Epigenetics and Nutrition: How Your Diet Shapes Gene Expression and Health
[Dr. Su-Nui Escobar, DCN, RDN] 10:31:33
Now, during this time that we have together, we're going to talk about how nutrition can act as an epigenetic factor influencing gene expression. Because yes, we're born with the genetic makeup that we are born with.
[Dr. Su-Nui Escobar, DCN, RDN] 10:31:50
But that doesn't necessarily mean that what we are born with is what is going to be expressed later in life.
[Dr. Su-Nui Escobar, DCN, RDN] 10:32:00
We want to recognize the long-term effects of daily dietary choices because it is amazing what our mothers ate that will impact our kids. So it's kind of mind-blowing when we see it that way.
[Dr. Su-Nui Escobar, DCN, RDN] 10:32:15
And we're going to talk a little bit about personalized nutrition and whether or not that is transforming the clinical practice.
[Dr. Su-Nui Escobar, DCN, RDN] 10:32:26
And to start let's um Let's just make sure that we all understand that gene expression is modifiable with diet, lifestyle, and behavior. So every disease, every condition has different components. And yes.
[Dr. Su-Nui Escobar, DCN, RDN] 10:32:43
Genes are a strong factor, but so the environment and so are behavior.
[Dr. Su-Nui Escobar, DCN, RDN] 10:32:49
Nutrition is one of the most studied epigenetic factors. And in fact, the science of studying how nutrients and bioactive compounds in food interact with individual genes to influence gene expression health outcomes and risk of disease is called nutrigenomics. And it's been around for a while.
[Dr. Su-Nui Escobar, DCN, RDN] 10:33:11
But I'm expecting that in the next few years, this is going to explode.
[Dr. Su-Nui Escobar, DCN, RDN] 10:33:16
Because research is coming back really fast.
[Dr. Su-Nui Escobar, DCN, RDN] 10:33:23
Hold on a minute. Okay. How nutrition impacts gene expression? There's a few ways. First is DNA methylation. Nutrients like folate, B vitamins, and some E are key to methylation.
[Dr. Su-Nui Escobar, DCN, RDN] 10:33:39
These metal groups are added to DNA and that can silent genes and prevent protein production. And if you remember, the one advice that we tell all our pregnant women is make sure that you have enough folic acid in the first weeks of conception.
[Dr. Su-Nui Escobar, DCN, RDN] 10:33:57
My advice is Stephen, if you're thinking about having kids, if you are in that preconception state It is important that from that moment before the pregnancy occurs, you start taking folic acid. That way you prevent some of those birth defects and impact your DNA.
[Dr. Su-Nui Escobar, DCN, RDN] 10:34:18
For histone modifications as well, that's another way how nutrition has this impact. Nutrients and bioactive compounds affect histone modifying enzymes This can impact DNA. This can impact DNA accessibility and influences which genes are turned on or off.
[Dr. Su-Nui Escobar, DCN, RDN] 10:34:39
Which, you know, that is obviously the goal. We turned on the gene expression that we want more of and we want to decrease or turn off those that are not so great for us.
[Dr. Su-Nui Escobar, DCN, RDN] 10:34:55
Also, chromatin remodeling, methylation, and histone changes, alpha chromatin X structure, and that controls gene accessibility and expression.
[Dr. Su-Nui Escobar, DCN, RDN] 10:35:05
And then we have some certain nutrients that can have an impact of an epigenetic effects more than others, right?
[Dr. Su-Nui Escobar, DCN, RDN] 10:35:13
For example, cruciferous vegetables. And that's something that when you are in functional nutrition, functional medicine will often will notice that this is a type of vegetables that we that we… ask people to eat often, right? But now we have to remember that
[Dr. Su-Nui Escobar, DCN, RDN] 10:35:35
As dietitians, one of my roles is not only to tell people what they need to eat, but I might also have to tell how to eat them, how to cook them, how to prepare them. So instead of like our patients hearing that, oh, you have to eat this and you don't know how to really cook or eat those foods.
[Dr. Su-Nui Escobar, DCN, RDN] 10:35:58
Now you come up with like ideas and ways that taste really the ways that like that sound really delicious. So as your patients leave your console, they're ready to go and make those vegetables.
[Dr. Su-Nui Escobar, DCN, RDN] 10:36:14
Resveratrol and curcumin does very often use in functional nutrition. And we can do this as supplements, but also I love to encourage people to to eat these foods, to cook with curcumin because the way that you actually eat it when you eat it through food is different. It will act different in your body that you if you only have the supplements.
[Dr. Su-Nui Escobar, DCN, RDN] 10:36:42
Besides, you know, like things like Durmeric, make the food taste great. Now you can take simple eggs and some exotic turkish eggs, or you can have a very nice Indian food by adding these nutrients.
[Dr. Su-Nui Escobar, DCN, RDN] 10:36:59
Which we know we're doing it because of the health of it. But at the same time, we're also encouraging people to eat them by providing some like great ideas in about how to use them.
[Dr. Su-Nui Escobar, DCN, RDN] 10:37:11
But obviously, sometimes we do need the supplements because we cannot get to that therapeutic level just with food.
[Dr. Su-Nui Escobar, DCN, RDN] 10:37:21
Now, let's go back a little bit and we're going to talk about how nutrition is going to impact us from the womb of our mothers.
[Dr. Su-Nui Escobar, DCN, RDN] 10:37:32
And if you are planning to have kids, your students, if you're a younger, then this is very important because it might get you thinking that What do you eat now what your weight and everything that is related to lifestyle nutrition before you conceive is really really important in the outcome in the health of your babies.
[Dr. Su-Nui Escobar, DCN, RDN] 10:37:58
And your grandkids, if that makes sense. Maternal diet obviously is going to influence significantly the epigenome of the fetus. And there's nutrition imbalances throughout the pregnancy that can occur that alter epigenetic marks and impact gene expression and future health.
[Dr. Su-Nui Escobar, DCN, RDN] 10:38:18
I don't know why I'm nervous today, but I don't know. It's something about your group that makes me a little bit nervous. I'm acknowledging that.
[Dr. Su-Nui Escobar, DCN, RDN] 10:38:27
And I'm going to move on. If you have any questions or hear me, Shalil Shaky, it's because of that.
[Dr. Su-Nui Escobar, DCN, RDN] 10:38:37
I tend to do much better when I can see people.
[Dr. Su-Nui Escobar, DCN, RDN] 10:38:40
Anyways, let's go back and focus again on this presentation but When… the women is undernourished or overnourished during pregnancy that can be linked to life lasting changes in gene expression.
