(Laughter)

If I had wanted you to think I was creative, I would have worn jeans.

(Laughter)

But I have a story to tell you about chronic disease,

and you're the first generation that can ever hear this story

because we didn't know it before.

I want you to join with me in a "hard think."

I'm going to tell you some nice stuff to make you feel good at the beginning,

but we have a lot of serious issues to face

and I'm going to tell you about those.

I hope you'll enjoy it so you will feel like we're all part of the same team

that's going to make our world better.

When I talk to you, I want you to answer this question all the way through:

I want you to ask, when will we decide to eliminate chronic disease?

The reason we can ask that question now is because we know what causes it,

and we know how to fix it.

So I hope that by the time I've finished my talk,

you will be convinced that you can make a big difference to do something about it.

So first the good feelings.

Here's the good feelings: if you look at the last century,

you'll notice that in 1900, we had a life expectancy of 50.

And now, at the end of the century,

actually in 2010, when we calculated it again,

our life expectancy was now 80.

Can you believe it?

Our life expectancy increased by 30 years over one century of time.

There's another interesting fact,

and that's chronic diseases like heart disease, stroke, and cancer,

those diseases have been killing fewer people every year.

So we should start feeling good that we're going to be healthier.

And if you look at these two facts, what you're going to think is,

"I can sit back and relax because isn't it nice

we as a human race, and we as Americans, are getting healthier?"

Now if you think that, you would be dead wrong.

And the reason is that our health has been declining over the last 25 years.

Now, why is that true?

We have some evidence for that and some of it you've read in the paper.

For example, more people are becoming obese,

more people are acquiring diabetes,

more people have uncontrolled blood pressure,

and all of these three things are the foundation for heart disease.

Now the interesting part of it is, we don't see it in our statistics yet

because it is predominantly affecting younger people

and they haven't died yet to show us that there has been a change.

So what you have to realize is that we are in a new predicament

of being able to predict what's going to happen in our future.

And here's one other thing I need to say that you might not have thought of before:

That is that our children are the first generation

that represents three generations of eating processed food.

And because of that, we now have a really big job on our hands

to understand what that has done to the human race

over the last three generations.

In this slide, you can see the first line is the one I already showed you,

that's 100 years of increase

that's perfectly linear over that period of time.

And if we did everything right,

we should be able to gain another 30 years in the next century, right?

That's what we'd like to do.

But, in fact,

medical scientists now tell us that because of diabetes and because of obesity

that are happening in our young people,

that they are going to be the first generation

ever in the United States to live shorter lives than their parents.

So what that means is that we are now on the trajectory that's going down.

And we don't even know it.

We know it because we who study disease can predict what's going to happen

to the people who have these diseases.

Are you feeling better?

(Laughter)

Just checking your pulse.

Okay, so what we need to do is find a way

to take that downward arrow, and put it on the up.

And if we can do that, we should be able to face a century of increased health,

and increased longevity.

Now I have to talk about my friend, David Barker.

David Barker is a brilliant Englishman,

who came to Portland to work with us over a decade ago.

He died a year ago, last August.

And 25 years ago, he started the whole movement

for us to understand how chronic disease works.

So what he showed was this curve,

and if you forget everything else I say today,

take this curve home in your mind because it tells the whole story.

What he showed was that if you're born at the low end of the birth-weight scale -

this has been done in seven countries now -

if you're at the five-pound end of the birth-weight scale on the average,

you have a three to five times higher risk of dying of heart disease

than if you were born at the eight to nine-pound range.

And furthermore, if you are on the upscale,

at the very high end of that scale,

say, above nine or ten pounds,

your risk goes up like the babies that were born small.

So, all of the sudden, we have a really new profound thing to say

about chronic disease that we never knew before.

And what that is, is that how you grow before you're born matters.

And it's not just how [you grow] before you're born,

it's also in the first two years of your life.

So the nutrition, and the conditions you lived in,

in your very earliest moments of life

determine whether or not

you're going to have a high risk for disease later on.

And how does this work?

I need to tell you a little about it

so that you can believe something about how this works

What it means is that the babies born at the low end of the scale

are small for two reasons.

One: they didn't get enough nutrition from their mothers.

That can be for lots of reasons.

Her diet, for example,

or her placenta that she tried to make to give nutrients to the baby didn't work.

