 Thanks for tuning out this afternoon everyone. I just want to pick up on a couple of things Diana mentioned for those who saw the previous presentation she was referring to food that gets transported all over the world. Just to help you guys out I'm gonna take with the New Zealand lamb and apples home with me so we'll do a bit of a collection and I'll just relieve you of that. We might give you James Cameron back because he's now a New Zealand resident and he's pushing a whole vegan agenda down in New Zealand so you're gonna have that one back. I'm gonna cover the developmental origins of health and disease which is a topic that I'm starting to see a little bit more of it's a pockets head up. I know Tim in his presentation this morning did touch on a little bit. I'm gonna give a very high-level overview despite degrees and stuff. I know nothing at a depth so don't ask me anything at a depth but I'll kind of skim over the surface and that might be enough for people to dive down a rabbit hole from there. Let's go. Alright so common theme to this symposium is that we've got this whole thing called mismatch going on and it's sort of getting largely agreed even outside of this little bubble of ancestral health that we live in. It's getting largely agreed that this mismatch is at the core of many of the chronic diseases which seem to kind of define the modern human state. By the way if anyone's struggling with the accent subtitles are up there for most of it that's that's important but while it's not uncommon for people kind of put forward a single theory of everything when we look at the problems that we're facing most people are starting to agree that we've got a bit of a perfect storm going on that's very complex it's very multifactorial and the largest portion of starting sets more and more in the discussions the largest portion of the problems that we face are environmental. We have a tendency to focus more on the individuals but as individuals we're largely products of our environment so many of the factors are external to us and just from this diagram here as I go through my presentation the probably not particularly clear but the developmental origins aspects are everything that's going to highlight it in yellow around here so it does make up a big chunk of perhaps some of these factors that we're thinking are at play with the problems that we face. We've got a we've set our environment up where it's such that most of us are opted in to ill health and in order to live a better life to be a healthier human being we have to opt out of the default environment which we're all landed in now that causes problems and that opting out of that environment requires knowledge it requires resources both monetary resources and sort of knowing what you're doing and we've also got the double double whammy where that opt out is being sold to those people with extra resources at a premium so we're seeing this of big inequality in this big split across the the population. Public health resources as they currently at they're often being directed towards treating acute manifestations of the chronic illnesses rather than preventing those diseases in the first place and you know this is fairly well accepted. What we're starting to see is this this thing called the transgenerational the transgenerational transmission of some of these these issues which means that they are skimming across one generation to the next they're not isolated to one particular group and they're being inherited so develop a little bit more as we go through this but we we're not directing any of the public health resources towards preventing that transmission we're still we're still largely of a model that is focused on the here and now and in particular towards individuals who probably have the most influence particularly at a political level. So we can see that historically we've waited until adults develop some sort of acute manifestation of some sort of chronic ill health before intervening so right at the very sort of top here so basically at the point that you historically as you've suffered a heart attack well we might sort of intervene in some sort of intervention there or you've been diagnosed with cancer we undertake some sort of intervention but that comes at a very very high cost both in terms of finances but obviously for the individuals going through some of these treatments at that point and it will have a very limited impact in terms of both the lifespan and health span for that particular individual but more recently we've attended we've attempted to head off some of the disease and development through screening of adults particularly in their middle years and so so around about here we might undertake a national screening program again particularly for some of the cancers around trying to kind of head off some of the development of these diseases but in the end they inevitably end up just being sort of not much more than a delay tactic more than anything else and again probably have fairly limited impact overall and often these these screening programs chase fairly dubious biomarkers at best so they're kind of questionable in terms of their overall impact and they may be or not maybe there's certainly too late in terms of making an impact on any sort of transgenerational transmission of these chronic diseases because typically at this age here where these screening programs kick in people have already had their children so any sort of an inheritable features have already been passed on to the next generation the developmental origins of health and disease hypothesis or paradigm very much focuses on this bottom