Māori and Pacific people have long been told that the state of their health is their fault. Now, genetics is giving scientists new tools to both improve health and fight discrimination. And the results could help us all.

At Auckland Girls’ Grammar School today, you’ll find more sugar in the science room than the tuck shop. The 30 girls who trooped into the ornate old study hall at 8.30am walked out again a couple of hours later with a piece of information that could change their lives: how well they absorb sugar.

They’re part of a research programme being run by scientists who say genetics plays a much bigger role in metabolic diseases than it’s given credit for, and sufferers are being unfairly stigmatised when people blame their condition solely on diet and lifestyle. This year, Auckland Girls’ Grammar is one of about 50 schools whose Year 9 or 10 students will discover how they respond to fructose in their diet – it’s estimated between 20 and 25% will be defined as fructose malabsorbers, which is linked to a lower body mass index (BMI) and may protect against diabetes.

The experiment, part of Tātai Oranga, a grassroots-research programme linking communities with scientists, is being run by the Maurice Wilkins Centre, one of the country’s Centres of Research Excellence. The nationwide group of researchers is investigating genetic and other factors that increase or reduce risk of diabetes and change the way patients respond to common treatments.

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The Moko Foundation in Kaitaia, founded by GP and former New Zealander of the Year Dr Lance O’Sullivan, is a partner in the Sugar in Schools programme, and other studies that are providing new data linking genetic and other personalised patient-health information in a bid to revolutionise treatment options.

“The opportunity here is exciting,” says O’Sullivan. “We have limited resources as a country and targeting risk-reduction strategies universally gives us really mediocre outcomes, whereas if we have precise information about individual risk through genetic information, we can be really clear about people who need customised treatment.”

At least half his diabetic patients have a problem with side effects of metformin, the mainstay of treatment before insulin. “Māori patients tend to need high doses, which come with a lot of complications, including chronic diarrhoea. Often with these patients we don’t have a second chance. You give them something for their diabetes that’s horrible and has bad side effects and you never see them again, so we should be trying our best option first.”

Diabetes triggers

Knowledge about the triggers for diabetes and gout is expanding rapidly, outpacing what doctors learnt in medical school. “I compare what we are learning now about gout, for example, with what we knew then. We know now it’s a very genetically driven condition in Māori, yet for decades the advice from doctors was, ‘You’ve eaten too much kai moana and you drink too much, so you’ve got to change your lifestyle.’

“I saw a patient yesterday who said, ‘Yeah, it’s my fault, I’m eating and drinking too much.’ The reality is that’s probably not the case, but you’re genetically programmed to process uric acid differently and, regardless of what you eat, you are going to have problems with gout. We can manage it a bit differently. Patients get sick of being told off and treated like a naughty kid, so that’s why I’m excited about these initiatives.”

University of Auckland-based Maurice Wilkins Centre (MWC) deputy director Professor Peter Shepherd hopes the research will break long-held stereotypes. “There’s no doubt exercise and a good diet are helpful, but there are people, including scientists, who will look at the data and say, ‘Well, that’s all very interesting, but we know people can still control their food intake and should be able to’, because for them it’s not a problem. It’s the skinny-white-men-in-bicycle-shorts syndrome – they would never get fat in their life if they tried. You can’t just choose the facts you like if you want to solve the problem.”

Up to 20% of Māori and Pacific people are thought to have a genetic variant that may make them process metformin differently, and another, which occurs in about 15% of men, that increases the risk of high blood pressure. “Anecdotally, there is evidence Māori and Pacific people do worse on metformin, but no one has done the studies in New Zealand because the medical system just says, ‘Here’s a pill, everyone take it.’ Doctors figure we’ll give it to everyone and it’ll work in 80% and that’s good enough. The problem is, a lot of Western medicines were trialled on Western people and we don’t know if they are going to work the same way in Māori and Pacific people.”