on opposite spectrums almost. So the one is we started looking at dietetics to populations epidemiology. So we come up with this idea of dietary guidelines that there’s a percentage of protein or a percentage of carbohydrate that is just right for you.

Yael Joffe: So this was the kind of general sweeping recommendations. And then on the other side, the other thing that dietetics did is this concept of kind of reductionist nutritionism, which is that the only thing that counts is nutrients or macronutrients or even fatter nutrients.

Yael Joffe: And what we lost sight of is where food lives in the world, how food lives in our world, why we eat food, because most times the reason we eat food isn’t because of the micronutrient content. It’s social, it’s cultural, it’s ethnographic, it’s sociological, it’s environmental, and of course it’s genomic.

Yael Joffe: So if you don’t mind, James, I’m going to tell my story about how I was three weeks into my dietetics degree, but leaving that dietetics was going to give me a way to study health, and really impact people’s lives, where my lecturer recommended that we use chocolate cake and ice cream for a patient in hospital.

James Maskell: Yeah, it’s really interesting when I’ve met dieticians over time because there’s always like one story where they kind of lose faith in what’s going on. Like if they know anything going into it, and that is super excited about their profession. Typically, early on, just like you, there’s just one story where they’re like, hang on a minute. I know that’s definitely not true and we have to reassess what’s really happening.

Yael Joffe: Exactly. And that was exactly my experience. So just I thought it would take a little bit longer to these lose faith, but it took a whole three weeks. And when I was like, “Why would you do that?” Blood walls got protein and it’s got calcium and it’s got carbohydrate and it’s a fully balanced meals. So that was the end of me and dietetics.

Yael Joffe: But because I couldn’t find anything better than dietetics, I got through my degree. But with this constant sense of this, there’s something so fundamentally wrong with this profession. It has nothing to do with health. It has nothing to do with trying to heal people. And so I was always searching. I was always looking, I was like, what is there that comes off to dietetics.

James Maskell: Yeah. And I guess before we get into any conversation about genomics, I just want to ask you about there’s been this sort of like dietician, nutritionist wars, right? And one of the things that we always try to do at the Functional Forum, Meetups, as an example, is to say, look in our Meetups, there’s no hierarchy, right?

James Maskell: We want to make sure… because in medicine, the way that it’s been, there’s this crazy hierarchy and nutrition versus dietetics is one part of it, but then there’s the naturopathic doctors don’t like the dieticians. And then the conventional doctors don’t like the naturopathic doctors. And then the specialist don’t like the generalist and there’s just this crazy kind of stepladder.

James Maskell: And ultimately, what we wanted to create was community and in community, it’s about groups of practitioners working together to the highest level of their skills. But even with that, we started to have some like dieticians didn’t like the nutritionist showing up and those wars, can you just speak a little bit to that? Because obviously as someone coming into the industry who didn’t go through a professional education in any one of the disciplines, it was just so crazy to me that this had like evolved the way that it had.

Yael Joffe: Oh, you’re preaching to the converted. I’m probably going to make myself quite unpopular in this podcast, but I couldn’t agree more. And I think what’s happened with dietetics… and it’s not just started, but I’m a dietician so I’ll speak to it is that it’s become a politicized organization, and there’s one thing I learned.

Yael Joffe: So for the 20 years I’ve been working in genomics, I’ve worked with practitioners, and I’ve worked with a completely multidisciplinary engagement whether it’s a chiropractor or a naturopath or nurse practitioner, dietician nutritionist. And I learned something 10 years ago, more or less, which is that a healer has nothing to do with the undergraduate degree. What makes for a great healer is not their degree. It’s what they do when they’ve got their degree and they continue. So we have a lot of problems around homeopaths.

Yael Joffe: We can’t work with homeopaths. We even have a law in South Africa that says, “A dietician can share an office space with a homeopath because they’re not a real health practitioner.” That’s the insanity. And what I completely understand is that your ability to heal is based on who you are as a healer, and what you did after you’d got your degree, because the reality is there are no degrees that teach health. So except perhaps naturopathy, I have to say.

