New film ‘The 100 Year Effect’ explores Oregon researcher’s quest to bring chronic disease knowledge to the world

Kent Thornburg is a Professor of Medicine Emeritus at Oregon Health and Science University. But he is far from retired. He’s actively promoting the research he and others have done into the Developmental Origins of Health and Disease. Thornburg coined the phrase “the 100 year effect” to describe how early life environment before and during pregnancy can affect the lifetime risks of chronic diseases — and how those effects can actually be traced not just to both parents, but grandparents as well.

A new documentary about both the research and Thornburg’s unconventional campaign meant to galvanize people and communities to spread the word about this research premiered at OHSU on March 20. The date was chosen in conjunction with the National Future Generations Day. “The 100 Year Effect” is now available to view free of charge by request for individuals or community screenings on the film website.

Thornburg says the only way anything will change is if young people and community leaders get energized and motivated. That’s where people like Kelsey Mueller Wendt come in. She is herself a young mother and the coordinator for the Nutrition Oregon Campaign Hub in Klamath Falls. Mueller Wendt and Thornburg join us to share more about larger education campaign and the film, which is both a showcase and an invitation into the larger effort to eliminate chronic disease.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Miller: This is Think Out Loud on OPB. I’m Dave Miller. The OHSU scientist Kent Thornburg has been on a public health mission for decades now. As he likes to point out, the egg that made you was created in your mother’s ovary when she was in your grandmother’s uterus. Another way to think about this is that if you are pregnant right now with a girl, you carry inside you the eggs that could become your future grandchildren. What’s more, your health could have major effects on those future generations. Kent Thornburg says if, as a society, we want to reduce chronic health conditions like heart disease and high blood pressure, we have to consider these generational connections.

Thornburg and this research are the focus of a new documentary about this. It’s called “The 100 Year Effect.” Kelsey Mueller Wendt is featured in the film as well. She is a former Klamath Falls City councilor who is now the coordinator of the Klamath Falls Hub for OHSU’s Nutrition Oregon campaign. They both join me now. It’s great to have both of you on the show.

Kent Thornburg: Thank you.

Kelsey Mueller Wendt: Hi, thank you.

Miller: Kent, to start with you, you have been devoting a big part of your professional life to this issue. When did you get started on it?

Thornburg: Well, I’m a basic scientist, so I’ve studied all kinds of biological features of humans, animals and mammals for most of my life. But I met a man named David Barker, and he and I met in Italy in 1988. I heard him present his data. And his data showed that if you were born at the low end of the birth weight scale, you have a three to five times higher risk of having heart disease and dying of it than if you’re born at the middle of the birth weight scale, at a normal weight.

So I had dinner with him afterwards and he said, “What did you think of my talk?” And I said I didn’t believe a word of it. And he said, “Why not?” And I said, “Because that’s a correlation and we don’t know the biological underpinnings.” He said, “Why don’t you work together with me and we’ll figure this out?” And I was hooked by that.

Miller: If I’m not mistaken, this was based on some decades earlier data collected by some British people about births in England going back 100 years or so, right?

Thornburg: Yes, that’s right.

Miller: So as a scientist, you said let’s see if we can prove causation, that something is actually leading to something else as opposed to something happening at the same time. How did you go about doing that?

Thornburg: Well, there are all kinds of ways, but first we wanted to do epidemiology kinds of studies in other countries. And then there were at least five countries that were included in these studies, including the U.S. They all showed the same thing and they all showed the same slope. So I became a believer.

And then we tried to understand the biological mechanisms. And toward the end of David Barker’s life – he died in 2013 – the epigenetic side of this is a new way of understanding how genes get turned off and on. And then we really realize that there is a biological mechanism for this.

Miller: So what is it? Can you help us understand how, for example, the health status of your mother or perhaps your grandmother, two generations before you were born, can affect your own health as an adult?

Thornburg: Yes. So it turns out that when eggs are being formed, they’re nourished within a baby girl’s ovary by that girl’s mother. And that nourishment can change the way genes get turned off or on through a mechanism we call epigenetics. But the important feature is that the environment of a baby growing, and especially a baby girl who is making eggs, those are affected in such a way that they last for a lifetime.

