Bariatric Surgery

Well, you know, we've all heard about this epigenetics recently, haven't we? What is epigenetics above genetics? Something that's controlling how our genes are ultimately expressed. Something that regulates our function that's more than just our parentage. And we now know the environment plays a role in that. Like stress can play a role, environmental chemicals can play a role, our diet can play a role. Like folate deficient diets can alter our epigenetic imprinting and alter how our genes are expressed and put us at higher risk to certain diseases, like cancer, for instance. So this is a kind of a very remarkable change in our thinking about how our genes are ultimately transmitted into our function, how we look, act and feel. It's more than just an application card that we never filled out from our parents who gave us our characteristics. It's more how those characteristics ultimately get expressed as a consequence of the experiences that we have in life. Well, that is really a theme that was mirrored in this recent paper that's quite remarkable, talking about bariatric surgery. And I think this is one of those papers that just, you look at it and go, my word, really. Let me tell you a little bit about this. So, as you know, there is a rapid increasing incidence of bariatric surgery now for managing obesity. And in those surgeries individuals lose weight, obviously, at least hopefully they will, and they alter their physiological function. The question is, as they alter their physiological function, does it change at all the outcome of their children who ultimately would be born to them as it pertains to their predisposition to diabetes? Now this sounds very Lamarckian, doesn't it? It sounds like something is being transmitted from the mother by adapting to her environment through bariatric surgery. It's a very novel type of concept. So do the children have a higher risk to obesity or to diabetes or a lower risk to obesity and diabetes as a consequence of their mother having bariatric surgery and losing weight? Oh, kind of an unusual question, isn't it? Well, this paper that appeared just recently opens this box for a lot of discussion. This is in the Journal of Clinical Endocrinology and Metabolism, a very well respected journal in the end of 2009, volume 94, page 4275. And these workers at the Institute, Department of Surgery in Quebec, Canada, have actually looked at the epigenetic patterning of the mother and the children after the mother had bariatric surgery. And lo and behold, this unique study of children aged 2 and a half to 26 years born before and after maternal anti obesity surgery demonstrated improvements in cardiometabolic markers, meaning the risk to diabetes associated with these adolescents that were attributable to an improved intrauterine environment that was transmitted epigenetically to the children. Oh, my word. Meaning when the mother had bariatric surgery, that obesity tendency that she had, once it was treated by surgery, didn't seem to get transmitted to the children by an epigenetic transgenerational mechanism that then allowed the children to be less free of the risk to obesity and to diabetes and metabolic syndrome than that of their mother. Well, if you think of that just a little bit more, what other effects might be happening other than just obesity and anti obesity surgery that could modulate epigenetically the expression in children? Could it be things that parents have been exposed to, not just the mother, but the father, that epigenetically modify the eggs in the sperm to create a different outcome in their children? Could it be toxic environments, high stress? Could it be sleep deprivation? Could it be. I mean, just go down the list. It could be literally a myriad of different factors that in our environment of today, the 21st century living, could modulate epigenetically the outcome of a pregnancy to set a transmissible factor going forward in that child, either good or bad. In this case, the surgery of bariatric surgery seemed to be a good characteristic, right to the offspring. But one could conceive of other factors that might be less desirable, that could lead to increasing things like the appearance of autistic spectrum disorder or atopy, like asthma, things that might explain these rapid appearances of certain diseases in children that we cannot kind of understand just on the basis of normal Mendelian genetics that occurs over long periods of time. So I just leave you with the thought, maybe there are things we can do rapidly to improve the outcome of health in our society by modulating our epigenetic patterning. It's not all a bad news story. It might be a very optimistic story if we understand what we need to do.