With the attempts to repeal and replace the Affordable Care Act, it is a good time to educate our leaders on an opportunity to significantly reduce the incidence of the most expensive and common preventable, pre-existing condition: What your mother did or didn’t eat when she was pregnant with you.
Yes, it is a pre-existing condition that determines how you die.
Confused? Let me give you a little scientific context.
Recently I was at a scientific meeting when a bloke from South Hampton England, a fellow soccer aficionado with whom I had been hitting the pubs all week, delivered a stunning narrative. Our disease risk (the diseases that will kill us) is in large part determined by what our mothers did or did not eat when they were pregnant with us.
Dr. Tom Fleming is a developmental biologist who has devoted his research career to understanding the Dutch Hunger Winter during the Nazi occupation of 1944. The incidence and severity of common diseases (heart disease, high blood pressure, diabetes, obesity, kidney disease and mental illness) in people conceived during the Hunger Winter increased dramatically even though these people were essentially genetically identical to the Dutch generations that preceded them.
The effects of the Hunger Winter changed the structure, but not the code of their DNA. Molecules normally added to the DNA backbone to control or limit the expression of certain genes were removed. This unleashed a torrent of gene expression that irretrievably increased their risk for these diseases. These alterations are termed epigenetic changes.
Tom developed an animal model to study how these changes come about. His work determined that protein malnutrition early in pregnancy induces the epigenetic changes that increase the risks of Hunger Winter associated diseases. Even more alarming was these epigenetic changes persist through at least two generations, as seen in the offspring of Hunger Winter children. Thus, what you die from is in large part determined by what your grandmother or mother did, or did not eat.
In other words, the conditions that determine your disease risk are pre-existing. And there is little that can be done once this process has been set in motion.
From a teleological standpoint, the obvious question is whether there is a biological advantage to this epigenetic response. After all, biology doesn’t do anything without an overarching purpose.
Tom answered this the following way: If you are a hunter-gatherer in a protein-poor environment, then you need to birth better hunter-gatherers for your lineage to survive. In this scenario, higher blood sugar, and higher blood pressure give you a readily available energy supply and more blood flow to your muscles. This increases your chances of capturing protein rich quarry.
You also must efficiently store energy (in the form of fat) for those lean times in between successful hunts, making you predisposed to obesity. You are hyperactive as well, and thus more vigilant; an advantage when hunting, but a trait that puts you at higher risk of mental illness.
What about advanced heart disease? In a protein-poor environment, after you have procreated and raised your offspring, you shouldn’t stick around too long. It is to no one’s benefit for you to compete with your adult offspring or your offspring’s offspring for scarce resources. For the benefit of your progeny and their progeny, you succumb to heart disease.
As I listened to his presentation, I calculated the annual cost of these diseases in the United States. They account for about a third of health care expenditures in the U.S., or approximately $1 trillion. This, of course, raises the question of how much money we could save and misery we could prevent if only we could optimize nutrition in gestating women.
This last point brings me back to our political leaders who are working on health care reform.
If they want to achieve the dual goals of making the nation healthier and reducing health care expenditures, they have a tremendous opportunity at hand. By developing scientifically guided policies and nutritional strategies to reduce the incidence and severity of these diseases we can save tens of trillions of dollars over scores of years.
The question is: Do we have the will and long-term discipline to address this preventable, pre-existing condition?
Peter F. Nichol is chief medical officer, Medaware Systems.
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