Miller: Epigenetics, this is the kind of the complicating science of the last couple of decades that says nature versus nurture is too simplistic, and correct me if I’m wrong, but it’s less about exactly what genes are being passed down, but which genes that have been passed down are going to be expressed or not. Did I put that correctly?

Thornburg: Well, you’re pretty close.

Miller: Please, make it better.

Thornburg: So what happens is that the way genes are regulated – that means the gene can be turned off or on – is determined by epigenetics, which are mechanisms that change the DNA and decide whether that gene will be turned off more or turned on more. And that changes the way your genes work and that can be passed on to the next generation.

Miller: What you started by talking about and what started you on this path was babies with low birth weight. So why should that be so important in terms of your health as an adult?

Thornburg: Well, it turns out that if you’re not getting enough nutrient before you’re born, or you’re exposed to high levels of cortisol, which is the stress hormone from the mother, or for toxic chemicals, all three of these slow down the growth rate of the baby and the baby cannot make its organs in a proper way. And because of that, these genes get modified and they last for the lifetime of the offspring.

Miller: To zoom out to the big picture that you’ve often focused on, what’s happening right now population-wide, just in our country, in terms of chronic diseases?

Thornburg: So chronic diseases are on an exponential increase. We have an epidemic of chronic disease which includes diabetes, obesity, heart disease and hypertension. These are going up so fast that we eventually will not be able to care for all the people who are ill, under current conditions.

Miller: This hasn’t yet shown up in mortality rates, but you’re saying that it will soon?

Thornburg: Well, it’s starting to already, and it will increase even more, we know for sure, because people who have these chronic diseases live shorter lives.

Miller: Kelsey, when did you first become interested in these issues?

Mueller Wendt: I had the opportunity to hear a talk from Dr. Thornburg and his colleague here in Klamath County in 2019. I had heard about it before this because they were doing a statewide effort in communicating the message, and then before the Nutrition Oregon campaign started, they were just gauging interest and trying to get the word out. And then in 2019, we became the second Nutrition Oregon campaign hub here at Klamath County. June of 2019, we signed our agreement and we’ve been doing the work ever since.

Miller: That was well before you became pregnant yourself. You had a baby about a year-and-a-half ago. How did being pregnant affect the way you thought about these issues?

Mueller Wendt: It was a total 180, to be perfectly honest. I had always experienced some reproductive health issues, so I wasn’t sure if I was going to ever be able to conceive. I was fortunate enough to go through IVF and conceived after my first try, so I was very excited about that. It definitely put everything on its head when I actively started trying to get pregnant.

It took me about three years to get pregnant and we only were successful through IVF. So I think for me, it really changed everything because I had to really prepare my body. And knowing all of this information I think really equipped me to be able to have a successful IVF journey. We always say it’s not a silver bullet, but I do think that your nutrition – and it is proven through science – does impact your ability to have eggs that can be successful in pregnancy.

Miller: One of the issues that the film focuses on in your part of the story is a vote that you took, a lone vote. You didn’t win this vote on the city council, this is when you were a member of the Klamath Falls City Council. Can you describe the issue at stake and your vote?

Mueller Wendt: So my background really focuses on the built environment and how the different things in your environment impact your health. I just stepped down in February because I moved out of my ward, but as a city council, I think we always focus on the economic impact. So our economic development association had recruited WinCo to come to our community and they were going in right next door to two grocery stores that have been supporting our community for decades. And if anyone doesn’t know anything about Klamath, Klamath is a very rural, very spaced out geographically area, and there are several food desert pockets – food desert means that people don’t have access to fresh food. So we had this concentration within a quarter mile radius of four different grocery stores and we had just recruited another one.

I am the first to get in line to endorse new businesses coming to our community, our economy needs it. But I’m also the first to advocate for looking outside of the box and making sure that we are putting those grocery stores in areas that truly need them. Our geographic area is covered by 6,200 square miles and having a quarter mile radius where all of the grocery stores are concentrated, it’s not thinking of the public health in mind. It’s thinking of the economic impact.