line through here where if we get the timing right and we focus on the right aspects then we can set individuals and societies on a much lower risk trajectory overall and recognising that much of our health and disease is developmental in origin society may need to move away from investing its biggest chunk of its health resources, interlate it at output interventions and shift them over to the other end of the life cycle particularly focusing on infants children and adolescents and probably through to young adults in their very early reproductive years and there's an increasing call for the first thousand days of life which is a period basically peri-conceptually from conception through to about two years of age and that seems to be one of the critical intervention points if not the most critical one for altering the chronic disease trajectory that we are witnessing globally so you can see that's a that's a big paradigm shift to go from screening people in their 40s and 50s through to investing the largest chunk of our public health dollar down in the very young. The early work in this area in the terms of the development this hypothesis came via professor David Barker from population observations made in the 80s and 90s and Barker's hypothesis was based on based on these observations stated that if a nutritional environment in which a pregnant woman lives is constrained then the woman will program her developing fetus for what we call the thrifty phenotype so and if the infant then encounters a world which isn't nutritionally constrained its own metabolic settings become mismatched to that environment and susceptibility to the range of later life diseases increases so it's sort of you know potentially where we're at currently where by virtue of several mechanisms which I'll outline very shortly we've got the sort of postnatal over nutrition at play for infants that were probably programmed for this thrifty phenotype so alongside genetic and cultural inheritances it is also becoming understood that there's also environmental inheritances mediated maternally and paternally and there tends to be a lot of focus on the mother but there needs to be as much focus on the the father and in this development as well and through this of mediated maternity paternal inheritance environmental exposures from one generation can condition the phenotype of the next and possibly probably most likely subsequent generations and this is where that that whole sort of nature-nurture interaction occurs the environmental exposures of the mother and father can influence the epigenome of the ovum and sperm and while more acute environmental exposures experienced by the mother during pregnancy can obviously influence the in utero embryonic epigenome and here the the genotypes so the the base genetics of the developing child remain the same but it's the phenotypic expression may be altered by the environmental exposures of the the parents and again probably most likely grandparents and great-grandparents so you've got to up to potentially up to three generations worth of environmental information sitting in each particular generation that comes through this ability to developmentally shift your physiological form or the infant's physiological forms to suit the particular predicted environment is referred to as developmental plasticity and that developmental plasticity allows for a process of adaptation to environments operating between longer term natural selection of the species and then the more immediate homeostasis within the within the individual to give you an illustrative non-human example of this developmental plasticity we look at a species of desert locust which can change change the morph of her young based on the population density of other locusts around her and the stress response that this elicits within her so if the population density is low her stress levels will be low and she'll produce a flightless offspring which will live in a short range but if the population density is high her stress levels will be high and she can change the morph of her young to a migratory type which is enabled with long distance flight and the ability to travel over a much larger range so you can imagine low population plenty of resources available does make sense to to disappear off and so that's the morph that she's able to develop but if there's a very high population density she's competing for her own resources her cortisol levels or equivalent are very high she's very stressed so she's programming her young to take flight and to potentially go and seek out a better resourced area so that's the ability to morph will have that plasticity so in essence an assessment of the world in which an infinite is being born into a signal both maternally and paternally with the aim of inducing its development in a direction that is matched to that assessment if the developmental environment is secure then an investment can be made towards a larger lean body mass and longevity in the developing fetus but however if the developmental environment is signaled as being threatening then trade-offs have to be made in order to ensure the best chances of survival into reproductive years and this will be adaptation such as a higher fat mass early puberty and altered behaviors and stress responses so it becomes very interesting when you look at this secure developmental environment and what that means is basically you get programmed to play a long game so you can kind of relax chill out you can build up your tissue reserve build up your muscle mass and you've got a lot of time to play with based on the environmental programming that