Those babies are very different,

and they are vulnerable for the rest of their life.

Why are they vulnerable?

Because they have fewer heart cells,

they have fewer filtering units in their kidney,

and they also have one other problem and that is that their pancreas,

that makes insulin, has fewer insulin-making cells.

And because of that, they're vulnerable for disease as they get older.

Now what about the babies at the high end?

The babies at the high end are vulnerable because they got too much nutrition

and that's almost always because their mothers had poor glucose control,

their blood sugars were high, that sugar went across the placenta,

and the baby saw it as energy, and deposited it as fat.

So those babies have a lot of fat,

and I just want to tell you the most interesting thing we've discovered:

The babies at the small end and the babies at the large end

have almost the same risks.

And the interesting part about those risks

is they cause an inflammatory reaction that's very low-grade,

and they make those people vulnerable for the rest of their lives.

Now if you're feeling bad about that,

I'm just going to try to make you feel worse.

(Laughter)

And the reason I am going to make you feel worse

is because it turns out that those cases,

the small babies and the large babies,

can pass that effect on to their babies in the next generation.

First of all, I have to tell you a story about me.

I'm trying to get you convinced of this, so here it is.

I'm in my late 60s, not many months left, actually.

It turns out that the egg that made me

was made in my mother - she is 90-some years old,

still alive -

it was made in her ovary when she was in my grandmother's womb.

Do you get that?

The egg that made me was made in my mother's ovary,

when she was a fetus in my grandmother.

That means that the egg that made me was nourished by my grandmother.

That nourishment changed the way my risks for life will be.

I was also nourished by my mother,

so there's a two-generation effect on the nourishment.

I want to tell you about this picture:

This picture was taken in 1931, and if you look at the woman on the right,

she's a handsome woman, she's 86 years old,

and when she was a baby, she was being held by her mother in 1931.

It turns out that the egg that made her was made in her mother's womb

when her mother was in her grandmother's womb,

who was born in 1897.

There's one other interesting fact about this:

If you look at the lady on the left,

she was born to the woman sitting down in front.

Now that lady doesn't look too happy.

(Laughter)

I don't actually know what her issue is,

(Laughter)

but I think part of it is she was born before the civil war, right?

Times were tough.

So it turns out that I,

who am now in my late 60s,

the egg made me was made in my mother almost 100 years ago.

So that means in egg years, I'm 100.

(Laughter)

And this lady, that I am showing you here on the right, in egg years, she's 110.

We call this "The 100-Year Effect."

The 100-year effect means that nutrition flows across generations

from one person to the next, through mothers,

each successive generation.

And this nutritional flow means that you have to have good nutrition

every single generation in order to keep from having a risk for chronic disease.

So it turns out that it's a more complicated story than you might think.

That's because the nutrition that a woman gives her baby when she's pregnant,

not only comes from the food she eats, her diet,

but it also comes from the body which she was made as a child,

and as she was growing up.

And there's a man's story here too.

And that's because men also influence the health of their babies,

and both men and women do this through an effect we call "epigenetics."

Now if you don't know this word, learn it right now:

Epigenetics.

Learn it, say it, and use it on your friends.

(Laughter)

It'll wear out in a few generations, but right now it's hot.

(Laughter)

So here's the word.

Epigenetics means this:

The genetic code you got from your mother and your father

determines many things about you.

Those genes you got are expressed all the time,

and they're made of a DNA code, that you learned in biology.

The truth is, you can't change that code.

That code is found in every chromosome in your body, in every cell.

And that doesn't change.

However, what you might not know, is epigenetics, and what that means

is that before you're born, those genes, some of them, not all of them,

some of them are very sensitive to stress from the mother and diet from the mother,

and you can alter those genes that will change the way

you're going to grow for the rest of your life.

So you can't blame women

for the bad health of everybody.

And you shouldn't try.

Why?

Because both men and women, in this country now,

eat the worst diets of any Western country in the world.

We eat fast foods and we've been trained by industry to love the food they feed us.

And many of us have trouble getting off of it.

So don't blame women for this; blame our food culture,

because our food culture is doing us in.

So what will happen if we don't change?

Well, in 1960, one person out of every 100 was diabetic.

In 1995, one person out of 50 was diabetic.