I had voted against giving them a roadway easement. As city council, you don’t have jurisdiction over the zoning and it was zoned properly for a commercial enterprise. So they were zoned properly. When they had come to council to approve the roadway, I then got the opportunity to speak up and say that I had no intention of not welcoming WinCo to our community, but I had every intention of trying to get them to move locations.

So I voted against anything that came up, just simply because I did not agree with where they were going. I think it’s really important to support the businesses that have been building up your community, and not focus only on the economic impact, but also focus on the public health impact. And that includes access to foods.

Miller: Kent, access to foods … It reminds me of one of the scenes in the new documentary, which is about some data from the Netherlands in the immediate aftermath of World War II, when for close to a year, the entire population basically was undernourished because of lack of access to food. There simply were not enough calories for human beings there, and for newborns.

In the developed world right now, in the U.S., we have a different situation. In general, people have access to calories, but they’re of a different kind. When you look as a scientist at the access to the food that we have, and in particular access to food that people in more rural areas or people who have a lot less money have, what does it look like and what does that lead to?

Thornburg: Well, we call the condition of Americans now in general “high calorie malnutrition,” is what people are suffering from. They have plenty of calories and you can buy food at any fast food place or even cheaply off the shelves in a grocery store that have high calories, high salt, high fat. But these foods that you can get, like these fast foods, have low nutrient levels. So people live their whole lives eating these foods and they are malnourished. So we are in a condition in this country of being generally malnourished and being overweight because we have too much body fat from the kinds of foods that we’re eating, but not enough nutrients.

Miller: That’s a good example of the ways in which taking this 100 year view … and even the language I used at the beginning which came from you, talking about the egg that formed you being in your mom, being in your grandmother. That’s the language of the individual. But the solutions that you’re talking about seem way more systemic. If you, and Kelsey as you’re talking about the siting of grocery stores, this is not the individual level, this is the societal level.

Thornburg: Yes, our problem is a systemic problem. It’s also a cultural problem now, because our culture encourages certain kinds of eating. So what we are suggesting, based on the biological knowledge, is that we can never turn this around without involvement at the community level. So I’m really glad Kelsey’s on today because she is the kind of person who is active in a community and trying to help the community help all the people to eat well, men included.

Miller: Kelsey, how do you do that as the coordinator for the Klamath Falls Hub for this Nutrition Oregon campaign, a statewide campaign started by OHSU?

Mueller Wendt: We have done a number of different initiatives. Our primary focus right now is called the baby curriculum. We developed this with a partnership with a dietitian and it is all focused on the “developmental origins of health and disease,” making sure that whole nutritious foods are a part of your diet. Now, we fully acknowledge that being pregnant is a challenge in and of itself. So with this curriculum, we make it accessible online. We have directed it towards lay health workers, so individuals that are CNAs, MAs, they could even be an early childhood educator. And they learn basically how to have a conversation about DOHaD [Developmental Origins of Health and Disease] in a very casual way.

So an example of that is, “I have this pregnant person who’s experiencing morning sickness,” and that lay health worker will be trained to say, “Have you tried ginger? Have you tried anything with citric acid?” Instead of just pushing medications or things like that. Obviously, there’s a time and place for that. But there is a nutritional side of that and just making sure that you’re eating a well-rounded diet with lots of protein. So we do this through a number of different ways, but our primary focus is through our baby curriculum.

Miller: Kent, you’ve said that epigenetic effects are reversible. What do you mean by that? It’s a little bit counterintuitive, I should say, because one of the centerpieces of your message is that your health outcomes, to some extent, are going to be determined by the choices that that one or two generations back have made, or the circumstances that they were enduring, that not everything is choice. So given that, what do you mean when you say that it’s also reversible?

