Monthly Archives: March 2015

Why all of the Variability? Genetic Expression and Individual Response

IMG_4197For the most part, you are everything you are because your DNA says so.  Your DNA is like a soft piece of clay that continually is moulded into something different based on what it is told to do.  We are all human but our DNA is not all the same.  Our eyes, hair and skin are different colour, we are different shapes, sizes and personalities; some have diabetes, heart disease, chronic pain, different basal metabolic rates, high blood pressure, and thyroid problems.  Some have arthritis, cancer, lupus, methylation issues, depression, anxiety, ADHD, food sensitivities, and gall bladder problems.  In short we have disease and discomfort.  Everyone has issues.

 

Are these problems due to chance?  To some it would appear so.  When you take a step back and look at the bigger picture of all influencers affecting your DNA, it becomes a much clearer picture.  With genetic research we have an entire universe open to our eyes that we knew was there all along, we just didn’t know what it did and still don’t know to what extent.  We are now getting a clearer picture of what genes are responsible for what processes.

 

Just what are genes, chromosomes and DNA?  Simply put DNA is what carries your genetic information in each of your body’s cells.  It is made up of continuing pairs of just four different bases.  A gene is a section of DNA.  Genes are the hotspots we zero in on that code for all of your body’s processes, from diseases like Huntington’s and cancer to cystic fibrosis and sickle cell anemia.  Genes “express” themselves in various ways, from hair and eye colour, to instructions on how to construct proteins from the 20 different amino acids in your body.  These proteins go on to include themselves in various tasks in the body, like a receptor in a membrane to taking part in a biochemical reaction for a cellular process like making energy.  There are an estimated 20,000-25,000 genes that code for protein synthesis alone.  Genes are packaged in bundles called chromosomes, of which humans have 23 pairs.

 

Now, about the word “expressed”.   Gene expression is the process whereby that gene’s information is used in the synthesis of a functional gene product.

Our genes get expressed in various ways.  Some are obvious like curly hair or how tall you are.  Genes can also express themselves in other ways based on what is presented to them from our diet or your environment.  We are now finding that some genes are able to recognize omega 3 fatty acids and correspondingly have a favorable effect on heart disease whereas some people are missing this gene response.  Fat, protein and carbohydrates all influence genes to respond in various ways.  Vitamins and minerals have the same effect on genes.  A deficiency in a mineral can cause a gene to respond and sometimes the level of that mineral in one person’s body needs to be higher than the next person because of a difference in their genetic makeup.  Heavy metal exposure and other environmental exposures can also have an effect on how your genes respond.

 

The problem is that our DNA isn’t 100% the same.  When our cells duplicate the chromosomes in preparation for cell division, there may be errors in exactly duplicating all of the DNA.  These SNIPS or single nucleotide polymorphisms are minor errors in the new DNA strand that may prevent the gene from working properly.  Some genes therefore do not respond the same in all people.  Some genes remain off until triggered to turn on for some reason.  These SNIPs can partly explain the difference in response between two people when taking the same drug,  or needing different doses of the same drug.  It can explain why one person takes a sleeping pill and feels nothing and someone else takes ¼ of the same tablet and sleeps all day.  This leads to obvious arguments as to how badly designed one of the studies was or an issue with the randomization procedure being incorrect.  Perhaps more correctly would be the observation that two different geographical areas were used in each study. Maybe these two areas have inherent differences in their DNA.  It also leads to almost anyone basically being able to hunt down some sort of study to back up what they are saying.  The assumption that a one size fits all medical model may cover everyone begins to fall apart when we look at the way our genes look at the world. It also explains how different systems in the body interact together rather than individual independent systems.

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Individual attempts at large scale health outcomes
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I find it amusing, especially in the world of preventative therapies, the cut-throat competitive atmosphere in what works and what doesn’t; what is a waste of money and what is positively proven.  Unfortunately, virtually all of these claims (positive or negative) come from a claim or conclusion from the latest study.  The study might or might not be well designed, it may or may not have the power to come to the conclusion that it does, and it may be just an opinion.

