Spanish-language online science dialogue "Precision Nutrition".

Summary:

On 26 January 2022, the Rafael del Pino Foundation organised a lecture by José María Ordovás, principal scientist and senior scientist at the Human Nutrition Research Center on Aging at Tufts University, on "Nutrition for a healthier life".

Nutrition has evolved throughout human history, he said. In the beginning, we ate to survive. More recently, nutrition for pleasure was incorporated. Now we have reached the moment of food as medicine, which leads to precision nutrition.

Obesity is a 21st century pandemic, but it is something that has been with humans since the beginning. Art has depicted it over thousands of years in the venuses, the figures that appear all over the world during the Palaeolithic Age and then in the Ancient Age, the Medieval Age, the Modern Age, in the present age. Art has reflected that obesity was part of the human being.

Something we see today along with the obesity epidemic is misinformation, which has grown exponentially because of the creation of social media, the ease of communicating through the internet. Nutrition is one of the areas that suffers most from this misinformation, from the fact that everyone is an expert on nutrition. In Victorian England, advertisements were already appearing in the newspapers of the time denouncing fat. The miracle solution was to take capsules containing worms. Over the years it progressed and suggested those miracle soaps that removed fat. It has been an ongoing obsession over the decades. Lucky Strike sold cigarettes as a solution to obesity because it prevented you from eating other things. Another more recent advert points to the genetics of obesity and says, like mother, like daughter. Obesity follows a pattern. When this ad ran we didn't know about genetics.

Humans are really predictable. We are always looking for a scapegoat and in nutrition there are plenty of them, butter, coffee, eggs, bread, sugar, olive oil, oily fish. There have been scientific fads that, through poorly designed studies, have pointed in the wrong direction. One of the advantages of science is that, over time, it corrects itself. The scapegoat is now an obese person. Why is he or she obese? Because they want to be, which has been the wrong message. Today we know that it is not just the desire of the obese person to be obese, but that there is a genetic component.

The fact that the world is getting fatter is also due to the obesogenic environment in which we live. On the one hand, we have biology, and within biology one of the components is genetics. What we eat, which depends on many things, such as the information we receive, but also on production. What we eat is also influenced by our psychology. This is what we have to deal with in order to make progress in obesity. Nutrition is a very important component that we still don't understand very well, but there are others, such as physical activity.

There are some eleven million deaths worldwide each year due to problems associated with poor nutrition. What is poor nutrition, what is good nutrition? The answer is not simple. First, there is a need for information. In the United States, every five years, the Dietary Guidelines for Americans are published by consensus, published by experts under the auspices of the Department of Agriculture, and what we know about good nutrition. No one in the population reads these reports because their language, their volume, is more designed for health researchers. The public is given more visual things, like the old nutrition pyramid, or the plate, as it is done today. Today, obesity is on the rise in the world in spite of all this. Covid has contributed to the increase. The recommendations we are using have not had the desired impact.

This is because these recommendations have been based on studies where we were always playing with the statistical mean. In a year-long study by Christopher Gardner at Stanford, people were put on a low-fat diet and a low-carbohydrate diet. At the end of the year, you could tell that it was the same on one diet as on the other. But this is the average. The question is how many of us are in the average. But when you go to the individual data, each person responded in a different way. So, some people's weight went up on a low-fat diet, some people's weight went up on a low-fat diet, some people's weight went up very well. The same with the low-carbohydrate diet. There is a lot of individual variability that we don't understand. That's where personalised nutrition comes in, to understand what's going on in each of us and to predict the responses so that if someone goes on a diet, it doesn't result in them gaining weight, but that when you advise something you know in advance that it's going to be successful.

With personalised nutrition we collect as much information as possible about the individual, what they eat, what they do, physical activity with sensors. With them, at all times, we can collect information about our physiological reaction, the microbiotics. That amount of data feeds the computers and artificial intelligence allows us those personalised recommendations that, in many cases, will differ from those generalised recommendations.

Genetics is one variable to take into account, but not the only one. There are many others, but let's take examples from genetics. With precision nutrition we would take advantage of those millions of polymorphisms, of mutations, of differences in our genetic code, which make us function differently, including our diet.

To prevent obesity you would have to eat a pea, but nobody is going to follow that and even if they did, they wouldn't do it for long because they wouldn't survive. It may be obvious, but it doesn't work for everyone. In one experiment, in an obesity clinic, we put subjects first on a 600-calorie-per-day diet and then for the rest of the year on a 1,200-calorie diet. In some cases, the weight went down, but in others nothing happened. The difference was in a gene that is the most expressed in adipose tissue and is responsible for protecting or not the fat we store in it. The conclusion is that, if you have that gene, the hypocaloric diet is not going to work. That's one way of predicting. But you have to give an answer to people and to the health professional. What is the alternative? In this case we showed that the answer is to modulate, to adapt, the carbohydrates in the individual's diet. In the case of those individuals who were resistant to calorie changes, a diet rich in complex carbohydrates does work. This is an example of personalised nutrition, where at the end of the day everyone wins, the health professional and the patient.