Thornburg: That’s an interesting point because epigenetic changes are changes to the DNA. And that DNA contains our genes and it’s regulated through this epigenetic mechanism. So epigenetics is both heritable and reversible. Some of the genes that are leading us to be prone to have disease can be reversed by good nutrition and lifestyle, especially early in our life. And this also changes our biological clock, which is the rate at which we develop as human beings. Some people live much shorter lives than others because their epigenetic clock moves too fast because of this epigenetic effect.

Miller: I’m glad you put it that way, because it did seem to me that one of the potential unintended consequences of spreading the word about that our adult health experiences are shaped by the earliest moments of the lives of our parents or grandparents is the possibility that somebody could hear that and think, “Oh, I guess it’s already baked in. I have even less control over my own health than I thought I did, so why even bother?” Are you concerned about that at all?

Thornburg: I’m concerned that people get that message. And I’m also really one of the great proponents of helping people understand how a healthy lifestyle can reverse many of those negative changes they had early in their life. They can live a longer and healthier life.

Miller: What are the big scientific questions that you still have about this issue that you devoted decades of your life to trying to understand?

Thornburg: Where I think this will lead is that people will be able to modify their epigenetic background once we, on the medical side, are able to analyze that for everybody. This will be a part of our normal medical care in the future.

Miller: What do you mean by that?

Thornburg: What I mean is we will be able to take blood samples and other kinds of tissue samples to understand how your epigenetics was affected. And then give you lifestyle changes that will help you improve on those and prevent many of the chronic diseases we now face.

Miller: In other words, it’s your hope or assumption that in the coming years we’ll be able to do tests, and then a scientist could read that and say, “OK, you’ve got this gene and this gene and this gene, and they’re turned on or turned off in a way that makes it more likely that you’ll get heart disease, more likely you’ll have high blood pressure. But if you do these things, you’re more likely to be able to lower that chance.” Is that what you’re saying?

Thornburg: You’re exactly right.

Miller: In the end though, is the advice going to be what we’re already being told now? “Eat good food, not too much of it. Eat real food.” In the end, is the advice the same that we’ve been hearing for decades?

Thornburg: Yes, it is going to be the same. The problem is that we know that advice now, but we don’t take it.

Miller: And it’s your hope that by expanding the lens of human connections and interactions, you’ll make it more likely that people will heed this advice?

Thornburg: Yes. I’m concerned about men and women who are going to reproduce, because their body needs to be prepared to have the right nutrients so that the baby that will result will grow normally and be healthy later in life.

Miller: Kelsey, speaking of babies, how is your 16-month-old son doing right now?

Mueller Wendt: He is great. He’s big, happy and rambunctious as ever.

I just want to make a comment on your last question. I think it’s not only on the individuals. I think everyone hears this message all the time about eat nutritious whole foods. But honestly, our elected officials, our legislators, our hospitals, all of the people that have a voice have the opportunity to change this. They just have to step up and advocate for it. We can’t always always worry about the bottom line, aka the money. We have to worry about the people’s health.

So I would like to take this and turn it on its head and say it’s not the individual’s fault. It really is the marketing, and it really is our legislators that are approving and supporting these types of things where it is setting up a community for failure, because they don’t have access to the things that they need to live the lifestyle that we’re talking about.

Miller: So Kelsey, on that note, what’s one thing that you’d like to see change? What’s at the top of your list, societally?

Mueller Wendt: I would love to see a shift in the idea around what health looks like. When we think of health, we picture this vegan who runs marathons or something along those lines. When in reality, it’s someone who spends time with their family and has a grocery store in driving distance and has the means to buy groceries. For me, I think I would love to see our legislators taking that into account more than some of these arguments that they’re having that have nothing to do with people’s health. I would love to see people shift more towards the public health interest than anything.

Miller: Kelsey Mueller Wendt and Kent Thornburg, thanks very much to both of you.

Thornburg: Glad to be here. Thank you.

Mueller Wendt: Thank you.

Miller: Kelsey Mueller Wendt is the coordinator of the Klamath Falls Hub with the Nutrition Oregon campaign. Kent Thornburg is an OHSU scientist. His research, along with other people’s research on epigenetics is featured in the new documentary film, “The 100 Year Effect.”

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