Monday, January 24, 2011

Index to the First 25 Blogs:

# 1 Nausea 911 – The case of the woman who woke up nauseous

# 2 A Bear by any other name - Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep

# 3 PANDAS continued

#4 Looking for Mr. Rightcheese - Cheese substitutes for the dairy free

#5 Me and The GI Guy – The case of the sick apartment

#6 The Secret Life of A Nutritionist

#7 Two Salads to Go: Hold the Receipts – Hidden toxins

#8 And You Thought Your Teenager Was Tough

#9 Me and The GI Guy continued (Blog #5 Follow-up)

#10 I Want To Thank Jim Carrey - The story of how I got to write a book

#11 The Subtle Bouquet of Pear Juice - How to write a food endorsement

#12 How To Have a Difficult Conversation

#13 Vitamin M- The relationship between movement and learning

#14 Coming to a Store Near You- New products from the health food expo

#15 One Afternoon at the Conference- What you need to know about infections

#16 Vitamin M Continued

#17 The Most Hysterical Time of the Year- Getting geared up for the flu

#18 What to Do to Prevent the Flu

#19 Topsy Turnips- Getting ready for Thanksgiving

#20 Toddler Crack- Preventing picky eating in your toddler

#21 Men with Rashes- The case of the man with complex rashes

#22 An Afternoon at a Different Conference- Take aways from the American Academy of AntiAging Medicine Conference

#23 Men with Rashes Continued

#24 What You Got from Grandma that Wasn’t in the Will- What you need to know about epigenetics

#25 The Real Reason Some People Can’t Lose Weight- Epigenetics continued

Saturday, January 15, 2011

Epigenetics Discussion

In response to the thoughtful comments by the authors of the DNA article quoted in blog #23. Your points remind me of the Mark Twain quote about how the problem is not what we think we know but what we think we know that just ain’t so. I loved your article but still hold on to some hope that epigenetics will change our narrow understanding/definition of genetics. Perhaps the non-DNA regulatory material will be more reveal some of the answers. The clinical effects are certainly there and we have to come up with some way to deal with them. With a lack of useful research the clinician, as usual is left having to make it up.

Blog 25- The Real Reason Some People Cannot Lose Weight (Blog 23 continued)

Danika was of a young woman of African American descent who had been adopted by a Caucasian couple shortly after birth. She was a happy, bright child who was healthy overall except when it came to eating. "We are concerned about her appetite," her mother reported obviously uncomfortable. "We don't want to make a big deal out of it, but we are worried she might be getting rather too large," she tentatively concluded. She was going for tact but Danika was having none of it.

"I'm huge," she stated matter of factly.

I generally appreciate when people are blunt because it saves a lot of time and trouble figuring out how to approach a situation. So I liked Danika immediately. She was a big girl heightwise, too, making her look more like a fourteen year old. I would have to remind myself not to expect behavior beyond her actual years especially because she was so articulate.

"Don't say that about yourself," her mother protested, cutting her off and fidgeting in her seat. I stopped for a second and took in the situation. Here sat two thin Caucasian parents raising a non-thin child of African decent. They were trying so hard not to let any cultural preconceived notions prejudice them that they were practically sweating from the stress of not being judgmental. This could get dicey.

"What do you think is going on?" I inquired.

"I try to eat healthy," she explained, "but I am hungry a lot."

Looking at her food diary it was clear she had a good appetite but was not eating the quantity of food I would have expected given her size. Her thyroid had been checked and she was in otherwise perfect health. She was partial to pasta and bread so I suggested a gluten free diet for 6 weeks to see if that helped her feel less hungry. If a reaction to a food is causing excessive hunger, that food usually contains gluten or sugar. It is almost impossible to help someone lose weight if they feel hungry all the time so I thought it was a good place to start. Danika groaned. Her parents groaned but the deal was struck. Six weeks: no gluten.

What does this all have to do with genetics? I could pretend I am trying to build up some suspense, but in truth, it is just complicated so the answer will take a little while. The six weeks passed and Danika’s parents checked in. They were pleased to report her appetite had calmed down and she was eating less. Nonetheless, they were very unhappy because despite her food reduction she had gained of three pounds. It was that old medical joke where the doctor announces the treatment was successful but the patient died.

The laws of physics states this is not possible. In my profession, this phenomenon has only one accepted explanation: the client is fibbing. Nobody wants to blame the client because of course, they do not mean to fib but if there is weight gain, there must be a cookie somewhere nobody is copping to. But after much poking around and having run into this situation before, I concluded Danika was not eating in secret but is likely suffering the results of unfavorable epigenetics.

Recall that epigenetics is how the genes change in response to the environment. When big adaptations occur during pregnancy, the child’s gene expression changes and that child passes that adjustment on to their child and so on for many generations. What may have been useful and adaptive given your grandmother’s environment when she was pregnant, may not be so useful for you now. One of the strongest epigenetic trends has been high rates of obesity in the offspring of pregnant women suffering from starvation. This tendency has been documented to continue through four generations.

Danika’s birth mother’s history was murky. In adoption where the health history is not clear, there is a good chance it involves poverty or other social issues where food is not plentiful or eating is restricted (to hide weight gain, for example). I have also noticed through the years that Africian American women can have a particularly hard time losing weight even on severely restricted diets. I ran into this situation so many times that I developed a theory about it.