you've received however if you're being programmed or conditioned towards a more threatening environment you're not there for the long term and so you have a series of physiological adjustments and these are very highly integrated adjustments and you know we're seeing decreases in muscle mass we're seeing so very low muscle mass and tissue reserve levels in these developing infants we're seeing you know in particularly in western worlds we're seeing this early puberty come through and there's many theories for this but perhaps this developmental response is one of those so currently we would argue that you know despite all the features of a western world we're still sort of very much programming our children for a threatening environment so within this Doha concept there are adaptive mechanisms operating within the normal range of developmental exposures and then there are those associated with evolutionary novelty that are more likely to be non-adaptive and developmentally disruptive and by way of example I'll be focusing on over nutrition as a disrupting process but sort of looking at that in conjunction with under nutrition which is more an adaptive process that we can respond to so if we take maternal under nutrition as an example of an environmental challenge that can drive adaptive processes the range of uterine signals will range of uterine signals will occur in response to this challenge affecting the structure and function of the developing child this under nutrition state is signaled when maternal amino acid and micronutrient intake is low as will be the case on eating protein dilute highly processed western diet and you get this highly integrated multi-system adaptations occur which includes a decrease in muscle mass a mitochondrial mass making muscle less metabolically expensive is also as well as behavioral changes such as reduced desire to be active which is the sort of gluttony and sloth type problem that we seem to be playing out but you know obviously we don't think it's those those issues. Concurrent to maternal under nutrition we can also have maternal over nutrition with respect to very large supply of carbohydrate being delivered by those very same processed foods that we're exposed to. It gets very interesting because there are constraint mechanisms which exist to limit the supply of amino acids and fatty acids crossing the placenta but there are no constraint mechanisms for glucose and the the papers that I was reviewing and putting this together the suggestion was that this exposure to high maternal glucose has not been a common feature of human evolution therefore there's no mechanism to slow the influx of glucose through to the the fetus. So we can have two distinct kinds of mismatch operating concurrently with respect to this developmental conditioning linked to one singular aspect within the environment which we have which in this case is this highly processed western diet. So by virtue of their own either maladaptive or disrupting pathways we end up with virtually the same result which is a some sort of mismatch to the environment in which we're born into. If we take everything into account we can map quite a negative developmental cycle that society finds themselves unwittingly trapped into. We're seeing children born into very poor developmental environments and they become an increased risk of becoming adolescents and young adults who in their reproductive years unknowingly end up continuing this downward cycle of developmental conditioning. So you can kind of see it it's it's not a nice cycle that we find a good portion of all of our societies and I don't think there's very many western countries at least who are not not touched by this developmental cycle. You can perhaps look at that cycle that we've got sitting up there on the the graphic and you can see probably if you were going to direct your public health dollars at which point you're probably most likely to do it and it's certainly not going to be after pregnancy as tends to currently happen. For every iteration of this negative cycle each subsequent generation is set on a trajectory of lower tolerances to the key environmental mismatches we face in higher disease risks occurring much earlier in their lives. So this is kind of what we're seeing play out before us where it seems every every generation after the the previous one seems to be getting hit just a little bit earlier and perhaps a little bit harder with some of the key health issues that that we face in our societies. And there is definitely an increase in concern that if we look at specifics like diabetes that diabetes can be transmitted across generations via that mechanism so again we've got to look at ways of how we're going to break this cycle. There are some there is some work being done in terms of how to turn this around and again we come back to this first thousand days. So within this first thousand day window there's an opportunity to condition the health of individuals across their their lifespan. So instead of having each generation kind of get a little bit worse we we need to reverse it and have each generation get a little bit better which means that kind of the environments that we're setting for ourselves in the here and now are not going to be set for largely the benefit of us they're going to be for the benefit of two three generations down the track and unfortunately humans aren't particularly good at thinking that way but this this period this first thousand days is the period with the greatest plasticity which is that ability to morph and adapt in a matched way and it has the least accumulated exposure to a