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If you have a strong family history for Type 2 diabetes or a genetic Predisposition is it kind of clear that You're gonna get it no not at all even If you've had gestational diabetes which Dramatically increases your risk of type 2 diabetes and have a family history of Type 2 diabetes and have a high genetic Predisposition you still are in control Potentially of whether or not you Develop type 2 diabetes Oh I'm Dr Brett Shear the medical director At dietdoctor.com and this is a great Example of epigenetics and genetics and We've talked about this before we've had Dr Lucia Ronica from Stanford to talk About this that basically genetics sort Of set the path the potential path but Epigenetics Alters how that path is Expressed meaning we have control over How a lot of our genes are expressed so There's a study I want to talk about That really shows us in pretty dramatic Fashion and then tie it back to what it Means for you if you're at high risk of A certain condition and what you can do To potentially lower the the Manifestation of that especially type 2 Diabetes which is so prevalent so the Study is called modifiable risk factors And long-term risk of type 2 diabetes Among individuals with a history of Gestational diabetes mellitus

Prospective cohort study and it was Published in the British medical journal Or bmj and with this study it was it was Basically you know one of these Prospective studies that which is a Little bit lower quality evidence but Was a huge cohort that they followed Over 28 years and they found those who Had they took the subset of those who Had gestational diabetes so developed Basically diabetes while pregnant But didn't have diabetes before and they Followed those those individuals out and Of the 4275 people who had gestational diabetes Women of course 924 eventually developed type 2 diabetes And what they wanted to do was say okay What if they were had certain modifiable Risk factors that were normal than what Was their risk and so these modifiable Risk factors were a body mass index diet Quality which alternate healthy eating Index which is you know whole grains and Fruits and vegetables and sort of Standard Standard recommendations physical Activity alcohol consumption and smoking And okay you know usually I'm not a big Proponent of prospective studies as Showing anything but what's remarkable Here is the degree of Hazard Ratio or Risk ratio it is a dramatic change so Not one of these like 1.1 1.2 that we

See so often but much bigger so let's Get into the specifics so first when it Came to body mass index they use less Than 23 as a reference so if you were if They had a body mass index between 23 And 25 the hazard ratio was 2.7 for Developing type 2 diabetes okay that's Significant above two and 25 between 25 And 29 was 5.7 and greater than 30 was 16. now when we talk about difficult you Know drawing correlation and causation And so forth between these studies and You don't know if it's just healthy or Unhealthy user bias I mean a relative Risk ratio of 16 is very noteworthy and That really draws the connection much Stronger that's something to take note Of so body mass index over 30 very Strong correlation now interestingly When they looked at the diet this Healthy eating index Um and initially it was it looked like It also was correlated Um the better the higher the the healthy Eating index the lower the risk of Developing type 2 diabetes but once they Adjusted for body mass index it was no Longer significant and that's pretty Important because when we talk about Diet is it the diet itself or is it just The weight loss and if you're following The standard sort of whole grains fruits And vegetables higher carb diet According to this study it appears to be

Just because of the weight loss now Contrast that with studies looking at Low carb ketogenic diets for treating Pre-diabetes or type 2 diabetes and There it appears the effect certainly Has some weight loss effect because Those diets are very good at promoting Weight loss but the the degree of Improvement appears to be out of Proportion of the weight loss and some Studies showing Improvement even without Weight loss so it does appear that That's likely a better diet for glycemia Control and type 2 diabetes but not that It's the only diet right if you if You're eating a a diet that helps you Lose weight in a healthy way and Maintain a lower body mass index According to this trial you are reducing Your risk of um type 2 by type 2 Diabetes so interesting to see how you Can can can look at diets differently Right with with carb reduction likely Having the greatest benefit but if you Are you know not hungry and you're You're you have a sustainable diet and You're maintaining a healthy weight okay That's beneficial as well so interesting Combination there also interesting Smoking had no independent Association And alcohol had a u-shape so the people Sort of in the Middle Ground Um had the lowest risk now here's what Really gets interesting for me when you

Look at the people who had you know one Optimal of those of those modifiable Risk factors versus two three four and Five here's the different Hazard ratios For developing type 2 diabetes okay Um if you just had one okay there was Really no benefit if you had two the Hazard ratio already goes down to 0.6 if You had three the hazard ratio goes down To 0.3 if you had four it goes down to 0.1 and if you have five it goes down to Point zero eight so point zero eight Whereas 4 was 0.1 so that's really Significant I mean .08 is almost a Complete Um elimination of the risk of type 2 Diabetes with 0.15 being incredibly Powerful as well I mean these degrees of Risk ratios and Hazard ratios are almost Never seen in in prospective studies so This is is really impressive and they Stayed significant when adjusted for Body mass index too now not quite to That degree but still significant when Adjusted for body mass index Now the next part that I find really Interesting is these associations Persisted despite a strong family History and despite a genetic Predisposition so if you had a family History but you had either three four or Five optimal modifiable risk factors Your risk ratios were still 0.37 0.16 And 0.13 so still really dramatic even

With a family history and those who had Genetic susceptibilities were 0.42 or 0.11 for three or four modifiable risk Factors and then at first I was like Well what about five modifiable risk Factors why don't they list a hazard Ratio for that and then as they kept Reading it was because if you had five Healthy modifiable risk factors and a High genetic susceptibility zero people Got type 2 diabetes so they didn't even Report a risk ratio because zero people Got it all right so this is one specific Study right and I use this as an example Because of these impressive risk ratios Because one it teaches us about how to Interpret observational data Prospectives studies that this degree of Of Hazard ratio risk ratio I use them Interchangeably is is very dramatic and And very noteworthy but the other part Is even those people who had a strong Family history or had a strong genetic Predisposition to type 2 diabetes and Had gestational diabetes you can't get a Higher risk group they still Dramatically lowered their Risk by Having five healthy modifiable risk Factors or even four or even three Healthy modifiable risk factors and when It came to at least the way they measure Diet the most important impact of diet Was Maintaining a healthy body weight

So what's the take home for you well the Take home for you is just because you Have a family history of a certain Condition especially type 2 diabetes or Just because you've done a genetic test That says oh you've got genes showing You're susceptible to type 2 diabetes That doesn't mean your diet is cast that Doesn't mean you definitely are going to Get type 2 diabetes it's in my family What can I do about it right I hear that So often as a physician like oh I have It because my family had it no this Means this gives you empowerment this Shows that it is in your control that You can modify those those risk factors And those genes in that family history But it means you have to be vigilant About your lifestyle maintaining a Healthy body mass index not smoking you Know not drinking excessive alcohol Um getting physical activity and Following a healthy diet now what do Those each mean for you that's a tricky Point right what is a healthy diet for You what is adequate physical activity Right the 150 minutes every week of Moderate physical activity it's a good Starting point but more is better moving Your body more is better staying Physically Active throughout the day Plus doing some purposeful exercise not One or the other is the best combination And when it comes to nutrition finding a

Dietary pattern that you can stick with That is going to help you maintain a Healthy body weight without hunger Without Cravings you know low carb or Keto diet is is likely the best for Glycemic control higher satiety eating Is also a good way if you didn't want to Be on a ketogenic diet because that can Help you maintain healthy body weight Without the hunger so finding the one The right diet that works for you and Shows this study shows that you are in Control of your genetics very empowering So I hope this was helpful if it was Please click the Thumbs Up And subscribe And we'll see you here next time on diet Doctor news on YouTube

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