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I eat what you eat: Maternal Nutrition and Epigenetics

Potential mothers, new mothers and mothers of multiples often worry about how their nutrition will affect their children. With the high rates of childhood obesity, some mothers worry more than ever about what they are putting in their bodies. Although this could be a discussion that includes pesticides on food, chemicals in cleaners and even air pollution, let’s just focus on nutrition.

 

It has been shown that a strong predictor of a child’s future BMI is the mother’s pre-pregnancy BMI (Schou-Anderson et al, 2012). This prediction comes from two sources, environment (how parents eat directly influences how children eat) and genetics (especially epigenetics). Epigenetics is how our cells control gene expression without changing the core DNA sequence and can include both DNA methylation and histone modification. It is consistently reported that maternal diet can directly alter DNA binding sites (Aagaard-Tillery et al, 2008) and DNA methylation (Dudley et al, 2011) in the offspring of mothers fed high fat diets. High fat diets contain energy dense foods consisting of >45% of total calories from fat, essentially mirroring the typical Western diet, which is full of highly palatable, highly processed energy dense foods. While this is certainly not a comprehensive list of publications on this topic, it is safe to say that maternal diet can influence an offspring’s risk of developing obesity through epigenetics (a nice review here). Hence the idea that whatever you eat, your baby also experiences.

 

While this may not be a novel concept, it is more important than ever to educate mothers (and fathers!) about the influence their diet could have on their future children’s body composition and their overall risk for obesity-associated diseases. While this information may initially leave parents anxiously asking questions like “Is there anything I can do?!”; “Is the damage already done?”; or “What could I have done differently?”, our goal is to provide information that is both reassuring and accurate knowing that with the right nutritional decisions, your child will be just fine!

 

Multiple studies have shown interventions in eating patterns and exercise work for reducing obesity and risk for associated diseases (reviewed here, here, here, here, here etc.).

 

The trick? Implementing these changes in your families diet and exercise routines to change the trajectory that epigenetics may have imposed when your little one was no larger than a grain of rice.

 

Coconut Oil: Medical Miracle or Marketing Miracle?

Walking through the grocery aisles, one thing has become clear: coconut oil has come to officially dominate the store. Since when did everyone swap out the usual oil suspects and go nuts for coconuts?

This is not to say there is anything inherently “wrong” with choosing to consume coconut oil. Coconut oil is tasty and can be part of a healthy diet when consumed in moderation. The problem with coconut oil is that it is being touted as this magical, cure-all substance that can do anything from soothing unrelenting frizzy hair to curing chronic diseases. Further, a survey found that there is a discrepancy in the perception of coconut oil as a “health food” between the American public and those involved in nutrition. The American Heart Association recently published a scientific advisory report that recommended against consuming coconut oil [1]. This was met with scrutiny from various media outlets and healthy living figures on social media. So, let’s take a closer look at the current science behind coconut oil and heart health.

Coconut oil has been a staple food among indigenous populations in India, Sri Lanka, the Philippines, Polynesia, and Melanesia and has more recently made its way into the Western diet [2]. Observational studies of indigenous populations that consume significant amounts of coconut oil have found no adverse effect in regards to cardiovascular disease (CVD) risk [2]. However, these types of studies cannot prove causality and are subject to various biases, including recall bias. Further, these populations were more likely consuming a traditional diet with sufficient polyunsaturated fats, limited refined carbohydrates, and fiber-containing coconut products, such as coconut flesh and flour, which research has found does not increase risk for heart disease [2].

Coconut oil had previously been viewed as an “unhealthy” fat due to its high saturated fatty acid (SFA) content [3]. Upon closer examination, researchers found these saturated fats were primarily comprised of medium-chain saturated fatty acids (MCFAs). Compared to long-chain saturated fatty acids (LCFAs), MCFAs are smaller in molecular size, which increases their solubility in water [3]. Unlike LCFAs, which follow the lymphatic system for absorption, MCFAs are absorbed faster in the intestine into the portal venous system and are carried to the liver to be oxidized for energy [3]. This direct process reduces the amount of free MCFAs in the blood circulation and has been speculated to be a potential cardioprotective mechanism of coconut oil [3].

A recent systematic review has found that coconut oil raises total cholesterol, HDL, and LDL, when compared to cis unsaturated plant oils, whereas butter raises total cholesterol, HDL, and LDL the greatest amount [2]. This suggests that coconut oil may fare better than butter for desirable lipoprotein levels, but ultimately it may be best to choose cis unsaturated plant fats to help reduce risk for CVD [2]. This finding was what encouraged the American Heart Association to caution against consuming too much coconut oil, since the 7 studies included in the review all reported increases in LDL cholesterol, with significance reported in 6 of these studies [1]. However, the current literature for the effects of coconut oil on heart health is relatively sparse and the evidence of an association between consuming coconuts and risk factors for heart disease is mainly of poor quality [2]. Coconut oil has recently become trendy among the health food community, so, while it is probably best to not consume coconut oil excessively, a little bit here and there will likely be fine.

 

References:

  1. Sacks, F.M., et al., Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation, 2017. 136(3): p. e1-e23.
  2. Eyres, L., et al., Coconut oil consumption and cardiovascular risk factors in humans. Nutr Rev, 2016. 74(4): p. 267-80.
  3. Babu, A.S., et al., Virgin coconut oil and its potential cardioprotective effects. Postgrad Med, 2014. 126(7): p. 76-83.