[Dr. Su-Nui Escobar, DCN, RDN] 10:39:01
Is going to impact metabolism, weight regulation, and disease risk throughout life.
[Dr. Su-Nui Escobar, DCN, RDN] 10:39:08
In animal studies, we see that when women eat too little protein, doesn't eat enough protein during pregnancy, that has been associated with immune response, increased sensitivity to oxidative stress, metabolic abnormalities, and glucose dysregulation.
[Dr. Su-Nui Escobar, DCN, RDN] 10:39:25
Which we all know that those are key elements to health. And especially if you are practicing in a way that is like more functional, you even pay extra attention to these markers.
[Dr. Su-Nui Escobar, DCN, RDN] 10:39:38
Now, who will not have enough protein? Well, anybody that is plant-based, that is mostly vegan will be at risk of protein deficiency.
[Dr. Su-Nui Escobar, DCN, RDN] 10:39:48
Just because, you know, by nature, that diet is not very high in protein and it doesn't have some of the high quality protein that we want them to have.
[Dr. Su-Nui Escobar, DCN, RDN] 10:39:59
Obviously, they're eating soy if they're combining foods correctly, that is a phenomenal diet.
[Dr. Su-Nui Escobar, DCN, RDN] 10:40:05
But definitely we have to pay attention into how much protein and the quality of protein being consumed.
[Dr. Su-Nui Escobar, DCN, RDN] 10:40:13
And someone with a low socioeconomic status might also be at risk.
[Dr. Su-Nui Escobar, DCN, RDN] 10:40:18
But you'll also be surprised because we are thinking that, you know, right now in this day and age, everybody is crazy about protein.
[Dr. Su-Nui Escobar, DCN, RDN] 10:40:26
But when you start talking to people, there's many people that doesn't like any chicken, any animal products. And they really are not like really fond of soy products so they ended up having most of the calories from carbohydrates and fats so
[Dr. Su-Nui Escobar, DCN, RDN] 10:40:44
Something that when we are counseling patients, we have to take a dietary history and figure out those things.
[Dr. Su-Nui Escobar, DCN, RDN] 10:40:50
Now, this is a fascinating study. And this study started like a long time ago. I think this is even earlier than when my mother was born. The study started between 1943 and 1947, which was a big famine.
[Dr. Su-Nui Escobar, DCN, RDN] 10:41:12
In the Netherlands. And then the researchers follow these people that was born during that time in that population and followed them until you know like at least that we're following until like 2021 2022. So it's a very long study.
[Dr. Su-Nui Escobar, DCN, RDN] 10:41:33
They notice that. When babies were exposed to malnutrition in utero, especially that level of malnutrition, they saw higher rates of schizophrenia and affective disorders.
[Dr. Su-Nui Escobar, DCN, RDN] 10:41:49
People were also more likely to eat a high-fat diet higher risk of early onset of cardiovascular disease, glucose intolerance, disturbed blood regulation, and also kidney disease.
[Dr. Su-Nui Escobar, DCN, RDN] 10:42:02
That is kind of insane to think that that one period of time really affected these individuals throughout their 70s and 80s, right?
[Dr. Su-Nui Escobar, DCN, RDN] 10:42:14
Women exposing feminine utero were more likely to develop central obesity and higher higher mortality rates from cardiovascular disease, cancer, and breast cancer. And obviously, this is not surprising because once you have that adipose tissue in your belly.
[Dr. Su-Nui Escobar, DCN, RDN] 10:42:33
That will lead to higher risk for cardiovascular disease. And then a high fat diet might have a higher risk of cancer. So it might be what they're eating right now as an adult or what they ate as a child, their food preferences, but also what happened in the uterine.
[Dr. Su-Nui Escobar, DCN, RDN] 10:42:54
In men, the same situation exposed them, what was associated with a much older appearing brain.
[Dr. Su-Nui Escobar, DCN, RDN] 10:43:04
So their brain was not too level that it should be for their age.
[Dr. Su-Nui Escobar, DCN, RDN] 10:43:10
There was an increased risk of anxiety and depression and reduced in physical performance. So really the effects were very, very strong.
[Dr. Su-Nui Escobar, DCN, RDN] 10:43:23
Even infants born at normal birth weight were affected. You will expect that if someone is, if a mom is undernourished, the babies are going to be born small for age. That's the expectations. But even if these babies were born abnormal weight, they still have the same effects.
[Dr. Su-Nui Escobar, DCN, RDN] 10:43:42
Even more impactful children of men, this is specifically for men exposed to the famine were more likely to have a higher BMI at age 37.
[Dr. Su-Nui Escobar, DCN, RDN] 10:43:54
You know which kind of makes sense for where like the age of these individuals
[Dr. Su-Nui Escobar, DCN, RDN] 10:44:02
Now, undernutrition definitely impacts the generic makeup.
[Dr. Su-Nui Escobar, DCN, RDN] 10:44:08
But also maternal obesity, maternal overnutrition can lead to epigenetic alterations during pregnancy, which in turn will influence the fetal and neonatal phenotype.
[Dr. Su-Nui Escobar, DCN, RDN] 10:44:21
Pre-pregnancy and overweight and obesity is going to increase the risk of higher birth weight and off springs that are overweight and obese.
[Dr. Su-Nui Escobar, DCN, RDN] 10:44:34
And obviously, and obviously if the mother is living with obesity, it's more likely that that woman is going to overeat during pregnancy and gain excess weight, which will lead to further problems.
[Dr. Su-Nui Escobar, DCN, RDN] 10:44:48
And the problems are going to be at the time of birth and then throughout childhood and later on in life.
[Dr. Su-Nui Escobar, DCN, RDN] 10:44:55
This is really interesting because i'm really i and very invested in understanding what is the appetite regulation pathways.
[Dr. Su-Nui Escobar, DCN, RDN] 10:45:05
With all, you know, all that we see with GLP-1s, semaglutide, terapatide, and like the boom of these medications, we know that these medications act by helping regulate these pathways right But when the women is the women is it's eating more than they should during pregnancy
[Dr. Su-Nui Escobar, DCN, RDN] 10:45:32
They might cause permanent changes in the fetal brain. Particularly in this area of appetite regulations.