I am a firm believer in the concept that the sum of what we know is a result of all of the studies we have, not just from one or two studies.   When I stopped selling sugary drinks last year at my pharmacy or as some reported it, “banned sugary drinks”, some claimed I thought I could lower the weight of those in the village of Baddeck by “controlling” if they consumed these beverages.  Of course this is quite impossible an expectation and was never the intent.  Just last week a report of no change in obesity trends after a ban on new openings of fast food restaurants in South Los Angeles may have given many the impression that it didn’t matter if you ate there or not.  You were still going to stay obese anyway.

The messages that are lost on this are manifold.  First, there are people out there with good intentions that want to make a start or make some sort of statement if not to just remind you of the need to be healthier, even if there is no immediate measurable outcome.  Second, and perhaps more importantly, maybe the “measurable outcome” is that it spurs someone else to do something with the same intention.  Perhaps it isn’t directly related to the event that inspired the first act.  It could be that someone sees a ban on something and then they start a walking club because they want to be part of a solution to a problem that the first person wanted to fix.   Thirdly, no one is trying to control your lifestyle, regardless of how unhealthy it may be by taking these small steps.  These decisions that are being made are not micromanaging obscure trends, they are trying to apply general proven concepts of good diet and exercise to as large a group as possible.

It is easy to find fault with small measures when they don’t have the results we think they should have.  On their own however, individual changes do very little.  It just depends on how far back you step when you measure results.  One individual in my town getting healthy by my sugary drinks removal is huge.  You may not notice a significant difference when this is spread out over the entire population of the town.  A recent article in Science Daily had the title, “From soda bans to bike lanes: Which ‘natural experiments’ really reduce obesity”.  Being a part of a natural experiment with the Propel Centre at the University of Waterloo with the sugary beverage withdrawal this grabbed my interest.  The article stated that without before and after weight measurements of the population these studies may not have the rigor to come to meaningful conclusions on obesity related outcomes.  While this is probably true, it is difficult to argue the fact that a good diet helps to bring good health.  It is not rocket science at all to determine what diet gives you good health.  Of all of the scientific studies done today, there are very little out there that argue against the fact that calorie restriction and eating whole foods will improve your health.  Will the construction of a hiking trail in a community lower the obesity rate in that community, maybe or maybe not.  The only question is what is the tipping point that cumulative measures like this have a measurable effect.  What we should care about more is that it spurs others to push for ways that make others healthy, not just themselves.

There is a reason why many people don’t litter.  Not only was it driven into our heads as children and adults, but many get the fact that it is a cumulative measure in order to work.  It’s like the sand bag on the pile keeping a flood back.  Some bags aren’t even touching the water, but they all work to accomplish the job together.

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Are Young People Eating Their Way Into Depression

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As a pharmacist I see the alarming rate that antidepressant medication is used, especially in young people.  Along with this use, anti-anxiety and sleep medication are also one of the most commonly used medications that leave my pharmacy.  Statistics tell us that the number of patients diagnosed with depression increases by approximately 20% per year, that roughly 10% of us experience depression like symptoms at some point in our lives and that 80% of those with these symptoms never receive any specific treatment for their condition. (Healthline).  More alarming is the decreasing age of onset of diagnosed depression in our young population.  It is common for me to see parents of teenagers that are suffering from depression and anxiety.

When we look at a map of the world that shows the global distribution of depression, it looks much like a lot of other global distribution maps for diseases like cancer and obesity.  The “Western” type societies stand out.  Western refers to many things but for this purpose it refers to what is introduced into our bodies in the way of our diet.  The increase in the omega 6 in our foods over the last 60 years and certainly since the introduction of farming has taken our roughly 1:1 omega 6 : omega 3 ratio to something closer to 16:1.  This increase of omega 6 into the food chain via the way we feed our farm animals has drastically changed our once anti-inflammatory food to an inflammatory type diet that our DNA was not designed to function with in a healthy manner.  Added to this is the introduction of vegetable oils and omega 6 based oils that don’t spoil as easily as their omega 3 counterparts.  This leads to easier distribution of the food to its destination. These two fatty acids compete for the same enzyme systems in the body with opposite effects.  There is virtually no omega 3 in safflower, sunflower, corn, cottonseed, sesame and peanut oils.  Flax has more three than six and walnut, canola and soybean at least show some omega 3.