Other scapegoats are fried foods or sugary drinks. Banning them for some can be allowed. When it comes to fried foods we can have a genetic obesity score that depends on the genetic propensity for obesity that is informed by that set of genes. Today we can, very easily, tell a person that they have a high genetic risk of obesity and recommend that they don't eat fried foods. But for many people who don't have that genetic obesity score, it doesn't matter whether they eat them or not because they won't put on weight. The same goes for sugary drinks. There are people on whom it has no effect at all and others on whom it has a big effect.

We not only have to look at what we eat, but when we eat it, which brings us into the area of precision chrononutrition. Chronobiology is tremendously important. Our body is guided by circadian rhythms. Every hour of the day we are different and in the different seasons we are also different. It is not as noticeable as in other species, but humans are also governed by the same rules of nature, which are the seasons and the rotation of the earth. If we manage to have the circadian rhythm well synchronised, it is an advantage in terms of metabolic health. If we have a desynchronisation of our biological clocks, then we end up with obesity, diabetes, cancer. This was seen in the programme of another researcher, Martha Garaulet, based on the Mediterranean diet, where there were some subjects who did better, others not so well, and others better after 20 weeks. What affected them was not what they ate but when they ate. Those who ate later lost less weight. If we go back to the gene that we talked about earlier, we can go further because we get to more precision. We are not going to recommend that people eat earlier, we are going to recommend who is going to benefit. When you look at this gene, depending on your genetic variants, the carriers of the AA genotype of this gene, you see the difference in time. The late eaters lost little weight, while the early eaters lost more weight.

I want to finish by talking about the microbiota. With it we have been fishing in this dark sea of information for more than ten years. The conclusion we came to is that it is the microbiota that influences our health and that we influence our microbiota. It is a closed cycle. That is, what we eat influences our microbiota, but also our microbiota influences what we eat. The same can be said about exercise, about our genetics, which also influences our bacterial flora. The most important factor of our flora comes from our mothers. When we are born, if the birth is natural, it inoculates us with these bacteria. During gestation, it makes those bacteria change in order to make the inoculum as acceptable as possible for the newborn. Where we live, in which country, whether we live in a rural or urban environment, whether we have pets, also influences our microbiota. The success of drug treatments depends on our microbiota and this has also been seen in cancer immunotherapy. Age also has an important effect.

One of the largest studies that has been done so far on precision nutrition is the Predict study, done through collaboration with industry, King's College London, Stanford, Harvard, Tufts and a London-based biotech and artificial intelligence company, ZOE. The purpose was, first, to investigate the variability among people; second, what explains those differences in response to food; and then, using artificial intelligence, to be able to predict that response of individuals.

In terms of that microbiota, we have been able to identify a number of good bacteria and a number of bad bacteria. The good bacteria are associated with good lipid control, good blood sugar control, less inflammation, less obesity, a healthy nutrition pattern, healthy plant-based foods, healthy fats that may be of animal origin. The opposite is true for bad bacteria. Our goal is to see how through diet we can decrease the bad bacteria and increase the good bacteria.

What will the nutrition of the future look like? The first thing is for each of us to do studies with different types of food and generate biological samples that are processed through these new technologies through artificial intelligence. There will be a distillation of what those factors are that are most important to the individual. This will be incorporated into personal sensors. From there, the healthcare professional will be able to make those precision recommendations. In the United States, we have just kicked off the largest precision nutrition project to date, funded to the tune of $170 million by the National Institute of Health.

Precision nutrition is the answer to what to eat to stay healthy. With it we have the compass, the GPS that points us in the right direction. But this will be impossible to do unless we are all at the table, different types of researchers, the private sector, governments, health systems, insurers and the general public, who need to be educated. We all need to think together about how we can move forward with this project of how we can bring health to all through nutrition.

The Rafael del Pino Foundation is not responsible for the comments, opinions or statements made by the people who participate in its activities and which are expressed as a result of their inalienable right to freedom of expression and under their sole responsibility. The contents included in the summary of this conference are the result of the debates held at the meeting held for this purpose at the Foundation and are the responsibility of their authors.

The Rafael del Pino Foundation is not responsible for any comments, opinions or statements made by third parties. In this respect, the FRP is not obliged to monitor the views expressed by such third parties who participate in its activities and which are expressed as a result of their inalienable right to freedom of expression and under their own responsibility. The contents included in the summary of this conference are the result of the discussions that took place during the conference organised for this purpose at the Foundation and are the sole responsibility of its authors.

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