Yael Joffe: So what we do with ourselves when we finish our degree, what we go and study functional medicine, integrative medicine, lifestyle medicine, nutrogenomics, who we become as a healer in ourselves is what will truly determine how we affect this. So for me, I invite everyone into the room and in three explore, I invite everyone into the room. There is no hierarchy and it’s definitely not doctors because we know that there’s a lot of issues around that or dieticians. I think those are exactly the morph cycle that we want to break down.

James Maskell: Beautiful. Well, look let’s let’s jump into it now because I know that it can all seem a little bit depressing, but I think that this podcast is not depressing in nature. In fact, it’s very like uplifting as towards the potential that we’re all moving towards.

James Maskell: And one of the reasons why I wanted to have you on here is because ultimately, our theme for 2020 has been resilience, and our theme for 2021 is like really reinvention, reinvention of medicine, and medicine needs to be reinvented. And it’s being starkly shown with COVID just how sort of deep, wide and broad the reinvention has to be. And I’ve just always valued you as a thinker in that reinvention. And I know that’s what we want to talk about here today.

Yael Joffe: Brilliant. So for me, I actually think… and I totally agree with you about positivity that we truly are starting to understand what nutrition can be. And for years I’ve been talking about this idea of, if it’s not dietetics, what is it? And it’s nutrition as powerful as we talk it to be, and if so how and what does that look like?

Yael Joffe: Because it’s no use saying, well, dietetics didn’t deliver, but then does that mean nutrition doesn’t? And what’s so exciting for me is over the last 20 years of being in the genetic space, I’ve come to understand that there is more extraordinary power in nutrition than I believed 30 or whatever years ago when I started studying. So the dream is actually more powerful, more extraordinary than I ever imagined.

Yael Joffe: Obviously, we’re now on that journey and it’s part of education and mentorship and sharing and conversations with you. And I’m going to hopefully get a chance now to explain why I believe we finally getting to understand how nutrition is truly powerful as a medicine.

James Maskell: Let’s do it.

Yael Joffe: Let’s do it. Should we jump in? All right. So I spoke about this reductionist nutrient issue, which is like RDAs, everything’s about food labels and this population-based guidelines that everyone gets the same diet, everyone gets the same exercise recommendation, everyone sleeps the same amount, right? So how do we get away from those two extremes?

Yael Joffe: So in about 2,000, I started my journey in genomics, and it was really crawling before I could walk of a SNP, understanding what is a SNP. And for the next, I would say probably 10 years, I started learning how understanding genetic variation, genetic variability, remembering that we’re 99.9% the same, but that 0.1% where we’re different is everything.

Yael Joffe: And what that 0.1 does is it makes us understand who we are in the world, how we respond to our world, how we exist in our world. So everything from, we used to think it was only like, “Oh, can I drink coffee with caffeine or can I eat salt or can I eat gluten?” But actually it’s way more extraordinary than that.

Yael Joffe: It’s everything from, how do we manage stress, how resilient we are, you and I had a conversation about the genetics of resilience, how much of resilience is actually built into our DNA, and I mean, literally built into our blueprint. It’s about our potential on exercise. It’s about how we respond to people in our lives, connection. So every single element of health is built into that 0.1%. So for me, that was my first 10 years of my journey, which was about self knowledge.

Yael Joffe: If I understand more about myself, of what I’ve brought into the world, I can understand so much more about how I respond to my world. And then I can make really intelligent decisions to curate that environment for myself, to make the best possible decisions. And that may be optimal health. It might be recovering from a very, very chronic complicated disease. It might be weight or it might be sports. So it can be the same conversation in all the different room.

Yael Joffe: So that for me was really exciting because it got rid of this idea that there was a population guideline that all carbohydrates needed to be 50 to 60% or the opposite that we all needed to be on the low carb diet, like a 30% carb diet or keto diet. So that was the first part of my journey, James and I thought that was extraordinary, but that still didn’t give me the heart of imagining a new nutrition.

Yael Joffe: And I use the concept of a new nutrition science, because I really believe that that’s where the next decade is going to take us. Can I just carry on talking? [crosstalk 00:14:22].

James Maskell: Yeah, no, take us down. I guess I’m interested where these two things are meeting up. I’m wanting the genetic science and on the other side, the sort of like evolution of dietetics.