Consumption of omega 3 oils and fish in the diet has been correlated with a lower rate of depression as well as post partum depression, bipolar disorder, seasonal affective disorder as well as suicidal ideation. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC533861/ .  More specifically, Krill oil, with naturally occurring phospholipids and a higher concentration of EPA/DHA omega 3 fatty acids has shown even better results.  Epidemiological, lab and clinical evidence shows a positive result in numerous studies.  A number of different mechanisms have been postulated for this effect, and an increase of distribution of food from the affected countries to worldwide destinations threatens the mental state of those countries as well. http://www.ncbi.nlm.nih.gov/pubmed/12442909

Although fish is often thought of as a common source of omega 3, there are plant sources available.  Quite often these plant sources supply alpha linolenic acid (ALA), the parent compound of EPA and DHA.  This conversion from ALA to EPA/DHA is inefficient in the human body however so it is more desirable to get the EPA/DHA supplement. (Rebecca Long, Omega-3 Fatty Acid Deficiencies: How Our Modern Diet Has Made Us Unhappy)

Getting back to your kids and our young population that are experiencing depression more often.  Although I always recommend GI repair and probiotics to increase serotonin and improve mood in these patients, a key ingredient to any mental health protocol should always consider a measure of omega 3 and 6 via a simple blood spot test and corresponding supplementation with omega 3, and then a retest.  Personally, 4 g daily for a month of EPA/DHA increased my omega 3 markers in the blood positively but even with this higher dose there was still room for improvement in the omega 3 score in the blood.  It is important to remember that you are not suffering depression because of a physiological deficiency in an antidepressant and this disorder and anxiety do not occur randomly for no reason.  I sell antidepressants daily as prescriptions, I see the side effects they produce and I regularly steer patients towards omega 3 and probiotics for depression.  It’s important to not change your prescription therapy without discussing it with your doctor.  Those on blood thinners may need to use extra caution when using omega 3 supplementation.

You are what you eat

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A Simple Six Week Challenge to Extend Your Life
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dan and bryceA 200 pound person burns about 150 calories during an average brisk walk of 2 km on a level path for 25 minutes.  These are a lot of numbers to keep track of but if you did this daily for just 6 weeks (a month and a half) you would get 1050 minutes of exercise during that time and burn over 6000 calories at least.   Now most walks over 2 km will have some hills involved, big or small so it is possible that this calorie estimate could be higher.  Regardless of the debate of how many calories it takes to really burn a pound of fat (often quoted as 3500 calories), I defy you to do this for 6 weeks and only be down 2 pounds.  The number of pounds dropped after this type of simple regimen will often exceed this significantly.  Keep in mind it’s best to check with your doctor if you have chronic medical conditions before doing this.

In fact, before you start, ask your physician to take a baseline reading of a few simple biomarkers (blood pressure, cholesterol, blood glucose, and total body weight).  By the way, we can do all of these numbers including body fat percent and hydration at Stone’s Drug Store.  With the weather improving this plan can be achieved better now than 2 weeks ago.  This will bring you into the second half of April, a time close to May 1st, a date that we start thinking, “why didn’t I follow through on that New Year’s resolution” or “why didn’t I make that New Year’s resolution” and “wow the Summer is coming and I am out of shape again this year.”  Imagine the motivation in saying, “I’m glad I started this back in March.”  Imagine the momentum that is in motion at that point, all from just walking for less than 1/2 hour a day, especially when you revisit the biomarker numbers above and realize how much of a change results from such a small effort.

There is one catch.  Preventative results like cancer prevention click in only when this increase in physical activity is combined with a diet of five fruits and vegetables daily.  So do that.  This is not rocket science.  In fact you can walk to the grocery store, get your healthy food and carry it home.  In regards to other disease states like arthritis, parkinsons, psychological symptoms, diabetes, hypertension, hyperlipidemia, sexual dysfunction,  stress, hormone issues, sleep apnea, and and many chronic diseases all have been shown to respond favourably to this type of activity level.  Do any of these describe you?