[Dr. Su-Nui Escobar, DCN, RDN] 10:45:41
Leptin and insulin signal alterations can also affect the hypothalamus development, influencing future eating behaviors, because we know that leptin is a hormone that is that helps regulate hunger appetite. And then insulin when there's um a decreased insulin sensitivity that might also have an impact on weight.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:06
And I'm going to tell you like why like in a way I'm focusing a lot of weight. I know that that's not the focus of a lot of people.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:16
A lot of the times weight is being studied because it's easy to do.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:22
Other markers of health might take a lot more research power to be able to actually be conducted.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:29
But weight is super simple. So we're seeing a lot of research on this area.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:37
Now… When we have these changes in appetite regulation and leptin and insulin signaling.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:44
We're going to see higher energy intake, greater adiposity and other food preferences and body composition after birth.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:53
What this means is going to be a lot harder for these individuals.
[Dr. Su-Nui Escobar, DCN, RDN] 10:46:58
To maintain a healthy weight. And the issue is that it doesn't stop at the healthy way when you are very hungry all the time when you want to eat and that's something that you know it's a it's more it's stronger.
[Dr. Su-Nui Escobar, DCN, RDN] 10:47:14
Then it's much more difficult to focus on a healthy eating.
[Dr. Su-Nui Escobar, DCN, RDN] 10:47:21
One of the things that I observe often with my patients on GLP-1s is that now that the food noise is gone, then they can focus and all those wonderful advice that we dietitians give them.
[Dr. Su-Nui Escobar, DCN, RDN] 10:47:34
Now that they're not really hungry, they can wait and pick up something healthier. They can wait and cook something healthier.
[Dr. Su-Nui Escobar, DCN, RDN] 10:47:42
So it does make an impact not only on weight, but also on health.
[Dr. Su-Nui Escobar, DCN, RDN] 10:47:47
And then obviously with food composition and with body compositions, we know that someone that has more adipose tissue and less muscle mass that makes it even harder to maintain a healthy weight.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:02
Now, we also know that maternal BMI is linked to increased systematic and placental inflammation.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:09
And inflammation is something that is key in health. Inflammation will affect every single organ in our body.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:17
Is going to affect heart disease. It's going to affect cancer, it's going to affect weight.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:23
So when you have like a higher maternal BMI, then everything else is going to be impacted.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:33
When the mom has a high fat diet that is going to trigger inflammatory pathways.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:39
This inflammation is going to lead to insulin resistance in fetal adipose tissue.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:47
Then when the babies are also exposed to excess lipids, that is going to impact organ development, liver, brain, pancreas, you name it.
[Dr. Su-Nui Escobar, DCN, RDN] 10:48:58
Is going to be an increased risk of metabolic disorders in offspring. I mean, makes a lot of sense.
[Dr. Su-Nui Escobar, DCN, RDN] 10:49:04
And he's going to contribute to childhood obesity through fetal metabolic programming. And we know that once the child is obese.
[Dr. Su-Nui Escobar, DCN, RDN] 10:49:13
Is a much higher chances that they develop type 2 diabetes, hypertension. They might be, they might also have lower self-esteem.
[Dr. Su-Nui Escobar, DCN, RDN] 10:49:24
They might also be bullying in school. So again, it goes beyond just being a little chubby when you're a kid.
[Dr. Su-Nui Escobar, DCN, RDN] 10:49:34
Now, the biggest takeaway I have for this is that i have this early metabolic disruptions can permanently alter organ function, metabolism, and gene expression and this is going to has to future generations.
[Dr. Su-Nui Escobar, DCN, RDN] 10:49:53
Now, this is an old study, and I debated so much about putting this study here or not.
[Dr. Su-Nui Escobar, DCN, RDN] 10:50:01
But it really, when I first read it, it really blew my mind and that this is something that, you know, like I think about it often. Don't ask me why. I know I'm a little bit of a nerd, but that's what I do.
[Dr. Su-Nui Escobar, DCN, RDN] 10:50:17
But this is the question, right? Burweight is nature or nature For this study, they had it It's very small, 62 participants, but what was very interesting is that they compare how did the baby's weight was related to either the mom or surrogate mothers that actually carry the pregnancy to term.
[Dr. Su-Nui Escobar, DCN, RDN] 10:50:41
So they wanted to see if it is the genetics of it or is the environment of the womb.
[Dr. Su-Nui Escobar, DCN, RDN] 10:50:48
And very surprisingly, when they were looking at um the bare weight of the baby, it was correlated with the surrogate mothers more than it was correlated with the biological mothers who provided the genetic makeup of the baby. So this study really shows us that the environment of the womb is what makes the biggest difference.
[Dr. Su-Nui Escobar, DCN, RDN] 10:51:17
Another really interesting study, this was among people having bariatric surgeries, which we know are also very popular.
[Dr. Su-Nui Escobar, DCN, RDN] 10:51:25
And they compared like two siblings, right? Say moms and dad.
[Dr. Su-Nui Escobar, DCN, RDN] 10:51:32
And then they compare the child's born Before bariatric surgery with babies born after bariatric surgery and they saw a difference in between them.
[Dr. Su-Nui Escobar, DCN, RDN] 10:51:45
Sheila and born after the maternal bariatric surgery have lower risk of obesity then siblings born before the surgery.
[Dr. Su-Nui Escobar, DCN, RDN] 10:51:55
And they suggest that maternal metabolic improvements can reverse epigenetic risk.
[Dr. Su-Nui Escobar, DCN, RDN] 10:52:02
So this is true with bariatric surgery, but I'm also thinking if this is true with just lifestyle interventions to reduce obesity or with the use of pharmacology?
[Dr. Su-Nui Escobar, DCN, RDN] 10:52:15
Pharmacotherapy. To reduce obesity.
[Dr. Su-Nui Escobar, DCN, RDN] 10:52:20
And so that's, I don't know, those are like really interesting things that we're Because, you know, we hear a lot about how these new ways of treating obesity, they're really gonna change the obesity trends that we have.
[Dr. Su-Nui Escobar, DCN, RDN] 10:52:37
Are they going to change it just because more people are now able to lose weight, they have the help that they need to lose weight?
[Dr. Su-Nui Escobar, DCN, RDN] 10:52:46
Because we know they're effective. So we might be against or in favor, but we know these medications are effective.
[Dr. Su-Nui Escobar, DCN, RDN] 10:52:52
Or can we also impact the next generations by having babies when we are at a healthier weight.
[Dr. Su-Nui Escobar, DCN, RDN] 10:53:01
Now, beyond that, we know that nutrition can play a role on the gene expression.
