Overcoming Your Genetics

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Meet some people who are taking dramatic steps to avoid diseases that run rampant through their families.

The way I see it, it all comes down to this: My mother was Norwegian and my father is Greek. When the genetic battle lines are drawn, who will prevail—the Vikings or the Spartans?

Will I die in my late 60s or early 70s of cancer, as did my mother and most of her relatives? Or will I live to a robust old age, guzzling ouzo and dancing to “Zorba the Greek” till I drop, as my father’s family has done? (My paternal grandmother lived to 103, disease-free.)

From what the geneticists are telling me, it’s not quite that simple.

What we know: Each of us has 23 pairs of chromosomes and approximately 30,000 genes.

What we don’t know: Which of those genes are going to act up. But some most certainly will, says Louise Gane, M.S., a
genetic counselor for UC Davis Health System.

“Everybody has six to eight genes that are going to cause problems,” says Gane. “But we don’t know what those six to eight genes are.”
We all carry risk. Age alone is a risk factor, so if we live long enough, something’s gonna get us, says Arthur Grix Jr., M.D., a clinical geneticist for Kaiser Permanente, Sacramento.

“Our genes do wear out,” says Grix. “After 60 or 70, we’re all going to get something.”

But that’s not to say it will be fatal—and it’s not to say everything is fated, either. (Except for death and taxes.)

If Mom Had Cancer, Will I?

There is no escaping the power of your genes. Many diseases run in families, and many of them are the biggies: heart disease, cancer, Alzheimer’s, others.

But just because you had a parent with a scary disease doesn’t mean you’re doomed. When I told Grix my mom had breast cancer at 62, he immediately assuaged my concerns. “Early onset cancers are more of a red flag than the cancer that can randomly hit anyone in later years,” he says. (The same rule of thumb applies to other diseases.)

Other red flags that geneticists look for:

• Multiple instances of a disease within a family. “We look in terms of two,” says Grix—two generations, two individuals.
The greater the number, the greater the concern of genetic risk.

• Diseases of first-degree relatives (parents, siblings, children) carry more weight than those of second-degree relatives (aunts, uncles, grandparents, etc.) and beyond.

• Multiple miscarriages: Two or more points to a need for genetic testing and/or counseling for women who are trying to get pregnant, says UCD’s Gane.

• “And if you’re under 50 and have a heart problem, that’s a biggie,” Gane warns.

But even the geneticists want you to know that you are not at the mercy of your genes.

We’ve heard it so many times that we want to puke. But if you want a shot at derailing your DNA’s dance with the devil, it all goes back to the basics: eating right, exercising, watching your weight, not smoking, balancing work and play.
 

“Your grandma knew best,” says Grix. “She told you to eat your vegetables, to go out and play and to exercise, to be nice to people, have friendships, be socially interactive, don’t smoke and certainly don’t chew [tobacco]. It’s all those things we’ve known for hundreds of years.”

The practical things, Grix admits, “are the hardest things” to do. Still, he’s not going to let you off the hook for not doing them, especially quitting smoking. “Nothing damages your health like cigarette smoking.”

And for crying out loud, he says, know your family history. If you’re found to be at high risk for a disease, you can start aggressively doing something about it, maybe even nip it in the bud.

“Especially if you have something that runs in the family, get good quality information on your family and get medical records,” emphasizes Grix. “It’s absolutely invaluable.”

Fighting Fate

Feeling doomed by your genetic fate? You can either give up or fight back, as these locals are doing.

Gary Grogan, 57
Disease he’s dodging: Diabetes

As a server at Paragary’s for some 20 years, Gary Grogan has long been a fan of fine food and wine. But when he was diagnosed with Type II diabetes about five years ago, Merlot was one of the first things to go.

“I stopped drinking entirely, which was really hard to do,” says Grogan. “I started watching every little thing I ate. I was freaking out because I was diabetic.”

Grogan’s parents are deceased, so he can’t ask them about family history. But he’s pretty sure his maternal grandmother died from complications of diabetes, and he remembers his father taking a diabetes drug. His mother contracted diabetes during late-stage cancer.

But Grogan has pretty much told his genes to shove it. Through diet, exercise and minimal pharmaceutical intervention, he is no longer diabetic but pre-diabetic—and that’s big. Like putting a car in reverse, Grogan has significantly reduced his blood sugar levels and, by extension, reduced his risk of heart disease, blindness and other complications of diabetes.

For Grogan, exercise wasn’t the issue—he had been working out regularly (including weightlifting) for years. But he needed to clean up his diet and did, completely cutting out desserts (and wine), reducing simple carbs and eating more fish and chicken. He switched from regular pasta to whole-grain or spelt and scaled back on portions.

Within six months, he dropped some 30 pounds and everything else dropped, too. “My blood sugar dropped, my liver count—everything dropped dramatically,” he says.

And he did it all, he says, without diabetic medications (though he does take meds for blood pressure and cholesterol). “The diabetic medicines had all kinds of side effects, so I’d rather just keep up my exercise and diet,” says Grogan.

Getting diabetes, he says, was a “wake-up call about mortality. It can be a very life-threatening thing.”