disrupted environment. So again if we look at many of the the modern public health screening processes they all kind of sit down this this end of the scale where your ability to probably turn the ship around is pretty limited and you've got such an accumulated environmental exposure that you're really going to get limited traction with with some of those strategies. So based on the evidence accumulating within the Stowhead concept you can see the futility of messing around with the population at this end trying to you know create a healthy population it really needs to be directed towards the the other end of the scale. One of the strategies put forward is that we need to develop a greater level of empowerment and self-efficacy in terms of health literacy to teaching health literacy to children and adolescents. We need to develop these young individuals to have a greater understanding of their own bodies their own biology and the modern environmental exposures and lifestyles that that can impact on those. We already do it to a certain extent with older adults and certainly when you get to a point in life where people start to talk to you about healthy aging we start to educate older adults in terms of their health literacy and and what it means in terms of healthy aging we actually need to do that better at the other end of the the scale and this needs to go beyond just giving adolescents better education around drugs and alcohol and sexually transmitted diseases but actually give them more empowerment around teaching them about the environment what those environmental exposures mean what it will mean for their health but also the health of their children that they may potentially want to have but to do that we're actually going to need a societal shift which means that we start to place a much greater value on 16 year old girls in our societies than what we do with 60 year old men. We can kind of have a discussion as to why we have that values system in place currently but generally we value the older part of our society than the the younger one when it comes to health. The biggest advantage of this concept is that it creates an integrated integrated and coherent public health policy around it as well as help kind of shift that public mindset allowing the minimization of common disruptive developmental environments that we all face in one way or another we're all going to we will all have to eventually face up to whether it be sort of health or economically. By linking social inequality issues to both biological outcomes that have developmental origins researchers, policymakers, community members and parents and the influences such as we have in the room currently are going to be in a stronger position to argue that the total quality of our societies and lives matter and that inequality is much more than just a condition of social economics. So that's the nuts and bolts of my talk around this as I said I was only going to sort of deliver it across a very kind of high level high level skin. What I will flick through to now and this is me being a little bit cheeky is an advertisement and Tim already sort of slotted this in right at the start to say that we have got our own ancestral health society down in New Zealand. We did run a very successful international symposium last year which many people from this current symposium came along to. It is in the gorgeous Queenstown which you can see up in the photo there not too dissimilar I guess from where at Boulder except we've got large amounts of water floating around as Boulder probably doesn't. So everyone would be welcome to attend and come down and we're just doing a little bit of a sneaky recruit for speakers as well so those who are speaking across the rest of this event bring your A game and you might get an invite to New Zealand. And by the way when I say that the stand is pretty low because Tim's already in so I'm pretty much done so I'll field any questions if there are any. Clearly no one's understood a word so that's okay. Are you familiar with the Dutch hunger winter and how it sort of laid the foundation for Barker verifying his results? Could you talk a little bit about it? I'm just I'm going to be talking about it tomorrow and you set me up beautifully. That was a great talk by the way. You may need to develop a little bit more but there my understanding was that as we sort of studied different populations around the world who kind of underwent some of the famines various famines around there that we could see that even those who are exposed to some of the famine conditions but as as developing children once they were back in part of a society that had plentiful food and other resources and even were transposed into very sort of wealthy family so they kind of ticked all the boxes in terms of what we think a human needs to be healthy. They still carried forth many of the many of the illnesses that they were probably preconditioned for as part of that exposure to the famine at those sort of critical developmental points so it kind of it underscores the fact that during these very critical developmental phases that is the point at which we need to make sure that the environment is pretty solid because even once you get a good solid supporting environment outside of those times you end up having very very limited impact in terms of the the disease risk and trajectory that those people end up on so oh no this scares me a little bit. Oh time for one more question. That was a terrific talk. I just want to sort of second everything that you said but specifically for our US audience here everything that he's saying the dietary