DNA, Dunkin' and Dingbats

DNA, with rare exception, is not destiny. Dinner is -- to a far greater extent than most realize, or than our culture seems inclined to put to any good use. Lifestyle can alter gene expression; we can nurture nature.
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In the heady days of the genomic dawn -- not all that long ago, really -- we dreamed of dominating our DNA. Our hopes -- born in retrospect of characteristic Homo sapien hubris -- ran to wrestling with wayward ribonucleic acids; tinkering with our telomeres; and in all ways that matter, getting genes to genuflect to the power of our science. We thought, in short, to find the causes and impose the cures for our prevailing ills within the twists and turns of that double helix.

We were wrong. Chronic diseases are not the result of one wayward gene; they are, inevitably, polygenic to the extent they are genetic at all. Even if they were ascribable to one gene gone awry -- we still, for the most part, don't know how to fix alleles we happen not to like. DNA accounts for who we are, but is not accountable to us.

And so those early genomic hopes have gone, if not yet entirely the way of expertise, much in that direction. More than a decade into this new era, hope has abated.

There is, however, a case to make that hope had a rough ride because it was headed in the wrong direction all along. We subscribed en masse to the nature/nurture debate, thinking there was a choice to make. Instead, we have generated clear and compelling evidence that we can nurture nature. Genomic hopes may have diminished, but epigenetic hopes have flourished in their place. There is ever more evidence to indicate that how we behave alters how our very genes behave.

Of course, if we had been paying attention, we might have realized this long ago. Large migration studies, notably Ni-Hon-San, demonstrated dramatic changes in health outcomes as genes remained constant, but cultural influences changed. We got the memo; we just never read it. The peoples around the world who live the longest, live the best, get sick the least, are the happiest, have the most fun, and are most prone to go gently when that time does come -- do not have healthier genes. They have healthier lifestyles, in the context of healthier cultures.

All the while we were learning that our genes would not yield readily to our laboratory derived manipulations, we just kept runnin' on donuts. We were being told daily, as we still are, that America runs on Dunkin' -- and everybody seemed to be ok with that. Of course, we were never shown any data to indicate that it was a good idea. Since we live in an age of rampant obesity and chronic disease largely fueled by dubious dietary choices, I am, also... dubious.

But we just kept on keeping on, while looking for a genie in the genome. We kept marketing multicolored marshmallows to children as "part of [their] complete breakfast." We greeted the most recent disclosures about willful adulteration of our food supply with a collective yawn. We chose to ignore the fact that food companies were engaging high powered teams to maximize the calories it took for us to feel full, and instead bogged down in pointless debate about the relevance of calories. Naturally, we just kept getting fatter and sicker.

How did it ever occur to us that we could manhandle our DNA, but do nothing about the exploitations of Madison Avenue? How were we ever so benighted to think that we could cudgel our chromosomes into submission, but never muster any righteous indignation at the willful engineering of food designed to generate profit at the expense of our health -- and the health of our kids? How did we ever think to promote health within the twists of the double helix, while doing next to nothing about pork-barrel exploitations within the halls of Congress?

The trouble with culture, perhaps, is that you become blind to it for swimming in it. It becomes something you look through, but don't see; the constant background noise you forget to hear. You habituate to it so fully, changing it never occurs to you.

But of course, unlike unfortunate strands of DNA, we can change objectionable elements of our culture. We devised it. We own it. We control it. Unlike genes, culture is accountable to us.

But instead, we go the other way -- compounding our dysfunction, and encumbering our interactions with culture with only the follies of our genomic forays. We seem inclined to neglect at the level of our culture the most indelible lesson learned from intimate exploration of our DNA: there isn't just 'one' answer. Looking for single, isolated genetic causes of major chronic diseases -- we found none. The genes contributing to chronic disease are multiple, interactive, and all subject to outside influences.

The same is true of lifestyle factors. Living well involves a cluster of activities, all of which influence the others. It is easier, for instance, to eat well and be active when well rested from adequate sleep. It is easier to sleep well when stress is not out of control.

Instead, though, we perpetuate the foolish and distracting hunt for a scapegoat or silver bullet, all the while missing the forest for the trees. Don't worry about living well -- just down coffee with a dollop of butter. Let's blame sugar for the former indictments of salt -- rather than accepting that by choosing wholesome foods in sensible combinations, our intake of both would decline.

We continue to look for, at the level of culture, what we failed to find in our chromosomes. We propagate at the dinner table the mistake we made when parsing our DNA. It is enough to make one give up on us.

But we can't; we've all got skin in the game. Our own skin, and the skin of people we love. For our sake and theirs, we have to soldier on; sort through this; and get there from here. But we will have to stop going in circles first.

I invite you to decide for yourself what to call a culture that spends vast fortunes, and squanders years from life and life from years, pursuing a wild goose; all the while doing next to nothing with the beautiful bird firmly in hand. If it were up to me, I'd be tempted to go with: "flock of dingbats." I know -- I should tell you what I really think. Sorry to be so blunt about us -- but sometimes, the truth hurts.

DNA, with rare exception, is not destiny. Dinner is -- to a far greater extent than most realize, or than our culture seems inclined to put to any good use. Lifestyle can alter gene expression; we can nurture nature.

We have that knowledge, just like that bird, reliably in hand. We could, any time we decide we are ready, add years to life and life to years; we could eliminate fully 80 percent of all chronic disease. We could get there on our own, with the requisite skillpower, working against the prevailing forces of our culture. Better, though, would be to reorient the forces of our culture so they blew toward, not away from, health. We have the knowledge we need to do just that.

But knowledge of how to clasp a luminous prize is not power to inattentive fingers. Knowledge of how to get there from here is not power -- for a flock of apparent dingbats, flying in endless circles.


David L. Katz, MD, MPH, FACPM, FACP finds that flying in circles tends to make him dizzy and inclined to throw up.

Director, Yale University Prevention Research Center; Griffin Hospital

Editor-in-Chief, Childhood Obesity

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