But maybe, as his story shows, it doesn’t have to be.

Paul Cogan, 50
Disease he’s dodging: Alzheimer’s

Everywhere he looks on his family tree, Paul Cogan sees Alzheimer’s.

His father had it. His father’s twin had it. At least one of his aunts had it. And he strongly suspects his paternal grandmother had it, too.

Cogan found himself getting a wee bit nervous about his own memory banks about 10 years ago, when the full weight of his father’s struggles with Alzheimer’s hit home. “I used to be great with names and with little details, like remembering every stroke and every putt of everyone in the group after a golf game,” says the Rocklin resident. “But suddenly, I noticed I wasn’t remembering these things as easily and I got a little paranoid.” His wife and friends said not to worry, that it was a normal part of the aging process.

But he wasn’t so sure.

Cogan high-tailed it over to the family doc, who ran a battery of simple memory tests. “In his opinion, there was no imminent danger,” he says. “But that to me wasn’t a comprehensive enough exam for me to give myself a free pass.”

So Cogan went into action.

In addition to the basics—eating well, walking 6 to 10 miles a day, controlling his cholesterol and blood pressure—Cogan has become a voracious reader, increased his vitamin E intake and tries not to listen to “anything mindless” on the radio.

And if you give him your phone number, Cogan plays a little math game, adding up the digits. (Research shows that mental fitness may delay the dementia demon.)

Cogan knows these strategies may or may not give him the “free pass” he seeks. But they have given him a measure of empowerment, and that’s huge.

 “My memory aid habits have helped me to be less afraid, not as paranoid as I was,” he says. “I need acknowledgment and awareness because I want to meet this thing head-on.”

Nancy Rocco, 46
Diseases she’s dodging: Breast and ovarian cancers

With a preventive bilateral mastectomy and hysterectomy behind her, some would say Nancy Rocco has taken extreme measures to avoid cancer.

But Rocco would say it’s the best thing she’s ever done.

“I am so at peace,” she says. “I don’t have to worry about breast or ovarian cancer anymore. It’s done.”

Rocco was 40 when a cancerous lump was discovered in her right breast. It was a scary kind of déjà vu: Her mother also had been 40 when she was diagnosed with the disease.

Rocco was only 13 when her mom lost the battle. But Rocco was determined to make sure her story had a different ending. After successful treatment with a lumpectomy and chemotherapy, she was “doing great” when her oncologist suggested genetic testing. It wasn’t just her mother’s early onset that pushed the alarm button, but a double whammy: Rocco is an Ashkenazi Jew, a population known to run an increased risk of the BRCA1 and BRCA2 gene mutations that are linked to breast and ovarian cancers.

When Rocco tested positive for a BRCA1 mutated gene, her oncologist laid out the odds. “The odds were so high of getting a second breast cancer or ovarian cancer—something like 73 percent—it made surgery an easy decision,” she says. “Would you get on a plane if you were told there was a 73 percent chance of the plane going down?”

The hysterectomy was psychologically easy, Rocco says, because she’d already had her family (a 17-year-old daughter) and because “it’s invisible.” But losing her breasts was much harder to face. “It’s [a] very personal, very feminine part of your womanhood, and having that kind of physical deformity was very distressing to me,” she says. But the Antelope resident has since undergone reconstructive surgery and is thrilled with the results. “They look incredible,” says Rocco. “You probably couldn’t even tell I’ve had surgery.”

But that’s nothing, Rocco says, compared to this clincher: After one of her sisters tested BRCA1 positive, she, too, had a prophylactic hysterectomy. The surprise finding: She was in early-stage ovarian cancer. The surgery came just in time.

“That’s the beauty of my story—that because I tested positive, my sister decided to get tested,” says Rocco. “She says I saved her life.”

Tom Muntz, 54
Disease he’s dodging: Heart disease

In the battle between Tom Muntz and his genes, the score is Muntz 2, Genes 1.

Fit and trim, and an avid runner, Muntz is the last guy you’d expect to suffer a heart attack. But he did, last year—while running.
Are faulty genes to blame? It’s likely: Muntz’s father had a history of coronary artery disease, eventually succumbing to a heart attack at 72.
But Muntz is still around, and doctors say it’s because he’s been taking such good care of himself. (This is where he’s winning the genetics game.)

“The doctor told me that had I not been a runner, I probably would have had a significant heart attack 10 years earlier—and that if I had not been a runner, the heart attack I had that day would have killed me,” he says.

Muntz came through bypass surgery like a champ and is slowly getting back up to speed, logging 30 minutes on the treadmill and 15 to 20 minutes on the bicycle at least three times a week. To prevent another “event,” he’s also taking a cholesterol-lowering med, eating more fruits and veggies, and taking a daily aspirin.

Does he blame DNA for his dance with fate?

“My genetics were probably an indicator,” says Muntz. “The part [the doctors] can’t explain is why someone with below-normal cholesterol would have a heart attack.” Stress may have been a factor, too. “While I might not have thought my job was that stressful, I do supervise 14 people and two helicopters and also serve in a law enforcement role,” says Muntz, a CHP sergeant and pilot who lives in Shingle Springs. “But it’s hard to know what the impact of that (stress) was.”

