Cancer Nutrigenomics Q&A: Personalized Nutrition Based on Your Genes

Written by Melissa Schenkman, MPH, MSJ

An interview with Natalie Samson, MS, CGC, INHC, board-certified genetic counselor and founder of Golden Genetics.

What initially drew you to the field of genetics and genetic counseling?

Natalie: I didn't actually know genetic counseling existed until later in my undergraduate degree, which is not uncommon since it's such a niche field. I had always been obsessed with understanding the human body and going into the micro scale. I loved cellular biology, but when I took genetics, I realized genetics is even more micro than cellular, and it was blowing my mind.

I was pre-med and wanted to work with patients, but I didn't necessarily want to go to medical school. Working in a lab wouldn't bring me closer to patients either. Then someone introduced me to genetic counseling, which combines being with patients and the counseling component while discussing the science of genetics. I thought, "Oh my God, this is exactly what I want to do."

For those unfamiliar with genetic testing, what is a genetic counselor and what can they do?

Genetic counselors have a master's degree in both genetics and counseling. We have extensive training in psychology, which surprises many people, along with understanding genetics to its core. The psychology training is crucial because genetic testing information is not only complex but can also be emotionally charged.

We're trained in different specialties, ranging from prenatal to preconception to pediatrics to adult care. Sometimes we're giving diagnoses, and this information can be heavy, especially when delivered poorly. Our training allows us to counsel patients with psychology while understanding them from a human perspective. Most importantly, genetic counselors typically have an hour with patients, which gives us time to be with them throughout the conversation and help them understand how to share information with their families.

When would someone work with a genetic counselor as opposed to their physician?

It's really about collaboration, not replacement. We work alongside providers, offering genetics expertise and counseling, then ensuring providers have the information they need for clinical management. Genetics is so complex and evolves daily - it's almost impossible for physicians to keep up with every gene identified, all the different tests, and insurance considerations.

Our job is to handle the genetics piece, cover that for the patient and family, then work with the provider as a bridge. We don't expect patients to play telephone, trying to communicate complex genetics information to their doctor.

What are the main reasons people under 50 first learn about genetic testing?

A few years ago, people were typically introduced to genetic testing during preconception or prenatal care, like when pregnant women are offered what providers call "the gender test" Non-Invasive Prenatal Testing (NIPT), which actually checks for chromosome abnormalities like Down syndrome.

Now, the landscape has changed dramatically. Many people learn about genetic testing through social media, Instagram, or direct-to-consumer companies like Ancestry tests. This is challenging because not all genetic tests are created equal. Many direct-to-consumer tests aren't of the best quality, and some companies have turned this into a business without proper expertise.

We often see patients with results that don't make sense for their health, requiring retesting. The best approach is to work with someone who specializes in genetics, like a genetic counselor.

What does the genetic screening process typically involve?

It's simpler than people think. We can now use saliva or cheek swab samples for accurate DNA results. There's a misconception that saliva isn't as accurate, but there are labs that can accurately sequence DNA from saliva samples.

We always start with personal and family history because there are so many specialties, indications, and genes to consider. For example, someone might come for preconception carrier screening, but during family history review, we might discover an extensive cancer history that warrants adding cancer genetic testing.

Once we select appropriate tests and receive results, we interpret and review them in a session, then develop an action plan. Rather than leaving patients with just lab results and risk information, we prioritize empowering them with clear next steps.

Natalie discussing genetic testing options with a patient.

What does an integrative approach to genetic screening look like?

Integrative medicine combines the best of Western conventional medicine - like screenings, surgeries, and pharmaceuticals - with the best holistic practices, looking at patients through a whole-person care model. These pieces don't exist in isolation.

For example, when discussing cancer risk, we talk about screenings, but we also know the importance of nutrition, lifestyle, and stress management. We're not replacing conventional medicine but adding to it to support patients better.

In my previous work in oncology and neurology, I was giving risk information to people without diagnoses whose family members had conditions like dementia or Alzheimer's. I realized we weren't addressing all the other crucial health aspects. My integrative approach shifts the lens from fear to empowerment.

How is nutrigenomics used to tailor diets based on genetic predispositions?

Nutrigenomics is the study of how genes and nutrition interact. It's different from medical genetics because we look at genes working together using a systems biology approach, rather than genes in isolation.

For example, we test HLA genes that dictate how our immune system responds to gluten antibodies. This helps people understand their likelihood of immune reactions to gluten without needing an endoscopy. If you test negative for these genes, you actually rule out celiac disease.

Another example is the ApoE gene, which manages cholesterol transport. Some people have versions that lead to very low cholesterol and LDL, which is protective against heart disease and Alzheimer's. Others have a higher risk of high LDL and related health issues. This information helps personalize diet recommendations - someone with high LDL risk might not benefit from a high saturated fat diet, while someone with low cholesterol risk might actually benefit from it.

How can we distinguish between real science and hype in the biohacking field?

This is tricky even for providers because there's so much information and research constantly emerging. I recommend connecting with trusted, credentialed providers and developing communities where we can discuss research together.

For people without science backgrounds, the most important thing is to listen to your body. If you try something extreme that makes you feel terrible, it's probably not good for you. These trends might work well based on your genes and life factors, but they can also be detrimental.

Always look for trusted credentials, develop a community with knowledgeable people, and trust your body's intuition. I often hear patients say they tried something like keto because it's supposed to be cancer preventive, but they feel terrible. My response is simple: don't do it then.

At what ages should we pursue genetic screening for colorectal and breast cancer?

Ideally, we want genetic testing before anything comes up. The power lies in being proactive. If there's family history of colon or breast cancer, I'd recommend genetic testing in your 20s or 30s.

Some gene mutations like Lynch syndrome and BRCA can increase risk for early-onset cancers under 50, even in the 30s. I've seen cancer in patients in their late 20s. Starting early means your insurance should cover increased screening - like mammograms around age 30 or earlier colonoscopies.

Early detection is crucial. Cancer caught at stage zero or one usually means surgical removal instead of chemotherapy or radiation. If caught too late, sometimes even those options aren't available. Early detection can turn cancer into just a blip that's taken care of, versus extensive treatment.

How can genetic testing results inform our dietary choices for cancer prevention?

This is one of my favorite aspects because when we combine medical genetics with nutrigenomics, it's fascinating and empowering for patients. We look at different pathways in the body like inflammation, oxidative stress, detoxification, and methylation.

When these pathways are in dysbiosis, they won't support a cancer-free environment. For example, if someone has variants making them more likely to respond to inflammation, we focus on an anti-inflammatory diet and environment. If someone has issues with phase two detoxification - meaning trouble removing toxins - we might recommend cruciferous vegetables and sulforaphane to support that pathway.

We also examine hormonal pathways and glucose/insulin pathways. If someone is predisposed to diabetes, we ensure each meal has protein and fiber to stabilize blood sugar. We often collaborate with dietitians to approach this comprehensively.

How should we talk about genetic screening with healthcare providers and friends?

Genetic screening gives us a head start and allows us to shift from reactive to proactive care. Just normalizing these conversations about genetics and genetic testing with friends and bringing this up to providers is important.

Genetic counselors might be more accessible than you think. Ask your primary care physician if there are genetic counselors in your healthcare system - sometimes there are and you didn't know.

When you meet with a genetic counselor, it's never about pressuring you to test, but it's helpful to discuss the benefits and limitations. Cancer genetic testing is a powerful tool for prevention, being proactive, and personalization, giving you all three amazing things in healthcare.

If we normalize these conversations more, it becomes more accessible not only for us but for future generations, too.

Want to hear more from Natalie? Check out the YMyHealth podcast!