Obesity - Your Genes Are More Responsible Than You Think

Diet (what you eat) and exercise (how much physical activity you engage in) are well-known factors which affect Body Mass Index (BMI) and obesity. However, if you wish to understand how BMI affects
your overall health, a more holistic view of other elements like body composition (lean versus fat mass), food interactions within your system, nutrition requirements (as per current lifestyle) and genetic makeup is
essential.

A classic example of how phenotypic (physical character) variations exist in people: A regular jogger who watches what he/she eats is heavier, has a greater BMI than someone who eats out thrice a week, has a desk job and does not exercise. We all have those thin friends who never need to watch their weight and can eat like there's no tomorrow. Do not blame them... it could be in their genes. However, it is more than just having good genes.

Genes actually execute functions related to fat tissue metabolism, excess fat storage, transport, brain signalling (for those moments when you feel you can eat everything in sight!) and energy conversion. The two most important genetic determinants are the Fat and Obesity-associated gene (FTO) and Melanocortin receptor-4 (MC4R). Be it American, European, African or Indian, there are common variations found in their codes that increase obesity risk and therefore, risk for metabolic disorders, diabetes, etc. An individual who carries such variants has a higher predisposition for excess fat, by causing uncontrolled hunger pangs, lesser satiety after meals and irregular appetite. The MC4R protein is present in the hypothalamus of your brain. When a genetic defect reduces the amount of this protein, you may feel excessively hungry (as energy levels are miscalculated by the brain) and eat food in larger quantities. This directly results in obesity. One such variant is reportedly found in at least 22% of the general population.

A smart person will probably lose weight, and keep it off for years, without going on a crash diet or killing hours in the gymnasium. This is possible through a combination of the right nutrients in daily meals, consistent workout programs, which torch calories and retain lean muscle, consciousness of metabolic requirements for their own body and scientific know-how as well. A little bit of gyan a day will help keep obesity and other evils away!

Written by: Rasika Raman

Type 2 Diabetes and Exercise

The concept of physical activity and exercise has slowly picked up pace in India. People have recognized the shortcomings in their daily routine that adversely affects their health, and consequently are making efforts to stay healthy by involving themselves in regular workouts, may it be hitting the gym, cycling, swimming, jogging, playing a sport or aerobics – there are many fitness choices.

Physical activity benefits everyone, but it is especially advantageous to diabetic people.

Benefits of exercise for diabetics

There are two types of exercises often prescribed. For patients with type-2 diabetes or pre-diabetes, a combination routine is often recommended.

Aerobic exercises

Aerobic exercise can be done at various intensity levels; thus, no matter what physical condition you are in there is an aerobic exercise for you. Aerobic exercise is known to be one of the main reasons for "fat burning." This is because: after about 20 minutes of aerobic exercise the body begins to use its stored fat as fuel. If you do it regularly, your body’s metabolism speeds up and you are able to use more calories even when at rest.

According to recent research just 10 minutes of aerobic exercise 3 times a day, 5 days a week will help your fitness levels tremendously.

It is the duration of the exercise rather than the intensity that matters. A beginner is recommended to start with low-intensity training.

Once you are comfortable with your daily exercise, you can proceed with the moderate level intensity training. Your priority should be to do at least 30 minutes of moderate-intensity physical activity such as brisk walking or swimming every day. This can be two 15-minute sessions or even three 10-minute sessions. To achieve a level of moderate intensity physical activity, you need to notice your breathing and heart rate speeding up and perhaps a light sweat. If you are gasping and unable to talk, you probably require 1-2 minutes rest before getting back.

Eventually, you can step up to the final level, which includes more vigorous training and exercises. Three 20-minute sessions of vigorous physical activity equates to five 30-minute sessions of moderate intensity physical activity. It is advisable to consult your doctor and fitness trainer before you start exercising.

Resistance training/ Strength training

Once you kick start with aerobic activity, you can incorporate resistance training in your regime. Resistance training gives you lean, efficient muscles, and it also helps you maintain strong, healthy bones. This is especially beneficial for you if you have type-2 diabetes, as muscles require more glucose, and increasing their activity can control blood sugar levels better.

