Interview with Dr. Dylan MacKay


Image: UManitoba

AMY: Hello and welcome back to SciSection, I'm your journalist Amy Stewart, for the SciSection radio show broadcasted on CFMU 93.3 FM radio station. We are here today with Dr. Dylan MacKay, a nutrition and chronic disease researcher and an assistant professor of Food and Human Nutritional Sciences at the University of Manitoba. Thanks for joining us today Dr. MacKay!

DR. MACKAY: Thanks for inviting me.

AMY: So, to get us started, tell us about your educational and career background and how you got started in your field.

DR. MACKAY: Sure. I think I guess that all starts with when I was 13 years old, I was diagnosed with Type 1 Diabetes. And that kind of put me on the career trajectory that I have for right now. Getting diagnosed with Type 1 Diabetes, everything related to food is inherently related to your health, in a way. And it kind of put me on a path towards nutrition research, I think. So, after highschool, I went into an undergraduate program in Biochemistry Nutrition at Memorial University in St. John's Newfoundland. I was thinking about medical school, but then I didn't get in my first time applying and I decided to do a Master's in Biochemistry. I got into a Master's program at Memorial University with just two incredible researchers Dr. Robert Bertolo and Dr. Janet Brunton. And they're nutrition researchers, and they do research using Yucatan miniature pig models. So, like animal models of nutrition and what I was looking at is the development of Type 2 Diabetes in this pig model and the early development, so the DOHAD - developmental origins of health and disease - in a piglet model and we raised pigs and looked at the potential of developing Type 2 Diabetes in them for almost 13 months. And that was my Master's. And I really loved the research and I thought that the career that my supervisors had seemed like an amazing job. To supervise students, to sit on CI chair panels, review science, and it just inspired me to sort of, if I could, I wanted to be a researcher and having the research in diabetes being close to my own health was really what I wanted to do. After that I moved to do my PhD at the University of Manitoba, and sort of in a topic of nutrigenetics, which is the idea that personalized nutrition and how our genetic makeup may influence our response to diet or we might be able to influence our disease risk through our diet and then maybe mediate it by our genetics. In that PhD, I started doing clinical trials and so that’s interventions with people rather than animal models, and that really sort of fit for me because I think all of that mechanistic research eventually has to work in populations and with people in the real world. And so, that's the area where I really liked to research. And after my PhD, my post doctoral fellowship was also at the University of Manitoba, and I focused on clinical nutrition interventions in all kinds of different populations. After a couple years of postdoc, I was able to get a position at the George and Fay Yee Center for Healthcare Innovation, which is a patient oriented research support centre in the clinical trials platform. And that was an incredible position for me, I got to work on designing and assisting mostly clinicians, so you know, physicians and nurse practitioners, that kind of thing, and psychologists, people in the healthcare system in designing clinical trials and they were mostly related to lifestyle. That’s essentially the work I do now and I really enjoy it. So, the biggest connections I made were with some nephrology researchers and physicians. So nephrologist: doctors that treat people with chronic kidney disease, and the University of Manitoba has probably one of the best kidney disease research groups in the world. And I'm very lucky to work with them. So, we have projects ongoing right now with nutritional interventions. Really excited about one, we just got funded from CIHR to look at metabolic acidosis in chronic kidney disease. And so, as a kidney function begins to deteriorate in chronic kidney disease, the ability to maintain acid-base balance in the body is impacted and some people end up with metabolic acidosis. And so metabolic acidosis is associated with worse outcomes in chronic kidney disease and faster progression. So, ways to intervene to correct that acidosis are obviously of great interest. Right now it's treated essentially by giving people capsules of baking soda orally. And that treatment's not very well tolerated by people, so I'd imagine like a volcano in your stomach. A couple times a day you're taking these really big pills, and so the data around the world, but also in Manitoba, has said people discontinue that treatment very often and so we know if someone can't continue to take a treatment, it's not a very good treatment. And there's another option potentially through diet, where if you reduce the diet's acid load or you provide bicarbonate equivalence in the diet, you might be able to sort of intervene in a different way without neutralizing the acid, just not providing it in the diet. Fortunately, fruits and vegetables are good sources of dietary bicarbonate equivalence and there's been some preliminary trials have shown that giving people fruits and vegetables and modifying the diet to enhance the amount of fruits and vegetables can work almost as well or as well as the current medication that’s used. And so, one of the things that we're going to do now is we are going to have a feasibility trial where half the people coming into the trial are going to get the normal pharmacological intervention, the sodium bicarbonate drugs, and the other half, we are going to deliver fruits and vegetables directly to their house. And not just enough for that one person in the house, but to all of the members of the household, because of previous data suggests that if you just give it for the one person, they end up sharing it and they don’t get the dose that is needed to have the potential effect. So, we're very excited about that one and we're actually going to start that in the next couple of months.

