This week, a patient and I shared an aside that his child was acting out. She was having a rough time as her nanny had left, her teacher was on maternity leave, and her best friend had changed schools. And my heart just broke for all the little losses this little child was experiencing. Perhaps I was feeling particularly tender as I experienced a recent loss of relationship myself that was particularly devastating and difficult to endure. And of course, all of the loss that we're witnessing around the world, wars, hostages, they are tragically experiencing a whole other scale of loss and despair. And while we all experience different kinds of loss and different degrees of loss, One thing is for certain, we all experience loss. And so I thought this week, in keeping with the theme of Mental Health Month, I would dig in a little deeper into the universal experience of loss And as always, I'll start with a personal story. Welcome back to Health Bite, the podcast where we explore the intersection of science, nutrition, health, and well-being. I'm your host, Dr. Adrienne Youdim. I'm a triple board certified internist, obesity medicine, and physician nutrition specialist. And I just love sharing the science of living well. So thank you for being here on this journey with me. And I just want to give another thank you because I have been asking you to share the love. On the last few episodes, I've asked you to head back over to the Apple Podcast app or anywhere else you listen and leave us a review. I challenged you all with five reviews last week and we made that challenge. And I'm going to ask you once again, if you would be so kind and if you haven't done so already, please head out and review us. I am trying to grow the message and grow this community. and I need your help. So on to this week's episode. So many years ago when I was pregnant with my now 16-year-old, I went to see a therapist to help me with the tremendous mom guilt I was experiencing. If you're a mom out there on the day after Mother's Day, I want you to just raise your hand and say, me too. At the time, I just started my adult job as an attending and my position as the medical director of a new program I had helped to create. And I had an almost three-year-old that was born during my residency training. At the time, I was a resident, my husband was a resident. And in retrospect, we did a pretty darn good job prioritizing family and tending to her whenever we could. But the reality is, with the hundred plus hour work week of residency, we were missing a lot more than we wanted. The guilt for me was tremendous. And just before my number two was born, my family and specifically my dad, who had historically been very anti-psychology and anti-therapy, gave me a strong signal that I needed to get some help. And so I did. In the handful of sessions that transpired before I gave birth, one thing stands out. I remember her telling me, your experience of loss is so severe, it's as if you have been abandoned. Abandoned? I had not to my knowledge ever been abandoned. I was born into a loving family, and while they had the struggles that most immigrant families had, I felt loved and cared for. But many years later, the sense of loss is still close to my heart, without a true identifiable reason, at least in this lifetime. But that doesn't mean that there isn't a reason. And our current understanding of loss and trauma really spoke to me. The notion that the loss does not necessarily need to belong to you in order to be experienced by you. And the fascinating study of epigenetics has taught us that loss and trauma do in fact get passed down From grandmother to mother to child, to our progeny and to our progeny's progeny. My thoughts immediately went to my mom. Perhaps the loss of her homeland and her voyage across the globe, leaving all that she knew as the first to leave her family in Iran. Perhaps the fact that my grandmother had lost her mother at a very young age. and the loss of her sister, who died soon after, leaving a toddler and an infant that my grandmother would come to mother even though she was a child herself. It seems like almost science fiction that trauma could be passed down unknowingly across the generations, but it's not. The science shows that this, in fact, is true. And I want you to consider this. Women are already born carrying all the female reproductive cells. So the eggs that go on to reproduce 20, 30, 40 years later that are fertilized by sperm to conceive. Those precursors of those eggs already existed in your mother's body when she herself was in utero in her mother's body, as early as when your grandmother was five months pregnant, which is really a wild thought. As Mark Wolin states in his book, It Didn't Start With You, three generations existing in the same body, in the same container, sharing the same cellular environment at the same time. And the same is true of the genetic material that's passed on by your father. Precursors to sperm were present in your father's body when he himself was in the womb. But in addition to that, the sperm continues to be impacted by his own life events. And in order to understand this, we need to do a quick little review. So when we think of genes, we think of it as the information or the blueprint that codes for material traits like blonde hair or blue eyes, but that's only part of the story. Only 2% of the genetic material is coding for phenotypes or for physical traits. 98% of that DNA consists of what's called non-coding DNA. And when I was in medical school, they used to call it junk DNA because it wasn't expressed into a trait. And so they believed it to be junk. But that is so very far from the truth. because we now know that this non-coding DNA has a very important role because it basically determines the turning on or off of the expression of genes. So whether a trait actually gets turned on and off and actually shows up in us as an individual, like a disease, for example, is determined by this non-coding DNA. And I've shared on my prior podcasts and in my book, Hungry for More, that childhood trauma, which is also called adverse childhood events, increases the risk of obesity and other diseases like heart disease and autoimmune disease in this very way. It's called epigenetics. So we know that this, quote, junk DNA is very susceptible to the environment. Things like stress, trauma, parental emotions, nutrients that they consume, environmental toxins, and even behaviors of your parent, such as whether they exercised or not, impacts your genes in an epigenetic way. In fact, researcher Bruce Lipton has shown that a mother's emotions while she's carrying a child in utero, including fear, love, anger, hope, these emotions can biochemically alter the genetic expression of her offspring. Emotions in the mother cause a release of hormones and chemical signals that not only cause changes in