[Dr. Su-Nui Escobar, DCN, RDN] 10:53:09
And that can impact conditions such as cancer, cardiovascular disease, diabetes, obesity, non-alcoholic fatty liver disease.
[Dr. Su-Nui Escobar, DCN, RDN] 10:53:19
Thyroid disease and osteoporosis.
[Dr. Su-Nui Escobar, DCN, RDN] 10:53:25
And we'll do this by the same mechanisms that we did before, DNA methylation, histone tail modifications, and chromatin remodeling.
[Dr. Su-Nui Escobar, DCN, RDN] 10:53:34
Now, when it comes to heart disease. We know that nutrition play plays a huge role on heart disease at the different levels. But specifically, we're talking now that epigenetic modifications. We know that the Western diet is going to impact in a negative way.
[Dr. Su-Nui Escobar, DCN, RDN] 10:53:54
And what is the Western diet? What is the issue with the Western diet? Well, we know it's higher in ultra-processed foods high sugar, high in unhealthy fats and overall is it doesn't have all the nutrients that we need for optimal health.
[Dr. Su-Nui Escobar, DCN, RDN] 10:54:11
At the same time, we know that the Mediterranean diet is overall healthy, but specifically when we talk about epigenetics, it shows to improve cardiovascular disease through enhanced DNA methylation, gene expression.
[Dr. Su-Nui Escobar, DCN, RDN] 10:54:27
Related to reduce inflammation. Which we have talked before, right?
[Dr. Su-Nui Escobar, DCN, RDN] 10:54:31
This type of diet is going to have a lot of compounds that is going to support that positive gene expression. It's going to have your resverdol, your curcumin is going to have EGCG from green tea, and it's going to support anti-inflammatory responses to heart disease.
[Dr. Su-Nui Escobar, DCN, RDN] 10:54:53
And we all do this through food, right? The best is that he's like good food. It's not like food that is a diet food, but rather a lifestyle and a diet that were a dietary pattern I'm going to correct myself because this is more like a pattern. It's not a diet prescription, but it's more a way of eating.
[Dr. Su-Nui Escobar, DCN, RDN] 10:55:16
That is going to emphasize fruits and vegetables. These fruits and vegetables are going to make our plates colorful. They're going to add a lot of flavor to our meals.
[Dr. Su-Nui Escobar, DCN, RDN] 10:55:25
Is full of whole grains is going to have legumes and nuts, which we know that when we add a little bit of beans or some nuts, let's say to our salad or to our dishes, it makes it a little bit more enjoyable.
[Dr. Su-Nui Escobar, DCN, RDN] 10:55:39
Olive oil is the mind fat source. We have moderate amounts of fish and poultry, but we're going to limit red meat and sweets. So overall, it's a healthy diet.
[Dr. Su-Nui Escobar, DCN, RDN] 10:55:53
And we have plenty of studies that had support the use of this type of diet in cardiovascular disease. It was many years ago, it was a study with about 7,000 people.
[Dr. Su-Nui Escobar, DCN, RDN] 10:56:05
And the power of the diet the ability to reduce the cardiovascular effects of this diet when compared with back then the standard diet for the treatment of hyperlipidemia and other conditions that will lead to heart disease.
[Dr. Su-Nui Escobar, DCN, RDN] 10:56:26
Their response was so powerful that they had to stop the study because they felt that it was unethical to keep people on the standard diet that we use to treat the patients, right?
[Dr. Su-Nui Escobar, DCN, RDN] 10:56:40
Now, there's a So here are some specific nutrients.
[Dr. Su-Nui Escobar, DCN, RDN] 10:56:45
That have epigenetic effects. Mentioned before folate that is going to help with many things but includes insulin resistant and adiposity through DNA methylation is going to also have methionine, which is going to increase or is going to help with insulin resistance and obesity
[Dr. Su-Nui Escobar, DCN, RDN] 10:57:05
Curcumin, inflammation, obesity, and resveratrol obesity and liver stenosis. Now, there's a few other studies that study basically the genome-wide association studies and BMI.
[Dr. Su-Nui Escobar, DCN, RDN] 10:57:22
This is called WAS as well. And that has a significant advance in the discovery of generic variants linked to obesity. And they discovered that there's many genomic lucas identified that it influenced the PMI, like about 30.
[Dr. Su-Nui Escobar, DCN, RDN] 10:57:41
However, that sounds really promising to identify the gene that is going to help us with such a huge problem that we have in this country and in many countries.
[Dr. Su-Nui Escobar, DCN, RDN] 10:57:53
But when we see really the impact of like the genes they're really… is very small. There's a few diseases, genetic diseases generic diseases that really impact overweight and obesity. But that really, I mean.
[Dr. Su-Nui Escobar, DCN, RDN] 10:58:15
Genetic diseases that are not going to impact a very large number of people.
[Dr. Su-Nui Escobar, DCN, RDN] 10:58:19
They're going to be a lot smaller.
[Dr. Su-Nui Escobar, DCN, RDN] 10:58:25
One of the big key findings from these studies, it was to know that the FTO gene shows the strongest association with BMI.
[Dr. Su-Nui Escobar, DCN, RDN] 10:58:35
And many obesity associated genes are highly expressed in the brain.
[Dr. Su-Nui Escobar, DCN, RDN] 10:58:40
Especially in the regions associated with regulation of hunger and food intake.
[Dr. Su-Nui Escobar, DCN, RDN] 10:58:47
So I would love to have studies where someone can go in and I can, you know, well, I can ask the doctor to order a genetic test and can tell me, oh, this patient has this gene. And I know that that person is going to have a higher a harder time regulating hunger and food appetite. I know that that person, I'm going to have to give them
[Dr. Su-Nui Escobar, DCN, RDN] 10:59:12
Like nutrition advice, nutrition counseling of foods that can help with the regulation of hunger and appetite.
[Dr. Su-Nui Escobar, DCN, RDN] 10:59:19
Or maybe these individuals might be better candidates for GLP-1 medications.
[Dr. Su-Nui Escobar, DCN, RDN] 10:59:28
There's another trial, the pounds loss trial This was among 811 adults. And what they did is they randomized different diets with different macronutrient compositions, and they figure out if you know like what was the response of the overall group
[Dr. Su-Nui Escobar, DCN, RDN] 10:59:48
To the different diets. Based on the macroloutines, does the person on a higher carbohydrate diet, did they lose or the higher fat diet, they lose more weight, the person's with like higher protein, would they lose more weight?