Weight training is one of the most used resistance training techniques, although you can use your own body weight to build up strength — think of pull-ups and push-ups.

When you go ahead with a weight training program, make sure you know how to use all the equipment. Ask your fitness trainer to give you a demo on how you should properly use the weights and to learn the best exercises that are suitable for you.

Resistance training repetitions should be performed at a weight that cannot be lifted more than 8–10 times.

Prior to resistance training, it is advisable to do some basic flexibility exercises.

Perform an average of 8-10 different exercises using all the major muscle groups. Lifting weights for 20-30 minutes two or three times a week is sufficient to get the full benefits of strength training.

All these exercises suggested above are usually done in 2-4 sets and repeated 8-12 times.

Information Source: A position statement from Exercise and Sport Science Australia. Journal of Science and Medicine in Sport 15 (2012) 25-31.

The choices are many and choosing the right activity may be daunting. It is best to consult with a fitness advisor before starting an exercise routine. To consult with fitness consultants at Mapmygenome, write to info@mapmygenome.in or call 18001024595.

---

Written By: Arun Kiran
Geneticist, Mapmygenome India

Fight Diabetes with Food

by Jasmine Khurana

The best healthiest world approved foods to fight diabetes are unprocessed whole foods, such as fresh fruits and vegetables. Here are some food choices to manage your diabetes.

	Apples The great saying “An apple a day keeps the doctor away” has been proven right in a study where it is found that eating five or more apples a week reduces LDL cholesterol by 40 percent.
	Asparagus Asparagus is highly rich in antioxidants that help in preventing many diseases, including diabetes and heart disease, by maintaining the blood sugar level and increase in insulin production.
	Veggies Include nonstarchy vegetable in your diet, such as broccoli, spinach, and green beans. These high in fibre and low in carbs foods are perfect for better sugar control.
	Blueberries They have anthocyanins, specific types of anitoxidants, that reduce type 2 diabetes risk by 23% and also shows anti-cancer effect.
	Flaxseeds Flaxseeds are a good source of alpha-linolenic acid and lignans; proved to be good for health by researchers.
	Sweet potatoes Sweet potato a low GI vegetable packed with vitamin A and fiber.
	Salmon and Lean meats For non-veg lovers, having fish, skinless chicken breast and lean cuts of meat in a balanced way keeps blood sugar in control. Chromium present in meat helps insulin to function properly and metabolize carbohydrates.
	Melons Watermelon, muskmelon, honeydew, casaba etc. could be used as alternatives to sugar cravings
	Nuts Most nuts such as almonds, peanuts, pecans etc. consists of heart healthy substances.
	Citrus Fruits Lemons, Oranges, grapefruits constitutes of soluble fiber and vitamin C.
	Avocados They have monosaturated fat content, lowers the risk of diabetes and heart disease as well.
	Oatmeal They have high fibre content; can also help with weight loss. Its slow digestion delays stomach emptying, thus, you feel fuller for long duration.
	Pulses and Beans They have less effect on blood glucose level in comparison to other carbohydrate containing foods. Beans are high in fiber deliver essential minerals, controls glycemic level in the body.
	Cranberries It has abundant phytonutrients which helps in reducing LDL cholesterol, maintain HDL cholesterol, lowering blood pressure and diabetes.

Food to avoid

Food containing high amounts of fat, sodium, carbohydrates, and calories might lead to high cholesterol, high blood pressure, uncontrollable sugar and thus, many diseases.

• Fruits: Avoid Canned fruit with sugar syrup, fruit rolls, fruit punch, fruit drinks, etc.
• Meat: Avoid fried meats, higher-fat cuts of meat and fried fish.
• Veggies Canned vegetables having added sodium, veggies cooked with butter or cheese, pickles.
• Avoid processed grains, white bread, French fries, coffee drinks, cookies and all the high carb beverages and high sodium food products.