Yael Joffe: Okay, great. So I’m going to give you the second part of the equation. And the second part of the equation, I only started learning about in about gosh, about six, seven years ago. So even for me, it was a real away thing. Someone who was only thinking about snips and gene variants and variations. And what I came to understand was around what we call actually nutrigenomic.

Yael Joffe: So nutrigenetics is about steps, it’s DNA sequence changes, and then I discovered nutrigenomics. And nutrigenomic is all about gene expression because people would say to me, why must I do this genetic test? Surely it’s what my genes are actually doing that important, right? And this is when I came to understand the idea of nutrigenomics, people call it epigenetics, which is a tricky word. It’s got 100 meanings to it, but what it really means is how do my genes behave?

Yael Joffe: And we all know that our jeans are like this house full of switches, and our switches are switching on and off at all times. And the reason that those switches are switching on and off in genes is because of the environment that we expose our genes to. And that environment will be nutritional supplements, exercise, sport, pollutions, stress, trauma, emotional, or physical. And every time our body is exposed to one of these factors, it causes these genes to switch on and off.

Yael Joffe: And remember when genes switch on and off, they make a protein which makes an enzyme, which actually is the engine of our body, which drives. And the thing that really was my most exciting, awakening was nutrients. And I’m going to use the term nutrients broadly because it could be a macronutrient, could be a phytonutrient, could be a plant molecule can change the behavior of a gene.

Yael Joffe: So in the same way that a molecule of pollution or a toxin in our environment or something in the barbecued meats we’re eating can switch on a gene in a negative way causing something to happen in the body biochemically, we don’t want to happen. We can also use nutrition, meditation, exercise, cold water immersion to switch on and switch off genes that we want to switch on and switch off.

Yael Joffe: So suddenly, nutrition became a thousand times more expensive for me than it had ever been, okay? Now I’m going to put the two together because what is new nutrition? New nutrition is starting with self knowledge, who am I, how do I respond to the world around me, how do I respond to food, exercise, stress, et cetera. And if I know that about myself, I can then use nutrigenomics, nutrition and lifestyle to switch on and switch off genes that can change all my biochemical pathways and therefore impact my health in a significant way.

James Maskell: Yeah, I think the word significant is really important because I feel like even in the dietetics world, like you said, there’s just not this understanding of chronic disease reversal, maybe a little bit of prevention, but it’s on a long term timeframe, and certainly not turning around chronic illnesses. And I know that everyone in our community knows that as possible because they’re doing it in there clinics to one degree or another.

James Maskell: But ultimately what I feel like you’re saying is that the potential is in the new nutrition to really bring that down to a much more sophisticated and an accurate way of working where nutrition’s potential is unleashed

Yael Joffe: 100%, I love the way that niched because now we’re talking about something extremely powerful so I can give you an example. So at the moment, sulforaphane is like everyone’s best friends. Sulforaphane is a molecule that comes from a compound called glucoraphanin which you find in our cruciferous vegetables, broccoli, cauliflower, cabbage, kohlrabi, et cetera.

Yael Joffe: Now, why is it so popular? Why is there like a million podcasts happening at the moment talking about sulforaphane is because this plant molecule, we can call it a phytonutrient, a bioactive, a plant molecule has the ability to switch on genes and switch off genes. And there’s a couple of sides to it.

Yael Joffe: So it can switch on so many genes, so it can switch on our phase two detoxification genes. So when we know that we’re not clearing toxins from the body, we can use sulforaphane or glucoraphanin to switch on those genes, to help clear toxins from the body.

Yael Joffe: But one of the most exciting things sulforaphane done is it switches on a master switch. So I’m sure everyone listening to this knows about the master switch in RF2, which is a transcription factor. So you walk into your house, it’s a bit like having Alexas in your hand, and you say like, switch on all the switches and you switch on one switch, which switches on all the switches in your house and all the lights come on.

Yael Joffe: So an RF2 is so potent that if we switch it on, it switches on about 500 defense genes in our body, everything from detox and inflammation and oxidative stress, methylation, they all get switched on. Now what’s so extraordinary is just something as simple as cruciferous vegetables can switch on an RF2.

