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Translating Advanced Science into Personalized
             Health and Wellness
               Paula J Nenn MD
            Senior Medical Director
Who? What? Why?
    • 501c3 Non-profit research foundation

    • Formed 2 ½ years ago, San Diego based

    • Self-care and personal health accountability key to US
       economics

    • New science – 800 articles per DAY!

    • Public Interest in all things ‘alternative’

    • New science – personalized medicine, genomics, systems
       biology, early predictive biomarkers

    • Personal health tracking devices

    • Bring it all together into one program?
                                                        Optimal               Health
2                                                        AND PREVENTION RESEARCH FOUNDATION
‘New’ science
                     preventive / predictive                   conventional diagnostics
                    functional assessments

                EARLIEST SUB-CLINICAL IMBALANCE                    clinical diagnostic
                  AND RISK FACTOR BIOMARKERS                      threshold of disease


                                              DYNAMIC CONTINUUM


      optimal               sub-optimal                     pre-                                 chronic




                                                                              EARLY DETECTION
      health                  health                      disease                                disease
                                                                                                      CHRONIC DISEASES
                                                                                                     NEVER JUST HAPPEN
                                                                                                    TO YOU, THEY ARE THE
                                                                                                       END RESULT OF A
                                                                                                     LONG, PROGRESSIVE
                                                                                                          DECLINE.
                     Hyperinsulinemia
                                     Insulin resistance

                                               Cardiometabolic
                     American Diet




                                                  Syndrome
                       Standard




                                                             Pre-Diabetes
                                                                             Diabetes
                                                                                                Diabetes Complications
                                                                                                  - Leg Amputations
                                                                                                  - Blindness
                                                                                                  - Kidney & Heart Disease
                                                                                                  - Erectile Dysfunction, …

                                                                                                    Optimal              Health
3                                                                                                   AND PREVENTION RESEARCH FOUNDATION
Tree of Health and Disease
                                   PULMONOLOGY     CARDIOLOGY


                              ENDOCRINOLOGY          IMMUNOLOGY


                              GASTROENTEROLOGY       NEUROLOGY

                               PSYCHIATRY             ONCOLOGY



                                                           PRE-DISEASE
                            Clinical Diagnostics
                                                          Functional Imbalances
                       Genetic Predispositions            Systemic Inflammation
                            ( gate-keepers )
                                                          Oxidative Stress
               Functional Assessment Biomarkers             SUB-OPTIMAL HEALTH

                                                                        SPIRITUAL &
       MACRO & MICRO                                                  SOCIAL BALANCE
         NUTRITION
                                          SLEEP,                      EMOTIONAL & MENTAL
                                    CIRCADIAN RHYTHMS                    BALANCE AND
     PHYSICAL ACTIVITY &
                                      & RESTORATION   ‘ENERGY SYSTEM’
    STRUCTURAL BALANCE                                                 STRESS RESILIENCE
                                                          BALANCE
                     MICRO ENVIRONMENTAL
                         PROTECTION                                        Optimal     Health
4                                                                         AND PREVENTION RESEARCH FOUNDATION
Optimal Health and Prevention Program
                                                                               1    Comprehensive Predictive,
               OHP                                                                    Preventive Functional
             Program                                                                 Biomarker Assessment
           Optimal Health                                                                      OHP Dx
               GPS
                                                                                       Translational Algorithm &
                                                                                   2     Artificial Intelligence
                1
                                                                               3Personalized, Integrative Self-
                                                                                     care Recommendations
                3
                                                                                               OHP Rx




                                                     Genetic Predispositions
                                                                               4       Ongoing Educational,
                                                        ( gate-keepers )           Optimal Health Coaching and
                             Functional Assessment
                                  Biomarkers                                       Progress Monitoring Support
                                 roots & trunk


                                                                                 SPIRITUAL &
        MACRO & MICRO                                                          SOCIAL BALANCE
          NUTRITION,
          AIR, WATER
                                            SLEEP,
                                      CIRCADIAN RHYTHMS
     PHYSICAL ACTIVITY &                                                           EMOTIONAL & MENTAL
                                        & RESTORATION
    STRUCTURAL BALANCE                                    ‘ENERGY SYSTEM’             BALANCE AND
                     MICRO ENVIRONMENTAL                      BALANCE               STRESS RESILIENCE
                         PROTECTION                                                  Optimal     Health
5                                                                                    AND PREVENTION RESEARCH FOUNDATION
Demonstration Project
     • 100 subjects chosen from volunteers
     • Age, gender, ethnicity matched
     • Each acts as their own control
     • Start Spring 2011
     • In collaboration with Scripps Center for Integrative
       Medicine
     • Age ≥ 18
     • Exclusion criteria: acute illness, pregnancy
     • Current chronic illness not an exclusion criterion but must
       be stable
     • Consent from primary physician
                                                      Optimal              Health
6                                                     AND PREVENTION RESEARCH FOUNDATION
Week 1
               Registration,
                 EHR &
              Questionnaires
         10                    2