her own body, but also affect the body of the fetus that she's carrying, activating metabolic, physiologic, and genetic changes. That's really wild. And when these emotions and stressors are chronic and repetitive, like anger, fear, or stress, they can imprint on the fetus, impacting how he or she responds to similar events or to events that evoke those similar emotions. These stress hormones that are generated in the mother's body cross the placenta and they impact the reactivity in that child later in life and impact the behavior of this unborn child. So, for example, when a pregnant mom experiences stress, it causes the release of stress hormones, things like cortisol, adrenaline, noradrenaline. These hormones are then transported across the placenta and they impact the DNA of that child and impact its future reactivity. We know this through data that started out in animals but has also been shown in humans. And here's some interesting stuff. Humans and mice have DNA that are strikingly similar. In fact, 99% of our DNA is similar to the DNA of mice. Chemical changes in mice can be matched to behavioral patterns in the original animal and in subsequent generations. So basically, they're able to capture these chemicals in the blood of the mice and then match it to behaviors that are similar to our behaviors of stress, anxiety, fear patterns, and it can be matched to the genetics of the pups of the future generations of these mice. So they've done studies that are so sad, but but nonetheless have given us knowledge. Studies have shown that the effects of maternal separation cause changes in gene expression of pups that were seen three generations later. So in one study, mice were prevented from nurturing their pups for three hours a day in the first two weeks of life. So basically they separated the mommy mice from the little pup mice for three hours a day during a very critical time of growth and maturation, the first two weeks of life. They went on to study these offspring and they demonstrated that behaviors that are comparable to depression and anxiety in humans were present in these pups. And what's more is that unlike what you might think, that symptoms would actually go away or improve over time, the symptoms appear to get worse as those little mice aged. In some instances, the male pups didn't exhibit the symptoms themselves. but still were able to pass it on to their pups who then exhibited the depressive behaviors themselves, indicating that not only can this trauma of separation be experienced in the first generation, but they can skip that generation and then be expressed in generations still to come. In humans, this has been replicated, and studies have shown, for example, that children who were born to moms experiencing high stress while in utero were more likely to be preterm, to be underweight, to be colicky, hyperactive, and irritable. They showed this, for example, in children who were in utero during wars, during the Holocaust, during 9-11. who were in utero while the mom experienced this trauma or the traumatic events, have markers on their DNA that make them more likely to express genes that are associated with anxiety, depression, PTSD, and as a result, have higher rates of these symptoms and of these diagnoses as well. What is fascinating to me again, is that our DNA is affected by our thoughts and emotions, both negative and positive. But the thoughts and emotions can cause changes in physiologic signaling that then cross across the placenta and then impact the genetic material of the progeny while in utero. These signals impact the physiology of a cell and the expression of our genes. So cellular memory is transferred from the womb to the unborn child. I don't know about you, This seems heavy, and it may seem like a depressing proposition, both as the potential recipient of these non-coding genes, but also as the potential contributor to genes that could cause emotional distress in our own progeny and our progeny's progeny. But here's the flip side. This coding, it has been shown, also carries a blueprint that prepares us with tools for when similar stresses are experienced by us. Having this coding in our DNA, in a way, builds resilience to dealing with these stressors ourselves. It helps us cope, it helps us adapt, and it helps us to survive. The fact that trauma is coded and passed down in our DNA as a blueprint, as a memory, is an opportunity that we can rely on this past in order to navigate our own challenges, our own stressors and traumas. but only if we are aware and intentional. And so I want to encourage you to first acknowledge that loss and trauma is universal, no matter how potentially small, like losing your teacher during maternity leave, or very large, like experiencing the trauma of war. Validating these losses in ourselves and in our children is important and critical to beginning the healing process. And then exploring the feelings, the very visceral feelings, even when they are misplaced. Doing the work of processing these feelings, whether it's through therapy, mind-body practices, somatic healing practices, and the many other tools that can be and are available to us, not only helps us do the work of healing in ourselves, but again, can impact our DNA in an epigenetic way so that we can pass it off differently to our children and to our children's children. This work of healing is, again, not only therapeutic to us personally, but I would argue essential to healing, again, not only of our children, but to our world. When we can acknowledge our own losses and traumas and step out of the reactivity that grips us, the reactivity that right now, quite frankly, is in full view across the globe. We can then do the work that is healing and supportive to the safety of humans all over. The safety and support that all humanity craves and needs. So I hope that this conversation opens the door for you, opens the door of approaching the subject with a sense of common humanity, recognizing that we are all in it, that these losses and traumas are universal. Taking away the shame so that we can do the work in a constructive and healing way, and then to pay it forward in the way that we react, navigate our children's losses and also how we Navigate and treat the people around us in our communities in our workplaces which then can have a rippling effect to the way in which we walk and we move with one another out there in the great wide world So I am wishing you some Contemplative thought around this matter. I am wishing you lots of love and light during a time that I know is challenging for many and I hope that you can share this message with your friends and your loved ones and Meet me here again next week on health bite where we will continue the conversation around good mental health and well-being in honor of Mental Health Awareness Month. I look forward to seeing you then.