Yael Joffe: So when I started in dietetics, absolutely, we were going to have vegetables. And in fact, we weren’t going to have cauliflower and cabbage because it was white, remember when I studied dietetics, it was like, you need to have a million colors on the plate and if you were white, but of course, cauliflower and cabbage will contain this beautiful, beautiful molecule.

Yael Joffe: So now suddenly I’m using a vegetable in a very powerful unleashing, as you say, impactful way to switch on RF2, and sulforaphane is so powerful that it’s 80% bioavailable. So that makes it quite unique because there are lots of other great plant molecules. I’m going to, don’t want to go down the sulforaphane for not at all.

Yael Joffe: But what I wanted to talk about is the difference between everyone needs to eat five to eight portions of fruits and veggies a day. That’s the old school dietetics versus I can use a particular plant molecule in a vegetable to switch on RF2 and to switch on a myriad of other genes. And that’s when nutrition becomes medicine.

James Maskell: Yeah, absolutely. I think it’s such a critical, critical point. So, nutrition in that way is related to the two points that you said earlier, which is we have to understand it for our genetic variability and then we have to use it for our gene expression, right?

Yael Joffe: 100%, that’s it. That’s exactly it. And that isn’t the nutrition that’s being taught in universities right now.

James Maskell: All right. So ultimately, we’re getting into this year of reinvention and I know one of the things is… I know you’ve been passionate about this for a long time and if you guys want to go back, if you just Google James Maskell exposed, you will see Dr. Yael Joffe taking me through my genes. That was part of the Interpreting Your Genetics Summit.

James Maskell: I recognized even at that point, that was three years ago, almost four years ago now just how important genetic testing was going to be in the future of it. But I just don’t think it’s really living up to its potential. And certainly, in the professional channel, one of my big gripes with genetic testing and genetics generally is just that I don’t see a lot of people executing it in a way that is reasonable inside what is the practice of medicine today.

James Maskell: I mean, one of the things that’s always thrown off and one of the things that I see as a big problem with the delivery of functional integrative medicine already is that it’s super, super inefficient, right? Long appointments, long intakes with the most expensive provider.

James Maskell: And with genetic testing, I mean, I’ve sat in lectures and the people who are talking about genetics are very proud of the fact that they have like a four hour intake and you have to come down and sit there for four hours. And I’m like, “In what world is that useful?” Like, that is not useful. And it’s kind of embarrassing to the rest of medicine because the rest of medicine looks at this and goes, okay, but we’ve got like all these poor people here. It just thinks of elitism.

James Maskell: And ultimately, I hear what you’re saying, but we’re here to reinvent medicine. Ultimately, I want to know that genetics actually has a seat at the table with regard to being efficient enough to fulfill that potential and unleash that potential.

Yael Joffe: Great. So we’re going to deal with the next elephant in the room. So we’re going to take, we’re going to agree that there is value in understanding who we are and then switching on and switching off genes. Let’s put that aside for now. Let’s talk about what has genetics delivered. And I would completely agree with you that it has not in any way reached its potential. And in fact, I would go so far as to say, it’s been a huge disappointment even to me.

Yael Joffe: So in 2003, the human genome was mapped, and they published this drive, and everyone thought this is going to change the world. This is the single most important thing that’s happened in our century. And everything about health is going to change from here onwards. I was part of that journey and I was part of building genetic tests.

Yael Joffe: A couple of years ago, I sat down and I looked at what I built and what other companies had built. I had a really, really, really hard look at what I had produced in terms of genetic tests. And when I looked at the genetic test report that I produced in 2,000 with Sciona, the first Nutrigenomic company in the world.

Yael Joffe: And I looked at the genetic tests that I built in my last company in the early 2,000s, there was so little difference, James. We had more snips. The images were a little bit professional, Adobe worked a bit better, but I could not believe that in 15 years, genetics had not delivered any more value than what we were producing in 2,000. And I was horrified. I was horrified because I was part of that journey.

Yael Joffe: And in fact, what happened in the world is we got this huge excitement about genetics. We got 23 and Me, you sold like 10 million tests. Most 95% of which are ancestry. We’ve got ancestry.com selling another 15 million. But really, if we look at what impact we’ve had of bringing genetics into the healthcare system, it’s been extremely poor.