Case Study: Cardiomap for Type 2 Diabetes

by Sushma Patil

Introduction

Mr. Akshay (name changed), 28 years, came across an article regarding genetic testing for type 2 diabetes and approached Mapmygenome to know more about it. We scheduled a pre-test counseling for him, during which we collected his clinical history, diet and lifestyle preferences and detailed family history.

Findings from pre-test genetic counseling

Family History

Pedigree chart shows family history of diabetes on the maternal side. Mother, 2 maternal uncles, and maternal grandparents had diabetes. Grandfather died of diabetes-related complications.

Diet & Lifestyle Preferences

Diet and lifestyle information collected from a questionnaire

Genetic Testing

Genetic counselor recommended Cardiomap.

Cardiomap offers genomics-based predictive risk assessment and management panel for cardiovascular diseases and diabetes. This test includes the risk for various heart diseases and diabetes, associated factors and lifestyle factors, as well as drug responses and nutrition and fitness recommendations.

Report Findings

After clarifying all his doubts, he underwent genetic testing. Some of the findings are:

Condition/Trait	Inference
Type 2 Diabetes	High risk
Heart Failure	High risk
Adiponectin Levels	Likely to be low
Homocysteine levels	Likely to be high
Response to metformin	Positive response likely

Posttest Genetic Counseling

During the posttest counseling, one of the major concern which he had was that now he will definitely have diabetes in future. This concern was addressed by the counselor by explaining that it was just a risk profile. That does not mean he will definitely get diabetes. The good part about diabetes is that proper exercise and diet will keep it at bay.

Taking into consideration his personal information, family history and genetic report, the genetic counselor recommended him the following:

Posttest genetic counseling recommendations

He was told to show this report to his physician.

Client’s Feedback

I did know that I am at risk; this result actually confirms it. This will act as a motivating factor for me to start exercising and the diet recommendations are very useful and easy to follow. Will revert to you if in doubt.

TYPE 2 DIABETES MELLITUS

by Rasika Raman

Trends in India and genetic background

India ranks high in the list of developing countries with the greatest number of people affected with diabetes. Estimates from the World Diabetes Atlas and the WHO records place India in the top ten countries in the world with the highest burden of type 2 diabetes mellitus.

• Projected numbers for diabetes in the Indian population - 87 million by the year 2030;

• Highest prevalence found in the urban regions, compared with semi-urban and rural areas;

• Asian Indian phenotype associated with greater risk and earlier onset for type 2 diabetes (a decade earlier than Europeans) - clinical features include increased visceral fat and serum triglycerides, low HDL-levels.

Type 2 diabetes is a "multifactorial" disorder, which means that a complex interplay between genetic and environmental factors underlies the etiology of this condition. Individuals clinically diagnosed with type 2 diabetes complain of a lifelong burden in terms of daily medications, associated liver and kidney complications and dietary restrictions. There is no proven cure for type 2 diabetes, only "management". Since a majority of type 2 diabetes symptoms can be managed through epigenetic intervention, physicians have started calling it a "lifestyle syndrome".

Why genetic screening is useful

Type 2 diabetes is caused by impaired insulin secretion by the beta islet cells of the pancreas. Insulin is a very important hormone for metabolic function and is a key component of glucose "homeostasis" (state of balance). While investigating the mechanisms behind type 2 diabetes development and physiology, scientists have discovered at least 20 important loci (gene locations) linked to insulin function/insulin sensitivity.

Single base variations in the sequence of these genes, called Single Nucleotide Polymorphisms (SNPs, pronounced "snips") increase an individual's risk for developing type 2 diabetes. Screening for all known variations is an uphill task and reduces accuracy. However, large-scale population studies in Indians and Caucasians have successfully elucidated reliable results to help narrow down causal variants which will provide accurate risk scores, while predicting.

Scientific findings from type 2 diabetes-based studies have shown to be consistent across different races and ethnicities, for the genes mentioned above. A screening procedure that analyzes variations in these loci is useful to identify high-risk individuals, to facilitate early intervention and/or delay onset.