AMY: That is some really cool research you're working on. I love how you put an emphasis on lifestyle and it's so crazy that factors like good nutrition is something that has a lot to so with something like socio-economical status. That is really cool how that’s intertwined with what you're doing, too.

DR. MACKAY: Yeah, I think that’s really important because in interventions and in nutrition, all of those intersecting factors are so important, right. We can come with the perfect diet, but if people can't get it, or you can't afford it, or they can't store it, or they don't have the skills to prepare it the way it needs to be, or they can't shop for it, all of those are barriers that need to be addressed to make that intervention work. Which is why the more I've been in nutrition, the more I like the idea of just give the people the food, as close to ready to consumption and as easy it is for them to make it.

AMY: That’s really great and I love how your story is very intertwined with your personal history to what inspired you to pursue this career. That’s very cool.

Yeah that’s 100%, everything I eat influences my health. The other thing, is that almost all of the interventions that I've try to develop and work on, I like the idea of integrating them into the current healthcare system, because we have an amazing healthcare system in Canada. I think it needs to be supported, but a lot of research sometimes duplicates what the healthcare system already does. Like if we did a trial and we recruited people and we took blood samples, but they were normally getting those blood samples in the healthcare system, that data is already being paid for and then I'd be essentially duplicating that. So, there's ways to do efficient research and it also contributes to the healthcare system, because I think the healthcare system needs to use its data to learn and improve. So, the learning healthcare system and integrating nutrition research into it is sort of what I do, which I'm very happy about.

AMY: That’s very cool. I want to talk a little bit more about nutrigenomics now, which you said you worked in a little bit. And that’s a field that uses genetics to determine interactions between a person's genes, their nutrition, and health, and you said it could be used to develop personal diets plans. Do you think nutrigenomics is the future of dieting? And how much do you think we can rely on our genetics for what we should and shouldn't be eating?

DR. MACKAY: So, I may have just hinted at it. It's sort have been an evolution of my research career. I started my PhD really deep in nutrigenetics and the idea that maybe the right diet for somebody is dictated by their genes. And we just published a trial in the American Journal of Clinical Nutrition called "Gene Predict" where we actually did a clinical trial where we picked some genes in advance that we thought were going to influence response to an intervention and based on previous trials they'd been associated with response. But when we did a trial where we genotyped in advance and then intervened in sort of a better, I would say, methodological way. We showed that unfortunately - or fortunately for this set of genes - it didn't show any difference in the response. As I advanced through my PhD, and the more and more and through my postdoctoral work and subsequent jobs, I've seen there's so many factors outside of genetics that we just discussed that I think have a much larger influence on people's health. Genetics may explain some things, but even if you have certain genes that told you about an optimal diet, how you access and get that optimal diet is far more likely to be influenced by your education, your neighbourhood, where you were born, all kinds of other factors. You can't change your genetics and most of those other factors are hard to change as well. I'm leaning less and less towards seeing that personalizing based on genetics is going to be a way forward. One of the big things that I see with that also is that it internalizes the health, potential health problems, or the responsibility for your health outcomes, based on your genetics. And in general, I just don't think that’s a positive way to look at it, right. Our health is influenced by so many factors that I don't think individuals have the potential to change and the idea of testing someone and giving them the diet, it just doubles down on that. So, if you have something like Type 2 Diabetes and "oh it's because you had the genes" it may not be because of the food desert that you grew up in, or the fact that you never learned all the skills, or had access to resources to create a healthier diet for yourself, and those are not things that people can necessarily choose or change. I think it'd take society and community based changes and I think that’s where most impact comes from. So, I would say nutrigenetics/nutrigenomics is not the future of selecting healthy diets. It's something that I started in my PhD and thinking this could be incredible and then by the end and now it's completely opposite. So, I have to be open to new evidence and that's really been an evolution of my career.

AMY: That is really cool. And I'd have to say I agree with the point you make: if people learn that the way they are and how they eat, and their nutrition is because of their genetics, they're going to feel like it’s a lot harder to change that and I don’t think that’s a narrative you want to be sharing when it's concerning people's eating habits.