Yael Joffe: In November last year, we did a survey of practitioners at the American College of Nutrition Conference. And we asked them, “Do you work with genetics? Why don’t you work with it? What are your issues?” They don’t understand how to work with genetics. They don’t have the knowledge. They’Re not confident. But the thing that really broke me is that 78% did not trust genetic tests or genetic testing companies.

Yael Joffe: So it is my strong belief that we have broken the industRY, that we have completely under-delivered on what the dream of genetics could deliver because we acknowledge self knowledge, knowing who we are and being able to switch on genes is a huge part of health, And yet as companies in the marketplace, this is not what we’ve delivered.

Yael Joffe: And part of that reason, if I can just keep on ranting is that it has been science led. It has been led by people like me who built the genetic tests. And in doing it, we never got out of our own head, why? We were like, “We love snip. Snips are fabulous.” And we never thought for a minute, how does someone understand this information? What is the value to them? Is it meaningful? What are they going to do with it? When they wake up in the morning, how does it change their life?

Yael Joffe: And we didn’t ask the practitioners, how are you using this test? How do you explain it? And in fact, when we did ask them, they said it was taking them two to three hours to interpret a genetic test before they saw the patient, and another hour and a half to explain it to the patient. And in that entire time they were being paid for one hour. So what they’re seeing is that genetics have become a burden rather than transforming them into this new insight of health.

James Maskell: It’s like the worst parts of functional medicine just amplified basically. And that’s what I seen. Well, look, I’m excited here, ready to kick off in a certain way. Kickoff here at the beginning of December, 2020 to kick off 2021, really, and look at, okay, how do we fulfill this potential and how does genomics become a part of it?

James Maskell: And last year we were at a Jeff Bland’s conference, the PLMI Conference. And I was super, super excited to connect with you because I know that, one, you’ve been spending a lot of time thinking and working on this and also that there’s a solution now, which I’m super excited to do.

James Maskell: And also that, that solution is coming out of Cape town, where I grew up and my dad lives. And that there’s innovation that, that’s arriving so this is the moment. I mean, I’d love to just start with, I guess how three by four and this new iteration of your work is solving both of those big elephants that we’ve discussed.

Yael Joffe: So thanks. Yeah, that was so PLMIs actually had a huge impact on me, and the year before you and I met up in Seattle, and I showed you annual report, I had attended PLMI and I had a huge epiphany, which I just shared to you which is you cannot build a genetic test as a scientist because we’re not the ones using the test.

Yael Joffe: And I realized that as long as it was me driving product development, we would never have something that had value or meaning to the end user. So I decided to go back and try and figure out a solution to this. And I knew the solution had to be in finding a partner who would bring something to the table that could help me take what I knew in my head and make it into something meaningful for the end user.

Yael Joffe: And I met a company called Sea Monster. And Sea Monster is a gamification company. Sea Monster builds apps and games to drive people’s behavioral change. So they don’t build candy crush, but what they do is they use the concept of gamification to get people to change their behavior. So I went to them and said, “I have genetics, it’s really cool. It should change people’s behavior. It’s not changes people’s behavior, how do we do this differently?”

Yael Joffe: And I met Jason Haddock who went on to be our CEO, and my co-founder who said, who had experienced in VR and AR user experience and design thinking, all the things that I did not have. And he said, “How do we take this information, and how do we put it into a report in such a way that both the practitioner can use it easily, but end user, the patient can understand it, but most importantly, we can create a meaningful conversation between the patient and the practitioner.”

Yael Joffe: So that started the journey with Jason, and I have learned an extraordinary amount over the last three, four years working with him about this idea that we have to be customer-centric, user-centric. We have to think where do they create value? So that for me as a scientist has been very humbling of saying, you know what? Science is great, and it needs to be awesome and credible and defining, but it isn’t the experience of user. So that was the first real big learning James.

Yael Joffe: The second learning is you can’t fix an industry by building a test. So we went right back to basics. So in between my building tests, I was very disillusioned and I left the genetic test building world, and I focused on nutrigenomic education, and I built an online course called Manuka, which is I’ve got practitioners around the world studying it because I knew that if practitioners didn’t understand how to use genetics in their practice, you could build the best genetic tests in the world would have no value.