[Dr. Su-Nui Escobar, DCN, RDN] 11:00:04
Basically what they were trying to see is what kind of what type of diet will help people lose the most weight.
[Dr. Su-Nui Escobar, DCN, RDN] 11:00:12
The study duration was about two years. On the average, they lost a kilo per month, so about six kilos in six months.
[Dr. Su-Nui Escobar, DCN, RDN] 11:00:23
And it was some weight regain observed by 12 months, which is very typical in any diet. And then the weight loss was similar across the diets at two years. So really, we didn't see a lot of variation.
[Dr. Su-Nui Escobar, DCN, RDN] 11:00:38
But we did see that we did Depending on the genotype, so when they look at the individual response to diet, then there it was some differences. So some people with specific genotype did better on a high carb diet at six months.
[Dr. Su-Nui Escobar, DCN, RDN] 11:01:00
There was no effect in the low carb group. And then for other people with other genotypes, they respond better to the high protein diet and that this was an influence fat mass and fat-free mass.
[Dr. Su-Nui Escobar, DCN, RDN] 11:01:15
And this will be really, really nice to know, right? Nowadays, they're selling kits And then you can test yourself and figure out based on your genotypes, what is the best diet for you.
[Dr. Su-Nui Escobar, DCN, RDN] 11:01:32
The promise is that by you following the diet, you're going to do much better when it comes to weight loss.
[Dr. Su-Nui Escobar, DCN, RDN] 11:01:41
The problem is that the difference is so small that is really small statistically significant, but not really applicable to the day-to-day scenario.
[Dr. Su-Nui Escobar, DCN, RDN] 11:01:58
In this meta-analysis, they look at the 10 different studies almost 7,000 participants and they compare different genotypes. And we showed that some phenotypes.
[Dr. Su-Nui Escobar, DCN, RDN] 11:02:12
Genotypes respond better to specific diets. But if you see the difference is very small i mean
[Dr. Su-Nui Escobar, DCN, RDN] 11:02:21
Yes, it could be statistically significantly, but to me as I audition, this information is not great.
[Dr. Su-Nui Escobar, DCN, RDN] 11:02:26
So I'm hoping to see more of this. There was another study in which they did 30 different studies about 46,000, 47,000 to um participants and they did see that it was a significant body weight reduction in people that were carriers of the FTO gene
[Dr. Su-Nui Escobar, DCN, RDN] 11:02:53
But again, if you see the number. It's very insignificant in terms of real life.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:02
What is interesting is that this gene is highly expressed in the brain.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:07
Which plays a role on the regulation of appetite and energy intake as we have been talking about.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:15
Now. Let's talk for a second about personalized nutrition.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:22
Personalized nutrition Taylor's dietary advice based on individual's genetic information.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:31
We are very interested in this topic. And as I mentioned before, tests are already available for people to purchase them and figure out what is the best lifestyle to follow to to lose weight. Unfortunately.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:49
We don't have a clear answer yet. For this study, they used nine randomized trials.
[Dr. Su-Nui Escobar, DCN, RDN] 11:03:57
And it was no consistent improvement on diet, behavior, or health And data was limited to individuals with chronic disease.
[Dr. Su-Nui Escobar, DCN, RDN] 11:04:07
Now, why would this be important for many reasons? A few years ago, I studied at the University of Miami here in Miami, Florida. And it was It was all about integrative medicine, integrative nutrition. We learn a lot from many different experts.
[Dr. Su-Nui Escobar, DCN, RDN] 11:04:32
In particular, I remember this day. Amazing conference.
[Dr. Su-Nui Escobar, DCN, RDN] 11:04:38
Speakers, top of the line. Cleveland Clinic, Harvard, like all the big universities, all the big names that you wanted to see on functional nutrition, they were there But one of them will tell us you gotta eat salmon And the salmon needs to come from
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:00
You know, needs to be farmed or needs to be wild I can't remember which one specifically who this person was referring to.
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:10
And you do need omega-3, but make sure that these omega-3s that come from marine sources.
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:16
Somebody else is like, you know, you want a diet that is like a little bit heavier on animal proteins and you want to make sure that you don't eat legumes.
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:26
Because legumes can cause all these problems into your body. Then another person will say like, no, but like plant-based diets are the way to go.
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:37
If you can do like more vegan style, that's great. And then the other will say like, well, you have to be very careful with where you get your water from.
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:47
So at the end of the day, where you were trying to formulate the best diet to follow, you really couldn't.
[Dr. Su-Nui Escobar, DCN, RDN] 11:05:53
Because you really cannot follow a plant-based diet that eliminates all the legumes, all the beans or your garbanzos, because what are you going to eat? I mean, you don't want to eat soy every single day, right? We also know that soy every day over 25 grams is not good for us, right?
[Dr. Su-Nui Escobar, DCN, RDN] 11:06:12
You cannot really follow the plant-based diet. Also, you cannot really have marine omega-3 if you're vegan because Yes, you can have plant-based omega-3s, but they're not going to have the same effect.
[Dr. Su-Nui Escobar, DCN, RDN] 11:06:27
You know, so We sit down at the end of the conference.
[Dr. Su-Nui Escobar, DCN, RDN] 11:06:32
Debating what was the best diet and really nobody had a great answer So if we could have a test.
[Dr. Su-Nui Escobar, DCN, RDN] 11:06:41
Where we just like send it to a lab and then distill as well for this individual for you the best diet you can follow is a plant-based diet.
[Dr. Su-Nui Escobar, DCN, RDN] 11:06:53
A plan forward diet, you know, like a high protein, lower carb diet. And I'm not talking about very low carb diet. I'm just talking lower carbohydrate diet so This would be amazing if we could have all this information. So I'm hoping that within the next few years.
[Dr. Su-Nui Escobar, DCN, RDN] 11:07:11
We can get there. Right now, it is the position of the Academy of Nutrition and Dietetics that nutritional genomics provide insight in how diet and genotype interacts affect the phenotype.
[Dr. Su-Nui Escobar, DCN, RDN] 11:07:26
And the practical application of nutritional genomics for complex chronic disease is then emerging science and the use of neutrogena testing to provide that their advice is not ready for routine dietetic practice.
[Dr. Su-Nui Escobar, DCN, RDN] 11:07:42
But I'm hoping it's soon. Now, it's a little bit of your turn.
[Dr. Su-Nui Escobar, DCN, RDN] 11:07:48
I don't know how to do this, maybe via chat. Stephanie, if you have any suggestions.