DR. MACKAY: The other thing is, I just don't see the effect size there, too. So when you look at the impact of genetic variations, if we're finding other than things say like phenylketonuria or something like that where it's like a rare disease that’s caused by a well characterized variation of genetics that has a huge impact. I think we know all of those basically, because they're such huge changes to the phenotype or the outcomes that they're easy to find. But the genetics of common complex diseases like heart disease and diabetes, the influence of diet interacting with genetics, very, very small. Relative to other things that we know that have a larger impact on diseases, right. So, when something has a very, very small influence and it's interacting with numerous variations, you could have let's say five variations that put you at greater risk of diabetes, you could have 20 that put you at less. How do you calculate that? And it becomes very complex and it's not something I think that science is at the level to handle at the moment. Maybe in the future. But then, even if we can design the perfect diet based on the genetics, implementing that is going to still have all of the other barriers that we know exist to getting a healthy diet.

AMY: And with your career in nutrition which has a lot to do with weight loss, I'm sure you see a lot of misinformation in your field and on the internet. And I know you're really big on combating that misinformation. What do you think the scientific community could do to ensure that the research they are doing is being heard by the people who need it and that it’s being communicated effectively?

DR. MACKAY: It's about approachability, I think, and humanizing the researchers that are there and I know it’s not for everybody in science but, being available, and honest, and transparent, it is really key on these things. Because every time that you aren't, there's so much potential for that stuff to be used for disinformation or to be used to discount. So some of my research has funding from governments, other projects I have research from industry, and it has to be very transparent about that. I guess I'm very active on Twitter, and approachable, increasingly more political, I guess. Being apolitical is not something I think scientists can morally be right now, because that in itself is a stance. But fostering trust has to be about being transparent and approachable in translating our research. You know, podcasts, social media, everything that can get the message out there and see that the people who work in science and who generate this are real humans with the same lives and issues that everybody else has, it’s a job. I think its important in developing trust. That being said, it is a huge, huge problem to combat misinformation and you see that a lot of the misinformation overlaps incredibly and there are political forces that are fighting in misinformation. And then there is also financial things that push misinformation, especially in nutrition, and dieting, and weight loss, right. Where the message comes from I always think, because "who does this message benefit financially?". Because in many things in our society, it's benefiting somebody and that’s why they're putting it out there and that's an important first step "why is this message being put out there?". Misinformation in diets, people are often selling those diets or those things and there's a lot of money in it - you know supplements, and dietary strategies, and books - these are billion dollar industries. And so, that money can buy a lot of directed misinformation to keep people going to their products.

AMY: It definitely is a very dangerous cycle. I mean, we've seen it with climate change, we've seen it with COVID. It's very important that people get their information from experts that aren't influenced by factors like politics, and financing, and all that. But it's definitely a messy, messy field. Ok, so for my last question I just wanted to ask which areas of nutrition and chronic disease research are the most up-and-coming and you think you'd like to explore further?

DR. MACKAY: I'm a little biased when I say this, I think the type of research that I'm getting to do now where you're delivering the foods to the people, removing as many barriers as possible, and then leveraging existing healthcare infrastructure to access the populations of people who really need the interventions, is what I think nutrition needs to concentrate on. Nutrition interventions that have impact in people's lives and give the food directly to them is really what I'm excited about researching.

AMY: That is really amazing. It definitely is the most effective way, it is the most simplest and I feel like sometimes that’s the way we overlook the most.

DR. MACKAY: I have actually wrote an article once called: "Food isn't medicine" and some people will constantly say, well Dylan, the exact type of work you're doing now falls into "food is medicine", and I think it’s a nuance that there may be particular places where food can be very important to health, but seeing it as medicine just rips it away from a lot of the other context that is has and creates an environment where scam artists and grifters really tend to be the most common, rather than actual solutions for health.

AMY: That is some very awesome research you're doing. I feel like it's going to help a lot of people and I think it will be very effective. But that’s all the time we have for today, so thank you so much for joining us Dr. MacKay, it was fascinating to hear about your research in nutrition and chronic diseases and I'm very excited to see what your research has in store.

DR. MACKAY: So am I, I can’t wait to see what it's going be, how it's going to turn out, so it's why I do what I do. Thank you for having me.

AMY: Thank you again. That’s it for this week of SciSection! And make sure to check our podcast available on global platforms for our latest interviews.