Reshuffle the deck on your genes

My friend and colleague, Dr. Dean Ornish, is the lead author of a ground-breaking study, just published in the Proceedings of the National Academy of Science, that suggests nothing less than the concept of "Nature versus nurture" is flawed, and obsolete. We can, it seems, nurture Nature.

The trial in question, called GEMINAL, was a pilot study in 30 men with early-stage prostate cancer. Because the cancers were not advanced, these men were candidates for 'watchful waiting,' close medical supervision without surgery, radiation, or chemotherapy.

Instead, they were enrolled in an intensive lifestyle intervention--closely modeled after the Lifestyle Heart Trial run by Dr. Ornish some years ago. The program included a very low-fat, plant-based diet; daily exercise; daily meditation; and a social support group. The intervention lasted three months, with various measures obtained at baseline and following completion of the program.

Many of the usual measures of overall health were tracked in this study: weight, blood pressure, cholesterol levels, and so on. They all improved significantly, as one would expect. The PSA, a tumor marker for prostate cancer, improved very slightly.

But what makes this study unique--and ground-breaking--is that it measured health markers beyond the list of usual suspects. Using advanced laboratory techniques, the investigators measured the effects of the intervention at the level of the genes.

What they found was remarkable. By examining prostate biopsy specimens before and after the three-month intervention, they saw significant changes in gene activity. Roughly 50 genes became more active in generating RNA, and nearly 500 became less active. The pattern of change observed in gene activity was all associated with lower risk of cancer development and progression.

We have long known that lifestyle has a powerful influence on health across a wide array of outcomes. It will not surprise you to hear that eating well, being active, controlling your weight, managing stress, and not smoking, for instance, can influence your fate.

But we have tended to think in terms of “Nature versus nurture,” as lifestyle and genetic influences on health as independent, and potentially competing, forces. This study changes the game. It suggests that lifestyle and genetics are not independent after all, but interact. Even our genes are influenced by lifestyle choices.

To a Preventive Medicine specialist like me, this is of profound importance. Complacency and fatalism are enemies of disease prevention. For many people, the notion that their medical destiny is written in their genes is a disincentive to take matters into their own hands.

The lifestyle intervention in GEMINAL was rather intense, allowing only 10% of calories from dietary fat, and requiring more than an hour and a half of exercise and meditation daily. We don’t yet know if less intensive lifestyle approaches would influence genes as this program did. And the current work is, admittedly, only a pilot study, limited to 30 men with prostate cancer. More research will be required to prove what it suggests. But what it suggests is quite provocative enough for now: Take good enough care of yourself, and even your genes will get a makeover.

Healthful behaviors are not a mere attempt to bluff our way through whatever genetic hand we were dealt. They are, it turns out, an opportunity to reshuffle the genetic deck in our favor.



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