[Dr. Su-Nui Escobar, DCN, RDN] 11:07:55
But what I want you to start thinking and give information is about How can you individualize nutrition and physical activity advice for a 27-year-old patient living with lifelong obesity?
[Dr. Su-Nui Escobar, DCN, RDN] 11:08:12
One who you know, you really did a complete history. You realize that the mother had a BMI of 32 at the time of conception. She gained too much weight, 45 pounds. And we know that for someone that is living with obesity to begin a pregnancy, the weight gain should be
[Dr. Su-Nui Escobar, DCN, RDN] 11:08:33
Anywhere between 15 and 20 and 20 pounds. So this mother gained more than double What advice will you give?
[Dr. Su-Nui Escobar, DCN, RDN] 11:08:46
And I'm going to maybe stop sharing stephanie?
[Dr. Su-Nui Escobar, DCN, RDN] 11:08:53
Okay. I'm going to stop sharing my screen. And what I'm going to do is I'm going to let people perhaps comment in the chat.
[Dr. Su-Nui Escobar, DCN, RDN] 11:09:04
What type of advice they will do?
[Dr. Su-Nui Escobar, DCN, RDN] 11:09:13
Okay.
[Stephanie Gandomi, MS, CGC] 11:09:14
Dr. Esquire, so the question again was, what would you recommend to this patient who gained much weight in her pregnancy? Is that the question?
[Dr. Su-Nui Escobar, DCN, RDN] 11:09:25
Well, actually, there is For the kid. Now you have an adult that is overweight A 27-year-old that is overweight. The issues with obesity started with their genetic makeup.
[Dr. Su-Nui Escobar, DCN, RDN] 11:09:41
Because the mother was obese when she was pregnant before conception and then she gained too much weight during pregnancy. So you have that background.
[Dr. Su-Nui Escobar, DCN, RDN] 11:09:51
And really, I didn't provide with any more background. The point that I wanted to illustrate is that perhaps the advice will not change that much, even though we might not know exactly what is the genetic makeup of this person?
[Stephanie Gandomi, MS, CGC] 11:10:08
I have a question regarding this. So usually, so living here in Hawaii, I see a lot of obesity And in families and it's very multi-generational And I noticed that also a lot of it has to do with the habits, right? So mom's got obesity
[Dr. Su-Nui Escobar, DCN, RDN] 11:10:21
Mm-hmm.
[Stephanie Gandomi, MS, CGC] 11:10:28
Gives birth to several children. And then we see the children eating McDonald's or Or, you know, fast foods because that's what mom eats. So how do you differentiate between the habits like the multi-generational habits and the actual genetic part of it
[Dr. Su-Nui Escobar, DCN, RDN] 11:10:49
I mean, that is it, right? I mean, we know that when we have these generic components um That is only part of it.
[Dr. Su-Nui Escobar, DCN, RDN] 11:10:59
Or genetic makeup is one part. The expression of those genes are really They can be modified by the environment in which we live in. So that is your ending habit that we heard from our parents. So yeah, you might have…
[Dr. Su-Nui Escobar, DCN, RDN] 11:11:19
You might have even the same mother that in between pregnancies lost weight.
[Dr. Su-Nui Escobar, DCN, RDN] 11:11:24
Then the next kid will be less likely to gain weight.
[Dr. Su-Nui Escobar, DCN, RDN] 11:11:29
But that sibling that was born when mama was a little heavier, then that kiddo is going to have harder time.
[Dr. Su-Nui Escobar, DCN, RDN] 11:11:38
But then, you know, that is not the full story. What happened during childhood? Do you see parents? And it's not only fast food. Are they drinking sweetened drinks? Because, you know, I mean, you have kids, I have kids. We know that if we get them, get away with things.
[Dr. Su-Nui Escobar, DCN, RDN] 11:11:57
They will like be drinking Gatorade all day long because they went outside and played like for five minutes um or they would like prefer the snacks that maybe are a little bit more processed and maybe cookies instead of an apple.
[Dr. Su-Nui Escobar, DCN, RDN] 11:12:13
So is that environment that we create is also our behavior, what style of parenting do we have? Do we have something that is a little bit firm And guides the kids or we have something that is more permissive and we let them get away with murder in terms of nutrition.
[Dr. Su-Nui Escobar, DCN, RDN] 11:12:32
And then at some point, it's not the parents although this person that is now 27 will have all that background.
[Dr. Su-Nui Escobar, DCN, RDN] 11:12:43
What choices they did once they got out of the home. If they were in college, were they overeating in the cafeteria? Were they choosing eating the salads instead of the hamburgers at school? And it's a lifelong process in terms of obesity that is impacted by
[Dr. Su-Nui Escobar, DCN, RDN] 11:13:06
Genes, your body, how it works in terms of hormones, but it's also impacted by behaviors by the environment and what environment you create as a person.
[Stephanie Gandomi, MS, CGC] 11:13:20
I think it goes to show that it's everything when we work with patients or families.
[Stephanie Gandomi, MS, CGC] 11:13:27
That it's not just one thing, right? Interconnected and we have to think about if we're thinking about whole person care we have to think about everything related to that person, their genetics, their environment, their diet, their lifestyle, their stress factors.
[Stephanie Gandomi, MS, CGC] 11:13:46
Their support networks. So thank you. Yeah, everything that you're sharing is like one of the many important components of taking care of a whole person for sure.
[Dr. Su-Nui Escobar, DCN, RDN] 11:13:57
Absolutely. I think it's no right answer. And I have another case scenario because that's something that is probably like something that we already can get tested.
[Dr. Su-Nui Escobar, DCN, RDN] 11:14:08
Easily as You have family history of breast cancer.
[Dr. Su-Nui Escobar, DCN, RDN] 11:14:13
You test yourself. You actually have the gene. You know that you're more likely to develop breast cancer.
[Dr. Su-Nui Escobar, DCN, RDN] 11:14:22
What do you do? What nutrition advice what nutrition habits will you make sure that you follow to minimize the risk.
[Dr. Su-Nui Escobar, DCN, RDN] 11:14:32
Of that gene expressed and getting you with a disease that is very significant.
[Dr. Su-Nui Escobar, DCN, RDN] 11:14:41
And I think in a way Yes, having sometimes that like the knowledge that you have the gene will be more impactful, will give you that urgency of I better get my act together and I make sure that I like do what I need to do. I will make sure that I have mammograms every year. I'll make sure that I follow that lifestyle that is going to
[Dr. Su-Nui Escobar, DCN, RDN] 11:15:06
Decrease my risk. I'm going to drink less alcohol because while other people can drink more alcohol.