     9                             3




     8                             4




         7                     5
                                   Optimal                  Health
                    6                  AND PREVENTION RESEARCH FOUNDATION
Week 1: Blood and Urine tests
               Urine & Blood Tests
                        &
                 questionnaires

          10                         2




      9                                  3




      8                                  4




          7                          5

                                         Optimal                  Health
                       6                     AND PREVENTION RESEARCH FOUNDATION
Week 2 - Genetics
              1
                         SNPs
                    (Genomic Saliva
         10
                        Panel)
                    & questionnaires




     9                                 3




     8                                 4




         7                 5

              6                        Optimal                  Health
                                           AND PREVENTION RESEARCH FOUNDATION
Week 3 – Autonomic Nervous System
                1

          10         2




                            24-hr ABPM
                            24-hr Holter
      9
                      Saliva Cortisol + DHEA
                         & questionnaires




      8                         4




          7          5

                6                Optimal                 Health
                                    AND PREVENTION RESEARCH FOUNDATION
Week 4 - sleep
                 1

          10         2




      9                         3




                         Sleep Assessment
      8                   EEG + Oximetry
                          & questionnaires




          7          5

                 6                  Optimal              Health
                                    AND PREVENTION RESEARCH FOUNDATION
Week 5 & 6: Caloric Balance, Sleep Actiography
                      1

             10                   2




        9                                      3




        8                                      4




                           Physical Activity
              7
                           Food Diary, FFQ

                      6                        Optimal                  Health
                                                   AND PREVENTION RESEARCH FOUNDATION
Week 7: Non-Invasive Physical Tests
                            1

                 10             2




       9                            3




       8                            4




           Physical Tests       5
              (Onsite)
                            6       Optimal                  Health
                                        AND PREVENTION RESEARCH FOUNDATION
Week 8: MD and coach
                      1

                 10            2




        9                          3
                          START…



   Integrative                     4
   MD Consult




                 7             5

                      6            Optimal              Health
                                   AND PREVENTION RESEARCH FOUNDATION
Week 8: Start Program
     • Personalized Interventions
       •   Nutritional recommendations
       •   Physical activity
       •   Breathing
       •   Sleep
       •   Environmental toxicity
       •   Stress
       •   Energy medicine
       •   Spirituality / connections / gratitude
                                          Optimal              Health
15                                        AND PREVENTION RESEARCH FOUNDATION
Week 26
                            1

                  10             2




   Interim Data                      3
     Analysis

                       Week 12

        8                            4




                  7              5

                            6        Optimal                  Health
                                         AND PREVENTION RESEARCH FOUNDATION
Week 52: Program Finish
                        1

         Final Data          2
          Analysis



     9                           3




     8                           4




                      2012
             7               5

                        6        Optimal                  Health
                                     AND PREVENTION RESEARCH FOUNDATION
Biomonitoring
• Assessment Phase
     • 24 hour HRV
     • 24 hour AMBP
     • 2/52 Body Media – calorie balance, sleep
       actiography
     • 3 day Apnea link sleep apnea screening
     • Zeo Sleep Monitor 7/7
     • Text and IVR food diary
• Intervention
     •   Body Media
     •   Zeo
     •   Emotional sampling
18
     •   Biofeedback devices: meditation, HRV etc O p t i m a l              Health
                                                        AND PREVENTION RESEARCH FOUNDATION
Questions?
     Paula.Nenn@OptimalHealth.org



19

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Paula Nenn - Quantified Self San Diego