Probably the best thing that’s come out of this—besides Muntz, that is—is that it’s sent his five siblings scurrying to their doctors.
One was found to have a clogged artery, resulting in a same-day stent and this clever comment to Muntz’s wife:

“Tell Tom thanks for the heads-up so that I didn’t have to get cut up.”

The lowdown on DIABETES

David Hite, Ph.D., a diabetes expert and clinical health educator in the chronic conditions management department at Kaiser Permanente, Sacramento, offers these key points on Type II diabetes:

• “Our genes load the gun, but our lifestyle pulls the trigger. Your lifestyle and your environment can change the expression of your genes—not just with diabetes, but across the spectrum.”

• On genetic predisposition: “Sometimes we think we’re genetically predisposed to diabetes when we’re actually genetically predisposed to putting on weight.” Putting on weight—particularly in the belly—is one of the loudest warning bells of diabetes. (So are low HDL cholesterol, high triglycerides, raised blood sugar and high blood pressure.)

• Insulin resistance unlocks the door to diabetes. So what can we do to avoid it? “It’s gonna sound like your mother, but it goes back to the basics: Eat right, be more physically active, take care of yourself.”


• Take-home message: “I think the future is largely in our hands—that we can control to a large extent the direction of our lives. Be strong, take care.”

The lowdown on ALZHEIMER’S

Neurologist William Au, M.D., of Sutter Neuroscience Medical Group in Sacramento, offers these key points:

• Having one parent (or another first-degree relative) only slightly raises the risk of developing Alzheimer’s. Risk is much higher—about 54 percent—if both parents have the disease, according to one major study of patients who lived to be 80.

• Genetic testing is not currently recommended for Alzheimer’s. “Even if you carry the ApoE 4 (apolipoprotein E) gene (known to increase risk), it doesn’t change how you treat it. All you get is this big worry.”

• The usual suspects—high cholesterol and high blood pressure—are linked to Alzheimer’s, hammering home the usual advice: Eat a healthful diet and watch those numbers. “And don’t get diabetes.”• What else can we do to minimize risk? “Stay mentally active, be socially involved, go out with friends, play card games, play an instrument, get exercise—exercise may help to prevent Alzheimer’s. And keep educating yourself because you can increase the number of brain cells and the synapses (connections) between them by keeping mentally active.”

• Take-home message: “I think the major thing to make clear is that Alzheimer’s doesn’t usually hit until the 80s and having one parent with the disease only raises your risk a little bit. So don’t worry, don’t let it prey on your mind, and just practice ‘good brain health.’”

The lowdown on BREAST CANCER

Kim Van Ysseldyk, a nurse practitioner, genetic counselor and clinical manager of Sutter Roseville’s Cancer Risk Program, offers these key points:

• Everybody’s worried about BRCA1 and BRCA2, gene mutations strongly linked to breast and ovarian cancer. But, truth is, most breast cancers are not hereditary.  “Most cancer is sporadic. We can only tie about 5 to 10 percent to an actual mutation.”
 
• Still, those who are BRCA positive have a 50–50 chance of passing breast cancer on from one generation to the next, “so we definitely see a hereditary pattern.” Those with a strong family history—meaning multiple first- and/or second-degree relatives with the disease—are of particular concern. Other red flags that may signal a need for genetic testing and/or counseling: early onset (before age 50) of cancer, Ashkenazi (Eastern European) Jewish descent.

• A positive genetic test does not necessarily mean you’ll develop the disease. “But it can impact a patient’s care. Even if they elect not to have a (preventive) bilateral mastectomy or removal of ovaries, we can do increased surveillance (mammograms, other tests).”

• Men get breast cancer, too. (But women are at much higher risk.)

• Take-home message: “People see these things on ‘Oprah’ and start thinking everybody needs genetic testing, and not everybody does. Certain criteria must be met. But for those who need it, I think it’s important they have access to the services.”

The lowdown on HEART DISEASE

Michael Chang, M.D., medical director of cardiovascular services at Mercy General Hospital in Sacramento, offers these key points:

• If you have risk factors, particularly family history, it’s a good idea to check out your heart with noninvasive testing, including functional tests (such as a treadmill test) and maybe calcium scoring with a CT scan, “though that’s somewhat controversial and not recommended as a first-line test.”
 
• Want to measure your risk? Check your waistline. “Some studies show that waist size is more predictive [of heart disease] than general obesity.” The danger zone: 40 inches (or more) for men, 33 for women.

• An aspirin a day can help to keep a heart attack away, “especially in people who have risk factors or who already have heart disease.” (It’s not advised for everyone, so ask your doctor.)

• Prefer a natural approach? Red yeast rice is a cholesterol fighter that has been shown in randomized studies to reduce the risk of heart disease. Ramping up on vitamin D may help, too: Some studies show that people who have heart attacks have lower than average vitamin D levels.

• Take-home message: “I tell patients you can’t choose your family so you can’t do anything about that, but the other things you can do something about—smoking, obesity, high blood pressure, high cholesterol.” Still, you can’t discount the power of genes: Chang admits he sees people with “horrible diets” who have low cholesterol.