New York City Precision Medicine
What is Precision Medicine?
It’s all about preventing and treating disease by considering the variants in genetics, lifestyle and environment for each individual person. A precision medicine approach allows practitioners to better determine which treatment and prevention strategies will be most effective for particular people, rather than developing strategies for the “average” person without considering the wide range of differences that exists between individuals.
Personalized or precision medicine is a healthcare model that customizes treatment to the needs of each patient. By combining data from diagnostic tests with an individual’s medical history, circumstances and values, health care providers can develop targeted treatment and prevention plans with their patients.
Traditional medicine often relies on a standard of care that is geared toward an entire patient population. For example, patients with the same symptoms may be prescribed a standard antibiotic used to eradicate a suspected infection. Personalized medicine is not a one-size-fits-all treatment paradigm. It is precision medicine at its best and is the future of all medicine.
The Precision Medicine Initiative
In 2015, President Obama launched the Precision Medicine Initiative, a long term research endeavor by the National Institutes of Health (NIH) and many other research centers, with a goal of understanding the way that an individual’s genetics, environment and lifestyle can help practitioners decide on the best approach for treating and preventing disease.
The mission of the initiative is “To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care.”
Dr. Zilberstein offers patients interpretation of the information received from the tests below in order to determine the root cause of a patient’s condition. The interpretation of these tests and recommendations are not covered by insurance. The fee is $500/hr.
Urinary measurements of sex hormones allow a great incite into the levels of the hormones in the body.
These measurements are particularly useful for women taking hormonal replacement therapy. Another advantage of sex hormone testing is to determine and redirect a woman’s menstrual cycle to learn if she is ovulating, when she is ovulating and the amount of estrogen and progesterone produced in each phase of the menstrual cycle. This information is important not only for women who are interested in childbearing but also in feeling her best during the cycle.
All sex hormones undergo degradation and form different metabolites. It is important to evaluate estrogen metabolites. We know that estrogen can be converted to good (2OH estrone) metabolite and a “bad” (4OH estrone) metabolite which plays a key role in the predisposition of estrogen related cancers. Some progesterone metabolites are more important in sleep relating issues which start affecting women in perimenopausal age.
Certain testosterone metabolites contribute to adverse testosterone effects (like increased body hair and decreased head hair. It is possible to redirect sex hormone metabolism with some medication and nutritional supplement. Another advantage of the DUTCH test is evaluation of a person’s cortisol or stress. This information can be used to change stress levels with lifestyle, nutritional supplements and diet modifications.
DUTCH test also provides an insight into a person’s stress levels by measuring total production of cortisol and diurnal patterns of cortisol. Dr. Zilberstein designs treatment programs to help patients to optimize their ability to deal with the stresses of their daily lives.
Most health issues arise from dysbiosis or disbalance of our intestinal flora. For example, if one carries H.Pylori bacteria which can occur from bad diet, use of certain medications such as anti-acid medications or Non-steroidal anti-inflammatory) we do not digest our proteins properly and therefore don’t form proteins necessary for out proper body functions such as insulin, dopamine, etc.
Dysbiosis contributes to a condition called intestinal permeability (or leaky gut) which is in the basis of many inflammatory states in our bodies. One does not have to have intestinal symptoms to have dysbiosis. Therefore, it is a crucial test for an evaluation of a person’s well-being.
ORGANIC ACID TESTING
Metabolomics tests, such as the OMX® test or Nutraeval, help to identify a patient’s metabolic signature by providing a systems-biology perspective of key metabolic pathways. Those include antioxidant vitatmins (A,E, C) and substances (coQ10, Glutahione); content of omega 3 fatty acids; All B vitamins; neurotransmitters, etc. A metabolomics test is often used to identify a healthy patient’s baseline metabolomic profile, which can be included in yearly health evaluations. Metabolomic evaluation can also be helpful in patients with chronic health conditions because it gives us information about patient’s underlying biochemical pathways, including:
- Glucose metabolism and ketones
- Mitochondrial markers
- Fatty acid metabolism
- Neurotransmitter metabolites
- Amino acid metabolism
- Inflammatory markers
- Collagen breakdown
- B vitamins
- Dietary indicators
- Oxidative stress
- Kidney health