  • 1. Translating Advanced Science into Personalized Health and Wellness Paula J Nenn MD Senior Medical Director
  • 2. Who? What? Why? • 501c3 Non-profit research foundation • Formed 2 ½ years ago, San Diego based • Self-care and personal health accountability key to US economics • New science – 800 articles per DAY! • Public Interest in all things ‘alternative’ • New science – personalized medicine, genomics, systems biology, early predictive biomarkers • Personal health tracking devices • Bring it all together into one program? Optimal Health 2 AND PREVENTION RESEARCH FOUNDATION
  • 3. ‘New’ science preventive / predictive conventional diagnostics functional assessments EARLIEST SUB-CLINICAL IMBALANCE clinical diagnostic AND RISK FACTOR BIOMARKERS threshold of disease DYNAMIC CONTINUUM optimal sub-optimal pre- chronic EARLY DETECTION health health disease disease CHRONIC DISEASES NEVER JUST HAPPEN TO YOU, THEY ARE THE END RESULT OF A LONG, PROGRESSIVE DECLINE. Hyperinsulinemia Insulin resistance Cardiometabolic American Diet Syndrome Standard Pre-Diabetes Diabetes Diabetes Complications - Leg Amputations - Blindness - Kidney & Heart Disease - Erectile Dysfunction, … Optimal Health 3 AND PREVENTION RESEARCH FOUNDATION
  • 4. Tree of Health and Disease PULMONOLOGY CARDIOLOGY ENDOCRINOLOGY IMMUNOLOGY GASTROENTEROLOGY NEUROLOGY PSYCHIATRY ONCOLOGY PRE-DISEASE Clinical Diagnostics Functional Imbalances Genetic Predispositions Systemic Inflammation ( gate-keepers ) Oxidative Stress Functional Assessment Biomarkers SUB-OPTIMAL HEALTH SPIRITUAL & MACRO & MICRO SOCIAL BALANCE NUTRITION SLEEP, EMOTIONAL & MENTAL CIRCADIAN RHYTHMS BALANCE AND PHYSICAL ACTIVITY & & RESTORATION ‘ENERGY SYSTEM’ STRUCTURAL BALANCE STRESS RESILIENCE BALANCE MICRO ENVIRONMENTAL PROTECTION Optimal Health 4 AND PREVENTION RESEARCH FOUNDATION
  • 5. Optimal Health and Prevention Program 1 Comprehensive Predictive, OHP Preventive Functional Program Biomarker Assessment Optimal Health OHP Dx GPS Translational Algorithm & 2 Artificial Intelligence 1 3Personalized, Integrative Self- care Recommendations 3 OHP Rx Genetic Predispositions 4 Ongoing Educational, ( gate-keepers ) Optimal Health Coaching and Functional Assessment Biomarkers Progress Monitoring Support roots & trunk SPIRITUAL & MACRO & MICRO SOCIAL BALANCE NUTRITION, AIR, WATER SLEEP, CIRCADIAN RHYTHMS PHYSICAL ACTIVITY & EMOTIONAL & MENTAL & RESTORATION STRUCTURAL BALANCE ‘ENERGY SYSTEM’ BALANCE AND MICRO ENVIRONMENTAL BALANCE STRESS RESILIENCE PROTECTION Optimal Health 5 AND PREVENTION RESEARCH FOUNDATION
  • 6. Demonstration Project • 100 subjects chosen from volunteers • Age, gender, ethnicity matched • Each acts as their own control • Start Spring 2011 • In collaboration with Scripps Center for Integrative Medicine • Age ≥ 18 • Exclusion criteria: acute illness, pregnancy • Current chronic illness not an exclusion criterion but must be stable • Consent from primary physician Optimal Health 6 AND PREVENTION RESEARCH FOUNDATION
  • 7. Week 1 Registration, EHR & Questionnaires 10 2 9 3 8 4 7 5 Optimal Health 6 AND PREVENTION RESEARCH FOUNDATION
  • 8. Week 1: Blood and Urine tests Urine & Blood Tests & questionnaires 10 2 9 3 8 4 7 5 Optimal Health 6 AND PREVENTION RESEARCH FOUNDATION
  • 9. Week 2 - Genetics 1 SNPs (Genomic Saliva 10 Panel) & questionnaires 9 3 8 4 7 5 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 10. Week 3 – Autonomic Nervous System 1 10 2 24-hr ABPM 24-hr Holter 9 Saliva Cortisol + DHEA & questionnaires 8 4 7 5 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 11. Week 4 - sleep 1 10 2 9 3 Sleep Assessment 8 EEG + Oximetry & questionnaires 7 5 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 12. Week 5 & 6: Caloric Balance, Sleep Actiography 1 10 2 9 3 8 4 Physical Activity 7 Food Diary, FFQ 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 13. Week 7: Non-Invasive Physical Tests 1 10 2 9 3 8 4 Physical Tests 5 (Onsite) 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 14. Week 8: MD and coach 1 10 2 9 3 START… Integrative 4 MD Consult 7 5 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 15. Week 8: Start Program • Personalized Interventions • Nutritional recommendations • Physical activity • Breathing • Sleep • Environmental toxicity • Stress • Energy medicine • Spirituality / connections / gratitude Optimal Health 15 AND PREVENTION RESEARCH FOUNDATION
  • 16. Week 26 1 10 2 Interim Data 3 Analysis Week 12 8 4 7 5 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 17. Week 52: Program Finish 1 Final Data 2 Analysis 9 3 8 4 2012 7 5 6 Optimal Health AND PREVENTION RESEARCH FOUNDATION
  • 18. Biomonitoring • Assessment Phase • 24 hour HRV • 24 hour AMBP • 2/52 Body Media – calorie balance, sleep actiography • 3 day Apnea link sleep apnea screening • Zeo Sleep Monitor 7/7 • Text and IVR food diary • Intervention • Body Media • Zeo • Emotional sampling 18 • Biofeedback devices: meditation, HRV etc O p t i m a l Health AND PREVENTION RESEARCH FOUNDATION
  • 19. Questions? Paula.Nenn@OptimalHealth.org 19