Telenutrition: Reaching More People with Technology

We have all experienced the tedious process of setting up an appointment to see your doctor, PT, RDN, or other healthcare provider. You call their office to schedule an appointment and often have to wait weeks or even months to see them. You take time off work to drive there, you sit in the waiting room, then you wait in the patient room. You see your provider for roughly eight minutes and then you are done (1). The entire experience can take an average of two hours depending on how long it takes you to drive there or how long you have to wait (2).

 

Health care is traditionally structured as a provider-centric service, meeting the needs of the hospitals and doctors. Yet, there is increasing interest by patients and providers alike to provide health care that is more patient-centric, where patients are treated as customers who are interested in convenient and effective healthcare services (3). Introducing telemedicine! A method for providing healthcare services via technology such as video chat, telephonic, emails, or instant chats. This trend began as a means to provide services to people in rural areas with limited access to hospitals and providers. Today telemedicine has gained popularity as a convenient and prefered way to receive healthcare, solving many of the problems with in-person appointments.

 

Telemedicine is shaking up how service is provided, shifting the focus from treating the sick to being an active integrated part of individuals’ health and wellbeing. In other words, telemedicine is a great opportunity to implement preventative services and encourage patients to be involved in their health! Nutrimedy, a telenutrition startup out of Boston is passionate about the promise telenutrition holds in providing a much needed shift in our healthcare system. Karolina Starczak, the CEO of Nutrimedy says,

 

“Telenutrition along with other forms of telemedicine allow for improved access at a reduced cost to patients. As we embrace technology, we are not only helping reduce some of the barriers that patients have to overcome with in-person appointments, but we are also helping them understand how to fit health and wellness services into their day-to-day life. We have embraced the need for preventive and proactive care for decades, but with the help of telehealth we can actually create a less intimidating environment where patients finally feel like a member of the healthcare team and are encouraged to engage in their health”

Registered Dietitian Nutritionists (RDNs) are qualified nutrition experts to provide telenutrition services (4), yet society tends to not know who RDNs are or even how to get an appointment with one. This leaves people vulnerable to trusting nutrition guidance from unqualified personnel. You wouldn’t trust your carpenter to give you medical advice, right? That’s because people know and trust the credibility of MDs. Unlike MDs, RDNs are less known and less accessible, leaving people at the will of any person who gives information about nutrition, regardless of their qualifications. This has been an apparent limitation for Nutrimedy as they utilized RDNs to engage patients in their diets and health.

 

One of our biggest hurdles has actually not been around the video component, but spreading the word about why we are committed to having RDNs as the nutrition experts on our platform. We have found that many people don’t currently understand the training and education of RDNs, so we dedicate time to helping spread the word. Our goal is to make it as easy and seamless for the average person to access an RDN as it currently is to purchase sessions at a fitness studio. And who knows, maybe in the future with every tenth spin class you get a free session with Nutrimedy,” said Starczak.

 

With telenutrition, RDNs have the potential to reach more individuals, making them a common and well known provider in society. Even if the patient is aware of what RDNs do and is interested in scheduling a counseling session with one, very few know how to go about doing so.

 

What I have always found surprising is that when I ask people I meet how they would go about scheduling a visit with an RDN, most can’t tell me. Navigating the healthcare landscape and coordinating services can be disturbingly complex, but with Nutrimedy patients can connect to nutrition experts right through their phone or other device. It saves time and finally makes consults with an RDN simple, so that anyone can receive personalized video counseling and stay connected in between sessions all in one app.”

 

Currently, Medicare Part B will reimburse for approved services that are provided via telecommunication (5). Since nutrition counseling is covered under Medicare Part B, these nutrition counseling services will be reimbursed even if provided via telenutrition. In addition, more than thirty states have passed laws that require private insurance companies to cover telemedicine services (6). As telemedicine services become increasingly recognized as legitimate healthcare services, the use of and reimbursement for these services will continue to grow. Telemedicine has the potential to revolutionize our healthcare system, save money, and engage patients in their health to create lasting preventative changes.

 

  1. M.D, P. W. C. For New Doctors, 8 Minutes Per Patient. Well (1369886512). Available at: https://well.blogs.nytimes.com/2013/05/30/for-new-doctors-8-minutes-per-patient/. (Accessed: 3rd October 2017)
  2. Paying for Health Care with Time | HMS. Available at: https://hms.harvard.edu/news/paying-health-care-time?utm_source=twitter&utm_medium=social&utm_campaign=hms-twitter-general. (Accessed: 3rd October 2017)
  3. The Ultimate Telemedicine Guide | What Is Telemedicine? eVisit® Telemedicine Solution Available at: https://evisit.com/what-is-telemedicine/. (Accessed: 25th September 2017)
  4. Academy of Nutrition and Dietetics. Practice Tips: Telehealth Challenges and Opportunities. February 2017.
  5. Telehealth | Medicare.gov. Available at: https://www.medicare.gov/coverage/telehealth.html. (Accessed: 2nd October 2017)
  6. More than 30 States force Private Insurance to reimburse for telehealth. Available at: http://www.securetelehealth.com/private-insurance.html. (Accessed: 2nd October 2017)