So, before your six week window runs into next Fall, start tomorrow.  Just 25 minutes of walking, even if it’s just on your lunch break, for just six weeks. We’ll see you on April 22nd, just before May starts your Summer panic to be in shape for your summer clothes.  If the way you look during the Summer isn’t a motivating factor, how about adding years onto your life as a motivator?

Remember: 25 minutes per day, every day, for six weeks.  This gives you 1050 minutes of exercise.  Perhaps 1000 more minutes of exorcise more than you had planned for the next six weeks.  That’s it.  If you’re really half serious about this, then get your five fruits and vegetables daily and really just watch what you eat.  Take water with you on your walk. NO fruit juice, pop, or vitamin water – ever.  If you need a friend to accomplish this then get one that you want to see live longer and extend their life as well.  Good luck and keep us up to date on your progress over the next month and a half  (graham@stonespharmasave.com or Stone’s Drug Store on Facebook) and we’ll share it with everyone to help motivate them!!

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Pop Withdrawal From a Pharmacy and the new WHO Sugar Recommendations
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In response to my decision to remove sugary drinks from my pharmacy in September of 2014, there seem to be the odd lingering claim that “…targeting the sale of one particular category is not going to have a significant impact [on obesity]”, and that “information – not restriction – is key.”

While we agree with the point that obesity is a complex, multifactorial problem, it is completely baseless, in fact hovering on outright deception, that extra calorie intake does not increase your weight. In 2013, the journal PLOS Medicine published a systematic review of systematic reviews, which are the most comprehensive forms of evidence that we have. This review by Bes-Rastrollo and colleagues found that 83% of reviews not funded by the beverage industry a relationship between sugar-sweetened beverage consumption and weight gain. On the other hand, 83% of the reviews that were funded by the industry found insufficient evidence to support a positive association between sugar-sweetened beverage consumption and weight gain or obesity.

Also keep in mind metabolic disease which has also been shown to increase with consumption of these drinks and is one of the main reasons we pharmacists see our customers (high blood pressure, increased cholesterol, increased abdominal obesity, and insulin resistance). For example, a 2010 meta analysis in the Journal of Diabetes Care of over 300,000 subjects found that those that consumed the most sugary drinks, one or two per day (pop, juice, vitamin water, iced tea and energy drinks) had a 26% greater chance of developing type 2 diabetes than those that drank none or 1 serving per month.  They concluded that weight gain and metabolic syndrome correlates positively with consumption of these drinks. The New England Journal of Medicine published a study in 2011 which followed over 120,000 people and concluded that one 12 ounce sugary beverage serving a day increased their weight more than those that did not consume this beverage. Finally, a 2012 study in Circulation followed 40,000 men and found a 20% higher chance of having a heart attack or dying from a heart attack when one can of sugary beverage per day was consumed compared to men that didn’t.  This was verified by a second study.

Calorie consumption from all sugary beverages combined has continued to climb each decade, especially among children and teens.  By coincidence, today, the World Health Organization is changing its recommendation for daily total consumption of sugar to 6-12 teaspoons daily.  This would be exceeded by consuming even one can of soda.  Finally, we are seeing revised recommendations on sugar that follows science.  The new recommendation now recommends free sugars being as low as 5% of total calories, meaning a serving of orange juice is off limits – imagine, a recommendation that pushes you to eat the fruit instead of drinking the juice.  Brilliant!  There is now a separation of total sugars and free sugars.  The total sugar concept meant you could gobble up your calories with juice and pop, but now it’s considered free sugar.

The withdrawal of sugary beverages from Stone’s Pharmasave in Baddeck was not meant to “ban” pop sales, and I certainly do not expect to see a drastic change in obesity levels in my town as a result of my decision. I made this decision to help educate my customers on the effects of sugary drinks.  I therefore agree that education is an important component of healthy eating. However, in keeping with recommendations from world experts in obesity research (see the 2015 Lancet Obesity Series), I am also aiming to move beyond education by starting to create an environment in my store that is supportive of healthy food choices.  As a pharmacist, I know I shouldn’t sell tobacco, no matter what the industry claims. I don’t feel I should sell sugary beverages, either.

 

 

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