guidelines folks and the folks at Health and Human Services and USDA are already thinking along these lines however they're thinking with their nutritional paradigm in mind so we have the dietary guidelines for people age two and up now they're turning their sites to zero and 24 there's a zero to 24 program the thousand days will be next. They want to start looking at epigenetic effects and these developmental origins of adult diseases but what they'll be doing is restricting calories and restricting protein the two things that we know set the child up for metabolic diseases and especially limiting high quality protein that is as bad that that that causes adult metabolic outcomes that are as bad as simply having calories restricted so the the stuff that you are saying at the very beginning of the talk about this is a social issue this is you can't just sit back and go I personally cannot doubt your children are going to be marrying people and having children with people who haven't opted out so thank you for terrific talk. Thanks Adele. Yes it's very interesting we've one of the the lead researchers in this area Sir Peter Gluckman is actually the Chief Science Advisor to the government that we have in New Zealand so we're actually starting to see a program of investment in this area so we're sort of talked about at the start of and they're not as blatant in terms of stating this but a disinvestment from that later portion of life and actually reinvesting at some of these earlier childhood services supporting mothers supporting supporting infants however as Adele points out despite first-hand knowledge feeding policy in our country it is still hooked up to very poor dietary guidelines so there's this big mismatch between the information that the government is getting from one of the the leaders of this sort of research and still where we're directing the public to live and to eat and how to live and so on so we're not going to turn the ship around anytime soon the other aspect to that which we'll find very interesting Adele is that as soon as you start having this discussion at a public health level and it's it's fled up a couple of times in New Zealand I think it has fled up in South America as well that it often gets positioned as blaming mothers so it's it becomes an issue of mothers are doing the wrong things by their children or young girls are doing the wrong things when they're going to be the ones having the the babies and we really need to remove the stigma from from being a mistake mothers have made and we need to be very calculated with our language so that as this stuff gets to gets more traction and gets rolled out we don't get this public pushback of going right well great now you're blaming mothers for everything that's going on in our society well just not to jump on mothers again um in addition to protein and calories as being energy and growth substrates that can be limiting in utero that can have a doha effect oxygen is considered a nutrient most people don't see it that way it's a respiratory nutrient and if it's limited during gestation there's a new disease called gestational apnea which projects to the fetus that you're about to be born on top of a mountain and again i'm going to be talking about that tomorrow but there's there are other substrates other than energy and growth substrates but oxygen can can also through if a mom smokes if a mom you know snores has apnea that that can impact the same way as the energy substance there's there's there's a lot of developmental disruptors out there i only touched on the nutritional side of things more for for timing in fact i'm a nutritionist so that's where my bias is but there's anything from as i say oxygen availability microbiome seasonal seasonal aspects sun exposure illness exposure during pregnancy skeletal muscle mass that was that was probably my next presentation if i do one but the skeletal muscle mass of the of the mother is a developmental has a developmental aspect as well so there's loads of aspects out there but they'll kind of circle back around to this highly mismatched environment that we have so hello um i wanted to ask you if there was any um if any connection to maternal affect genes in these up to changes experienced you're asking the wrong guy you want to talk genetics talk to talk this guy down here but no genetics is outside of my my scope so i wouldn't be able to answer sorry thank you thank you one more no no you go you go i had a question about um the new zealand health system do you have what we have have over here like a kind of like a cartelized like the american medical association not even close like like what can can you just treat somebody like when you're a nutritionist do you have a like a state license and is that necessary and do you have to teach certain things can get in trouble for recommending like a high cholesterol diet on the nutrition side of things we have and probably very similar to to what you have here we've got registered dieticians and they walk a pretty narrow line and you know they've got certain expectations in terms of their scope of practice and the information that they're giving across you can be a registered nutritionist in new zealand but again probably similar to what you have here you can be also being an unregistered one i was a registered nutritionist for a while i got nothing out of giving someone some money so i deregistered so but and so there's there's no limits on my scope of practice i don't get i don't get hauled before a board if i step outside of the limit so i've got a lot of freedom in that in that respect so excellent thank you very much