From an epigenetic perspective, the best body type for surviving in Africa would be one that conserves calories well. The growing conditions are harsh in many areas and there can be long periods of drought when food is scarce. While in the womb, the smart, adaptive baby would naturally shift its metabolism so it could survive on very little food. And as long as the person lived in Africa, all would be well. But transplant that same metabolism here where most people can get all the food they want, drought or no drought and that same baby will put on weight.

A full figured woman once consulted with me because she had been on a 1,200 calorie diet and had not lost an ounce. She was understandably very discouraged. She insisted that calorie restriction never helped her lose weight and wanted some new ideas. We tried a low carbohydrate version of the low calorie diet with no success. On the plus side, she was an amazingly vibrant woman. She was strong and healthy and probably could survive well on a few turnips a week but her epigenetics was not geared for a plentiful food environment. I could not bring myself to reduce her calories further so I asked her to make a difficult decision. I explained epigenetics. Then I told her she would either have to accept the fact that she needed very little food compared to others to maintain weight or she would have to accept herself as a bigger woman. She chose the later.

I often wonder if this is the situation Oprah faces. Even with a trainer, a chef and 42 personal assistants, does she have an epigenetic situation where she can only lose weight eating ridiculously few calories? It is hard to live in this country on a severely calorie restricted diet and it would make sense that she would hang in there for awhile but periodically eat an extra cracker and gain 3 pounds. That sounds like an exaggeration but the small amount of food people with this epigenetic profile can eat is no joke.

Danika was another strong individual who needed very little food to maintain weight. In fact, when she reduced her calories by going on a gluten free diet, her body immediately interpreted this as starvation. Applying epigenetic theory, Danika’s body was highly adaptive for dealing with starvation and so it went immediately into conservation mode. She was not going to need much food to maintain weight. A tough reality at any age but I thought it might be a good thing for her and her parents to know.

“So, what are we suppose to do?” her mother asked.

“Well, here is the situation…….” I started.

Sunday, January 2, 2011

Blog #24 What You Got from Grandma that Wasn't in the Will

There has been a lot of talk in the medical media lately about genetics. After reading and listening to a number of interesting pieces there seems to be two main points….

1. Genes are not nearly as important/predictive as we have been told
2. Genes are significant in more subtle and profound ways then previously thought.

Media messages are nothing if not abundantly clear.

According to one article (The Great DNA Data Deficit: Are genes for disease a mirage? By Jonathan Latham and Allison Wilson in The Bioscience Resource Project, Dec. 8, 2010), knowing the make-up of your genes helps you predict your chances of getting an illness at about the same accuracy rate as reading an insurance company chart with population statistics of getting a disease and finding your demographic. Forty year old, normal weight black female who does not smoke? You can look up your group on a disease risk chart and find your chances of getting dementia and save yourself the trouble of cracking your personal genetic code.

Francis Collins, renowned geneticist and the head of US National Institutes of Health (NIH) encourages everyone to have their genetic disease susceptibility tested anyway. He had his own mapped and it was such a profound experience that he wrote a book. His most significant personal discovery was that instead of the average risk of developing diabetes given that he was a white male (23%), he had a 29% chance of getting the disease. Otherwise his likelihood of getting cancer, heart disease and dementia was like everyone else. The book must be very short.

Consequently, the gene mapping industry is in trouble. Most people who have done disease risk gene testing discover the same shocking fact: they are average. The exception is those with rare genetic disorders like cystic fibrosis. Of course these individuals by definition are “rare”. With consistently underwhelming findings, the monetary returns that were supposed to be generated from personalized gene mapping technology are looking bleak. At the moment, it looks like you would be better off investing in soap futures or uranium mining.

Genes are not as important and predictive as we have been told because one of the unexpected results of the human genome project was the discovery that DNA is not the most important part of the chromosome. DNA represents half of what is in the chromosome and the only material scientists were interested in until they realized how inert DNA is. Every cell has all the DNA needed for making everything in the body. In addition, there is enormous similarity between the DNA of human and all other animals. We have many fewer genes than scientists expected to explain human diversity let alone the bigger variation between people and fruit flies. DNA turns out to be mostly generic blueprint material. In other words, most of the DNA we carry looks like everyone else’s including monkeys and I don’t mean your brother-in-law.

What regulates and individualizes the DNA? The other half of the material that scientists thought was not important. Yes. It turns out that regulation is where all the action is and few scientists realized this until all the DNA was mapped and turned out to be stunningly generic. (For more on this topic see Dr. Bruce Lipton’s, The Biology of Belief.)

Which leads to point two about the ways genes may be more important than we thought. The DNA might be similar but the controlling proteins and regulation is wildly diverse. Regulation can be affected by your environment, stress, thoughts and your diet. The results are profound and can be so long lasting that what your grandmother or great grandmother ate or experienced while she was pregnant might be effecting how you are expressing your genes today. There is even emerging evidence that your grandfather’s health at the time of conception (try not to think about that part) could shift your disease risk today. This emerging field is called epigenetics and it is mind blogging.

Imagine the implications of this study. Scientists took some male rats and made them fat by feeding them a high fat diet similar to what we Americans eat today. The fat rats, who had symptoms of type 2 diabetes, were bred with non-overweight females. The pups did not become overweight (because of how they were fed) but a lot of them developed type 2 diabetes anyway! Ditto for the next generation.

We already know that pregnant women on starvation diets (due to famine or war) have children and grandchildren with much higher rates of obesity. The fetus makes decisions about gene expression in utero based on the kind of world it thinks it is coming in to. This early gene regulation has life long (and after) ramifications.

So, what practical application can this information have? The results of epigenetics walked into my office in the form of eleven year old, Danika. To be continued…….