[Dr. Su-Nui Escobar, DCN, RDN] 11:15:13
Really that is really increasing my risk. I want to make sure that I manage my way to something that doesn't have to be super skinny. It has to be more on a healthier range.
[Dr. Su-Nui Escobar, DCN, RDN] 11:15:26
And that might look different for every person. I'm going to make sure that I have a lot of foods that have antioxidants. I'm going to have those vegetables. I'm going to have those fruits.
[Dr. Su-Nui Escobar, DCN, RDN] 11:15:40
I'm going to eat less fats. So I'm going to follow all the habits that are going to decrease my chances because not because my My genetics are against my health That is my destiny. That is just information that I know.
[Dr. Su-Nui Escobar, DCN, RDN] 11:15:58
That can help me. In a way feel more motivated to do the right thing.
[Stephanie Gandomi, MS, CGC] 11:16:06
Interestingly, and though many, as we know, all of us who are genetic counselors on the call You know, we struggle with getting patients to like the appropriate patients to the testing right so you know, it's interesting to see where genetic counselors and nutritionists and other providers come together to help the patient
[Stephanie Gandomi, MS, CGC] 11:16:29
And I feel, you know, for me personally as a genetic counselor, it feels always like we're still struggling to get the patient the information they need, right? So even though This sounds amazing and it really would work very well for a patient
[Stephanie Gandomi, MS, CGC] 11:16:43
There still are so many patients out there or people out there with predispositions that don't even know they have it because they can't get access to care.
[Stephanie Gandomi, MS, CGC] 11:16:52
So this is definitely an emerging area that We want to continue exploring cross-functionally too with our nutrition and dietitian partners and other other healthcare providers that we work with.
[Dr. Su-Nui Escobar, DCN, RDN] 11:17:07
Absolutely. I feel like just setting up those collaborations, those referrals, because yes, my area of speciality is nutrition, but I also need the other components to truly help my patients.
[Dr. Su-Nui Escobar, DCN, RDN] 11:17:21
And I would love, for example, to have more partners that will help with the generic testing or understand even more certain diseases that lead to obesity because sometimes you have someone that is 300, 400 pounds And you are suspected maybe that you know it's
[Dr. Su-Nui Escobar, DCN, RDN] 11:17:41
It has some strong genetic component, maybe a disease but Many dietitians will not know that They maybe need a referral to a specialist that can figure out more. And sometimes even the physicians might not think about this So I think when we come together and we understand more what each other
[Dr. Su-Nui Escobar, DCN, RDN] 11:18:06
Do, then we can move forward and truly the patients are needed.
[Stephanie Gandomi, MS, CGC] 11:18:11
Yeah, absolutely. For those of you who are genetic counselors on the call, our SCU Health Center has chiropractic, acupuncture, Ayurvedic, and Chinese medicine services available. So if you are seeing patients who are have have BRCA positive and they're still trying to either they're going through chemotherapy or they're proactively trying to um
[Stephanie Gandomi, MS, CGC] 11:18:40
Prevent onset of disease. We do have some services. We're looking at some nutrition programs potentially at SCU in the future.
[Stephanie Gandomi, MS, CGC] 11:18:48
But at least know that those services are available and those services can actually also I mean, not so much acupuncture and chiropractic, but Chinese medicine and Ayurveda can be provided through telemedicine. So that is something that is available and
[Stephanie Gandomi, MS, CGC] 11:19:04
And then I think we just heard from Golden Genetics before from Natalie Sampson. She does some of the nutrigenomics. So there is a way and then Dr. Escobar does the nutrition. So there is a way to work interprofessionally with other healthcare providers if you have patients who are asking about what to do once they've received a positive genetic test.
[Dr. Su-Nui Escobar, DCN, RDN] 11:19:27
No, and that will be like some that that is something that is so scary that having the resources and the support really can make a difference in someone's life.
[Stephanie Gandomi, MS, CGC] 11:19:37
Yeah, we're starting to see more and more You mentioned it, you know, Harvard, Stanford, UCLA, there are some major academic centers who have created integrative and functional medicine like divisions or parts of their medical school because they are trying to look at ways to
[Stephanie Gandomi, MS, CGC] 11:19:58
Interprofessionally work together with nutritionists and other healthcare providers to help patients, you know, even mindful mindfulness-based practices, stress reduction Which we'll hear in a little bit from Abigail. Abigail Turnwald, Abby, about stress reduction and just some of the things that you need from more of a support system but
[Stephanie Gandomi, MS, CGC] 11:20:19
In order to take care of that whole patient. And it has to be everything. It has to be nutrition, stress reduction, diet.
[Stephanie Gandomi, MS, CGC] 11:20:26
Emotional support. It's not just the test, right? It's more than that so
[Dr. Su-Nui Escobar, DCN, RDN] 11:20:32
Yeah, it's part of that. And I've seen even not with integrative medicine but like with, because I feel like that has always been more the holistic approach. But I seen it more in mainstream medicine Where now you go to conferences where you have like the National Kindle Foundation, the American Diabetes Association, their guidelines and their conferences are more inclusive of other professions.
[Dr. Su-Nui Escobar, DCN, RDN] 11:20:57
To kind of work together in a patient as a whole rather than this is my part. And this is yours and we don't mix, but rather how we connect.
[Dr. Su-Nui Escobar, DCN, RDN] 11:21:09
To like improve the health of a patient.
[Stephanie Gandomi, MS, CGC] 11:21:12
Yeah, I agree. Thank you very much. What a great presentation. I'm going to open it up for any questions. Please feel free to stick them in the chat.
[Stephanie Gandomi, MS, CGC] 11:21:21
We have a few minutes left.
[Stephanie Gandomi, MS, CGC] 11:21:29
So thank you so much for, so this is from Anna. Thank you so much for detailed overview of how Mother's nutrition can affect the fetus in utero. Does mother's nutrition during breastfeeding?
[Stephanie Gandomi, MS, CGC] 11:21:38
Have the same effect on child's development.
[Dr. Su-Nui Escobar, DCN, RDN] 11:21:42
It's an excellent question. It has So what the mother is during breastfeeding is less impactful to the baby's health.
[Dr. Su-Nui Escobar, DCN, RDN] 11:21:53
Because somehow the body produces what it needs to produce for that baby. However, the good nutrition is important for the mother. Hydration is very important for the mother.