Yael Joffe: So I had already been in the education space for quite a few years, and I absolutely love nutrigenomic education. So Jason and I said, “What are the pillars that we need to change the industry?” Because we can’t change the industry, which is not a cowboy industry. There’s probably three to 400 genetic tests in the marketplace, a lot of them are cut and paste. Don’t get me started on that.

Yael Joffe: Anyway, so how do we fix the industry? Yes, we have to have the best test with the best science, the best user experience, but also we need to offer education to practitioners, which they’re not getting in their undergrad degree. And that doesn’t matter if you’re a doctor, dietician, nutritionist, chiropractor ND you’re not getting it.

Yael Joffe: The third thing is we need mentorship because studying something is not the same as practicing something. So how do I learn the theory, no matter how good that theory is. And when I start using it in my practice, how do I transition genetics into what I’m doing as a functional or integrative practitioner? So mentorship was that nurturing handholding.

Yael Joffe: And the last point is who’s my tribe, because I want to feel like I’m not alone. When we ask practitioners, they felt isolated, unsupported. And mostly they did not know to trust and they did not know where to go. So we built 3X4 based on not one pillar, which was genetic testing, but on the four pillars of education, mentorship, the test, which I’ll tell you a little bit about now and community

James Maskell: Beautiful. Yeah, it sounds right in line. I mean, ultimately, things like mentorship, peer to peer delivery of value, community, we recognize straight away with the Meetup groups that that was what really needed to happen in order for practitioners to come along, right? To do something that was on the edge of the emerging science and to go to that edge you need other people to validate that path for you and also to support you in that journey. So I’m super excited. So yeah, let’s get into it.

Yael Joffe: Yeah. Okay. So let’s ask the question, what did I do differently, or what did Jason and I do differently? Because this was very much this collaboration between his expertise and mine. So I keep on using this word epiphany, I’m probably overusing it, but there was a point where I realized that the way I had been building genetic tests for 15 years was wrong. And it’s quite a thing to acknowledge, but I was so wrong. And why was I wrong? Because all the genetic tests I had built were based on single snips.

Yael Joffe: So he has the MTHFR, he has a dietary recommendation, he has a supplement recommendation. He has APOE, he has a recommendation, and this is kind of sub-based treatment. So we see this all around us. And in fact, if you look at the genetic tests that you’re familiar with, I also see the question, are they giving dietary lifestyle or supplement recommendations based on a single SNP?

Yael Joffe: Because the reality is when you work in the world of nutrigenomics, we are not talking about genes that cause disease like BRCA and even BRCA doesn’t cause disease, right? These heavy monogenic, high penetrance streams, the genes that we’re dealing with are what we call load penetrance by themselves that have caused disease, but they have some impact on our biochemistry. So by themselves, we should not be offering recommendations or be at supplement or diet or lifestyle or exercise.

Yael Joffe: So what I did is I went back to basics, and this is entirely my functional medicine training, because what is functional medicine do? It teaches us to go upstream, root cause analysis, what is the dysfunction in the biochemistry that is causing the downstream? So if that works in functional medicine, it should be working in genetics.

Yael Joffe: So we were treating genetics in a completely different way and trying to use it in a functional medicine paradigm. So what I said is I’m going to go right upstream, right to the top of the dysfunction. And instead of looking at MTHFR, I’m going to look at all the genes that impact methylation, all the genes at inflammation and I’m going to build pathways.

Yael Joffe: Because in the genetic world, this idea of polygenic risk scores that you group a set of genes together and you can see whether they’re associated with diabetes or heart disease, or arthritis has been very well validated, but no one had thought, what if group genes to look at individual biochemical pathways upstream and not look at disease downstream?

Yael Joffe: So that is a fundamental base of our three explore report, which is we start upstream. We grouped snips. We don’t make any recommendation on a single SNP, but only on the pathway that the snips work in. So James, that was like a big, big change for us.

James Maskell: It probably makes it a lot easier to think through and to utilize because you’re dealing with like bigger categories because obviously one of the problems why in the genetic testing timeframe is that you have to go really detail into all these like thousands of data points.

Yael Joffe: Yeah. And that’s another thing. They shouldn’t be a thousand data points. So one of the things you always have to ask the company working with is how did you choose the SNP that you put into this test? Because what’s happened recently, and I say like the last 10 years is companies are marketing that is saying, I’ve got 500, I’ve got 1,000, I got 600,000 that they’ve made it out as though the more snips they have in their genetic tests, the better they have.

