Doctors Who Make a Difference in Hawai‘i

Meet five Hawai‘i physicians that are doing important work in our local communities.


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The Gene Switch

From diabetes in adults to autism in children, a trailblazing researcher reshapes the way we think about our genes and the environment.

By Ikaika Ramones

Dr. Alika Maunakea looks at genes and diet as well as ancestral knowledge to solve modern problems.

GROWING UP ON A NĀNĀKULI HOMESTEAD, Dr. Alika Maunakea saw firsthand how Native Hawaiians were disproportionately devastated by diseases and also shortchanged on medical services. And he witnessed how his great-grandmother Katherine Maunakea—a preeminent kahuna lā‘au lapa‘au, or Hawaiian medicine practitioner—filled those gaps by treating members of the community. “That’s probably why I fell into studying the role of the environment in health. In lā‘au lapa‘au practices, that’s a fundamental philosophy. ”


After medical school at the University of California San Francisco and post-doctoral research at the National Institutes of Health, Maunakea returned to Hawai‘i as an assistant professor and researcher at the University of Hawai‘i School of Medicine’s Department of Native Hawaiian Health. “It’s my home, and I’m kanaka maoli. My motivation to become a scientist was to serve my community. My great-grandmother’s role in the community was that; I saw there was a need to address the health problems I saw as commonplace where we lived.”


Today, Maunakea leads pioneering new research to improve diagnoses and treatment. But, he says, “Understanding the biological rationale for a disease is only one way of trying to reduce these health disparities. It’s also not enough; you need people to incorporate the cultural knowledge and the modern technology to implement them in a way that makes sense for our communities here.”


As an epigeneticist, he researches how environmental factors influence particular genes on the molecular level to turn on or off and thus lead to disease. Rather than waiting for symptoms to show up, his projects look for the root causes of a disease. 


And that’s how one community-based research project on diabetes began at a Papakōlea homestead. While traditional academia would study the community like a sample in a petri dish, this project invited the community’s input at every step. “We actually talked to them about concerns first; we didn’t make any assumptions. We asked them what they thought they needed.” The answer: help with diabetes.


Ailments like diabetes and cardiovascular disease disproportionately target certain populations, including Native Hawaiians. But, Maunakea says, “It’s not really genetic differences that underlie these health disparities in different populations. There are certain things—stress, toxicants, pollutants, nutrition and even cultural trauma—that can contribute to these health disparities. Once we identify those, then we can actually inform policy.”


After a 12-week program of lifestyle changes designed by the community (including diet and exercise programs tailored to the community and culture), researchers measured not only participants’ weight and glycemic control, but also looked at whether the molecules around the genes were changing. While most, but not all, patients showed improvements in their symptoms, “We saw changes across the board in all participants; their epigenetic patterns reflected a normal, nondiabetic condition in those cells playing a role in inflammation. This suggests that the lifestyle change really is impacting individuals at a molecular level.” After another 12 weeks, those who at first only exhibited epigenetic changes also began to show clinical improvements such as glycemic control. “We found that the change in molecular epigenetic profiles preceded the clinical outcomes,” so while the individuals may have technically been diabetic, the cells Maunakea studied were already beginning to normalize.


BREAKING FROM THE NORMS of traditional studies, Maunakea went to the community with the results. “They actually said the epigenetic information had more of an impact on them personally and their families than their clinical data like weight. The results suggested that all individuals are becoming nondiabetic, at least on the molecular level, which gave them hope and motivated them to continue to adhere to the lifestyle intervention and talk to their families about it too.” The community even wanted Maunakea to share the information.


Studying the molecular functions of cells leading to a disease can mean both earlier detection and also more targeted therapies. “It might lead to new drugs, alternative medicine or nutrition that might help us treat individuals specifically,” based not on their genes, but on the connection between the environment and their genes.


In another trial, at Shriners Hospital for Children in Honolulu, Maunakea also looks at the therapeutic effects of a ketogenic diet, one that is low in carbohydrates and high in fat, on children with autism. “With autism, there are few interventions that work and are cost-effective in modifying some of the behavioral and social issues that patients have. But a diet is simple,” he says.


 “In diabetes for adults or autism for children, you can see that we’re trying to understand the ideologies of the diseases at the molecular and epigenetic level, and taking that information to figure out how we can improve therapies or predict individuals with these diseases at an earlier state. We’re really trying to shift the focus of modern healthcare from treatment to prevention.” And Maunakea believes that knowing what’s going on at the molecular level can help prevent disease.


Maunakea’s research and respect for traditional knowledge continue his kūpuna’s traditions of helping the community. “A lot of the problems we face today with health, sustainability, the environment, all of that we can solve using our ancestral knowledge. Applying that not only to restore our culture and our practices, but really to solve those modern problems, that’s exactly why I’m in this lab and back in Hawai‘i.”  


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