[Dr. Su-Nui Escobar, DCN, RDN] 11:22:05
And also just the fact that the women breastfeed, that can have like lifelong health benefits for the baby i mean from higher IQ to less risk of chronic conditions such as diabetes, obesity, cardiovascular disease. So it is like wonderful.
[Dr. Su-Nui Escobar, DCN, RDN] 11:22:29
Help. And very interestingly When a woman breastfeeds, the baby learns a little better that eating when you're satisfied and eat when you're hungry. Mothers are not like stick to a bottle where, oh, that baby needs to eat four ounces. So they naturally let the baby
[Dr. Su-Nui Escobar, DCN, RDN] 11:22:53
Learn some of the eating responses that are beneficial and that later on we call mindful eating.
[Stephanie Gandomi, MS, CGC] 11:23:02
There's a question from Sarah. You mentioned GLP-1 a few times, and this is a newer on the scene medication.
[Stephanie Gandomi, MS, CGC] 11:23:09
In obesity context, is there any data on fetal or breastfeeding effects?
[Dr. Su-Nui Escobar, DCN, RDN] 11:23:16
At this point, they are not conducting studies with anybody that is pregnant and there's no studies determining the safety of pregnancy and they're actually what they're telling people is do not get pregnant within a year of using these medications.
[Dr. Su-Nui Escobar, DCN, RDN] 11:23:35
Now, I'm sure that is happening because there's one big thing. Sometimes excess weight make it make it a lot harder for women to get pregnant so They lose the weight and boom, they get pregnant. So unfortunately, there's no safety studies and definitely i will not recommend because
[Dr. Su-Nui Escobar, DCN, RDN] 11:23:55
We don't know yet. They're newer for weight loss. They're a little older for diabetes management, but wait a second because now they're approved for renal disease, they're approved for sleep apnea.
[Dr. Su-Nui Escobar, DCN, RDN] 11:24:09
So you're going to see them even more than we are seeing them now.
[Stephanie Gandomi, MS, CGC] 11:24:15
Actually, I have a question. If anybody on the call is a prenatal genetic counselor, are you seeing GLP-1 in your prenatal counseling sessions? And if so, what are you saying to patients for any teratogenic risk.
[Stephanie Gandomi, MS, CGC] 11:24:30
Is that something that's happening more frequently? Because that was not in my world when I was a prenatal GC.
[Stephanie Gandomi, MS, CGC] 11:24:43
Maybe we don't have any prenatal GCs. Today.
[Dr. Su-Nui Escobar, DCN, RDN] 11:24:47
I mean, that will be very interesting because I feel like these drugs have infiltrated all the different parts of medicine.
[Stephanie Gandomi, MS, CGC] 11:24:53
Yeah.
[Dr. Su-Nui Escobar, DCN, RDN] 11:24:58
I do some liver transplant and I'm seeing a lot more patients on liver or pre-liver transplant pre-kidney transplant on GLP-1 mitigations to get into the list.
[Stephanie Gandomi, MS, CGC] 11:25:11
Oh, wow.
[Dr. Su-Nui Escobar, DCN, RDN] 11:25:12
Transplant so transplant. You know, it doesn't matter where you work i'm sure you're going to start if you're not seeing them now, you're going to see more patients. So it's important that we know how they work and all the
[Dr. Su-Nui Escobar, DCN, RDN] 11:25:24
Challenges with nutrition to be able to best help our patients.
[Stephanie Gandomi, MS, CGC] 11:25:29
Mm-hmm. Any other questions?
[Stephanie Gandomi, MS, CGC] 11:25:36
Thank you so much for the interesting talk. Is there a separate link for the evaluation for the session? Yes, let me put that into the chat. So if you are getting CEUs.
[Stephanie Gandomi, MS, CGC] 11:25:51
I'll put that in right now. Okay, there you go.
[Dr. Su-Nui Escobar, DCN, RDN] 11:25:54
And thank you so much for the kind words.
[Stephanie Gandomi, MS, CGC] 11:25:57
Thank you. Thank you so much. It's been such a pleasure getting to know you and thank you for your time with us today.
[Stephanie Gandomi, MS, CGC] 11:26:06
Let's look and see no other questions. So we'll let you guys
During pregnancy, maternal diet significantly influences the epigenome of the fetus. Nutritional imbalances can lead to epigenetic alterations, impacting gene expression and future health outcomes. Both undernutrition and overnutrition in pregnant women can result in lasting changes in gene expression, affecting metabolism, weight regulation, and disease risk in their offspring.
Animal studies have shown that insufficient protein intake during pregnancy is linked to compromised immune response, increased oxidative stress sensitivity, metabolic abnormalities, and glucose dysregulation. Individuals who are plant-based or of low socioeconomic status are more susceptible to protein deficiency. It is important to monitor protein intake and quality in expecting mothers.
The Dutch Hunger Winter study (1943-1947) demonstrated that malnutrition exposure in utero can have long-term health consequences. Babies exposed to malnutrition had higher rates of schizophrenia and affective disorders. They were also more prone to high-fat diets and early onset cardiovascular disease, glucose intolerance, disturbed blood regulation, and kidney disease. Women exposed to famine in utero were more likely to develop central obesity and higher mortality rates from cardiovascular disease, cancer, and breast cancer. Men faced an increased risk of anxiety, depression, and reduced physical performance.
Maternal obesity and overnutrition can also cause epigenetic alterations during pregnancy, influencing fetal and neonatal phenotypes. Pre-pregnancy overweight and obesity increase the risk of higher birth weight and offspring overweight and obesity. Overeating during pregnancy may cause permanent changes in the fetal brain, especially in appetite regulation pathways. Alterations in leptin and insulin signaling can affect hypothalamus development, influencing future eating behaviors. Such changes can result in higher energy intake, greater adiposity, altered food preferences, and body composition after birth.
Maternal BMI is linked to increased systematic and placental inflammation, affecting various organs and systems. A high-fat diet in mothers can trigger inflammatory pathways, leading to insulin resistance in fetal adipose tissue and impacting organ development, increasing the risk of metabolic disorders in offspring and contributing to childhood obesity through fetal metabolic programming. Early metabolic disruptions can permanently alter organ function, metabolism, and gene expression, affecting future generations.
A study comparing baby weight correlation with biological vs. surrogate mothers indicated that the womb environment makes the biggest difference. Another study on bariatric surgeries showed that children born after maternal bariatric surgery have a lower obesity risk, suggesting maternal metabolic improvements can reverse epigenetic risk.