Yael Joffe: It’s like we only charge $300 and we’ve got 5,000 sets. But actually the reality is that what you really want is you want to find the snips that have good science, but also clinical utility that they make a difference. Because I always say, if the SNP would help you make a better clinical decision, it should not be in the test.

Yael Joffe: And so the question you should be asking, it’s not how many snips you have in your reports, but how did you choose them? And how do I know that they not only have science because there’s so much science out there at moment, but that make a difference to my clinical decision-making, to my medical nutrition care. So, that was a big part.

Yael Joffe: So we have built a methodology called Darwin that is based on science, how good is the science? And it gets a school. And how clinically useful is the SNP? Will it change my decision-making? Is there a way to measure it? Is there an intervention? Because if it doesn’t answer that, it should not be in a genetic a test.

Yael Joffe: And then to come back to your point that if you have pathways, and not even if it’s 200 snips, you cannot work out a recommendation for a patient on 200 snips. So we say the reason we called our company 3X4 is, if you look at pathways, choose the three pathways that are most been impacted by your genes as the starting point. It doesn’t mean don’t look at the others, and start upstream. So look for high impact authors and cellular in systems, and then go downstream.

Yael Joffe: And we made this really easy because what we did was we created a language of color because we know that patients and practitioners don’t want to talk science. They want to have a way to communicate with each other that is very easy. So we created this language of color and impact, and everything in the report has got color. So purple is always impactful. And we always say, just follow the purple, you will find the answer.

Yael Joffe: And the other thing we did was we built infographics because when I was… I was at a clinic for five years, only seeing nutrigenomic patients, and every time I had a patient, I used to draw them a picture. This is what detox looks like. This is what methylation looks like. This is what blood protein looks like. It’s like, if we’re doing this for every patient, why don’t we create a visual conversation? Why don’t we create images that speak directly to the patient?

Yael Joffe: So in our report, every image for these cellular pathways changes according to the patient’s results. So that now I have something to such as my patient and say, look at this picture, do you see you’ve got some purple there. Can you see the DNR unraveling? Can you see the toxins? And suddenly I have a visual conversation that changes how we talk with our patients around genetics.

James Maskell: All right. And three by four, 3X4 genetics, that’s how it’s written. It sounds like a weird name until you understood what it is. So can you just explain, like why it’s called that and what the test look like and what the promise of the test is?

Yael Joffe: Okay. So the 3X4 is when we teach them, we have an onboarding education, which teaches we always want for our patient, we want to decrease the amount of time you’re spending interpreting the test before you see your patient. And we want to decrease the amount of time you spend with your patients.

Yael Joffe: So the framework we teach is, what are the three most important pathways that your genetic test is telling you are most impacted for your patient? What are the three most important dietary recommendations that you should start with with your patient? What are the three most important lifestyle recommendations and what are the three most important supplements?

Yael Joffe: And that’s how we get 3X4 three times four it’s because it, you should be able to come up with the one-page summary of 3X4. And in fact, in our new report, which we launched on the 29th of September, we’ve actually created the summary for you. So you don’t have to figure out the top three pathways. We’re telling you, these three pathways came up as being the most impacted.

Yael Joffe: These are the three most important diet recommendations to consider. Remember, you’re the practitioner, not me. So you’re going to see our guidelines and you’re going to say that really resonates knowing my patient, and we’ve captured it for you. So we’ve created the report that if you only want to use the first five pages, you actually have your summary of what to do. If you want to talk about color and image and visual conversation you carry on.

Yael Joffe: And right at the back of the report, we’ve got more science and snips, which those practitioners who are deeply immersed in genetics can do. So our value is really in translation. We do not regard ourselves as a genetic testing company. We are a translation company and that is education, mentorship, community for practitioner, and then user experience of the individual.

Yael Joffe: I can see a picture. I can see a color. I can understand pathways because it’s something that makes sense to me, as opposed to MTHFR or APOE, which is not scientifically valid way of giving genetic results and also decreases my time. So it should take you five to 10 minutes to evaluate the report that you got from your patient. And you’ve got 30 to 40 minutes to explain it to your patient and you done.

James Maskell: I love that. So look, I mean, I guess I just want to finish off this podcast by saying that my goal with 2021 is that this community of practitioners that follows the Evolution of Medicine will be at the forefront of the re-invention of healthcare. I mean, that’s the vision here.

James Maskell: And I guess one of the things that we want to do is to be able to give our practitioners… for me, we were never going to really recommend or have this kind of conversation with a genetic test until it was easy for practitioners to do. It was easy for patients to understand, and it could be done in a reasonable timeframe. And ultimately, what you have here with 3X4 is all of that. And that was like a year ago, I knew. And the last year I’ve had a chance to do the test myself and start to see it.

James Maskell: And ultimately, what we want to do here today is to introduce you to this community, because ultimately, another big focus of this reinvention in 2021 is community. We’re going to be bringing back the meetup groups in a really, really strong way, but ultimately, we want to introduce you to this community.

James Maskell: I spoke to you, Yael in the last few months I said, “Look, what is the best way for practitioners at the minimum possible cost and effort to just be engaged into your community so you can meet the practitioners that are using this test every day. You can start to feel comfortable, making this test, getting these pathway diet, lifestyle, supplement recommendations, and then translating it into your clinical practice and doing it in a way that is hyper-efficient.

James Maskell: And so, let’s talk a little bit about what practitioners can do if they’re interested in and what we’re going to do to help this community of practitioners get on board.

Yael Joffe: So there’s a couple of different ways to come into our company. So the first obviously is through education. We have a three hour educational opportunity. We have a foundations course which is a longer one. If you want to have a little bit more depth, there’s about one standing from education, we transition you into mentorship. We also love practitioners to do their own report because nothing is experienced in the way it’s experienced when you do your own.

Yael Joffe: And then, we offer a mentorship opportunity where our mentor does your feedback takes you through your report, gives you the full experience, and you also get to understand how pathways and imagery and color actually work for you. So there’s a couple of ways to come in to 3X4, and we’re there for you.

James Maskell: Wonderful. Okay. So everyone, if you go to goevomed.com/3×4, that’s goevomed.com/3×4, and you go there, you’ll see the details of the courses. Some of you, I know probably just need to understand how this course works as the short three hour course for that, if you want a longer primer in nutrigenomics, we’re making that available to our community as well, so that you can start and go into 2021 with everything that you need to know to start to bring this into your practice.

James Maskell: If you want to go through the process of getting tested, mentorship and having someone go through the test with you who’s actually using that test in clinical practice and understands how to use it. Those are the ways that we are helping you to do that. What a great time, while you’re sitting at home in this next lockdown to really get your skills up and running so that you can be able to unleash the power of genetic testing into the marketplace in your clinic.

James Maskell: I’m really excited about this. It’s already got me thinking about ways that we might be able to do genetic testing groups. I’m thinking of just some of the innovation that we’ve seen with functional medicine groups and having patients go through a process of understanding their health in a group format more to come on that as we reinvent healthcare in 2021.

James Maskell: Doctor, thank you so much. I guess, first of all, in the last three years, just thank you for coming back and sharing. I think we’re really on the same page with it. And I do agree that going outside, going to different disciplines and meeting other people from different walks of life is how this industry becomes the standard of care. And having met Jason and just understood a little bit of his background, I do think that it does take people from outside the industry to come in to really unleash the potential of what we’ve got.

James Maskell: So I’m excited for a South African company to be making headway. I’m excited to see what happens in the expansion in America in the next decade and fully, fully supportive of the mission and vision. So thank you for all of your hard work to get us here. Thank you everyone for listening. We’re counting on you to reinvent medicine in 2021. This is just a flavor of what we’re going to be bringing you in 2021 as we transition to that theme, we’ve really needed resilience this year.

James Maskell: But ultimately it’s one thing to survive, it’s another thing to take us to the next era of thriving. Couldn’t be more excited to go on this journey with you over the next year. I’m your host, James Maskell. This is the Evolution of Medicine podcast. We’ve been here with 3X4 genetics co-founder, Dr. Yael Joffe. Thanks so much for listening and we’ll see you now.

James Maskell: Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.


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