What You Can't Control with Your Health
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About the Show
In this series, we’re exploring the balance between what you can and can’t control when it comes to your health.
On this episode, Chuck Gaidica is joined by Care Management Physician of Blue Cross Blue Shield of Michigan, Dr. Angela Seabright. Together, they explore the role of genetics and family history in our health.
In this episode of A Healthier Michigan Podcast, we explore:
- How genes provide a blueprint for how the body functions, and genetic mutations can increase the risk of certain diseases.
- How genetic testing can help identify inherited disease risks, but should be done with guidance from a doctor.
- How advances in genetics and gene therapy offer hope for future treatments that can target the root causes of diseases.
- How even though individuals can't change their genetic makeup, they can take control of their health through positive lifestyle choices.
While we can’t change our genetics, aging brings its own set of challenges. In our next episode, we’ll talk about how to embrace the changes that come with age while focusing on what you can control to thrive at any stage of life.
Transcript
Chuck Gaidica:
This is A Healthier Michigan podcast. I'm your host, Chuck Gaidica. And in this series we're exploring the balance between what you can and can't control when it comes to your health. Continuing now with episode 175, we're exploring the role of genetics, family history on your health, on my health. And back again to continue our conversation is Care Management Physician of Blue Cross Blue Shield of Michigan Dr. Angela Seabright. Good to have you back again.
Dr. Angela Seabright:
Thank you.
Chuck Gaidica:
We're sort of like the mafia on this podcast. You can never leave, so we'll keep bringing you back. Good to have you.
Dr. Angela Seabright:
Well, I'm happy to be here.
Chuck Gaidica:
Good. So, we know this idea of lifestyle change. We talked about that in our last episode. We're going to be unpacking more about that in the next episode as well. But lifestyle changes can play a significant role in our health. No escaping though, the influence of how we've been wired through genetics and family history. Some of that we're aware of, and for some we're not quite sure what may have happened to a mom or a dad along the way. But there are certain things that we all know we're born with that can increase the risk for certain diseases or even health conditions. So understanding our genetic makeup, it seems, doctor, can empower us to make informed decisions about our health. So let's get into it, this idea of how much of our health is actually determined by family history. And can we literally take control of that then?
Dr. Angela Seabright:
Yeah, it's a great question. Great topic. Your DNA is the code, it's the blueprint of your life. So it tells your body, every cell in your body how to function. And it's so much more than what eye color you're going to get, it's really a set of instructions. And it also can increase your risk for disease, depending on what the instructions say. So if there's an error or a mutation in the DNA, it gives your body bad instructions and can lead to diseases. But genes are only part of the story.
So the majority of our risk for disease comes from our environment, our behaviors, and our lifestyle. So while it's important to know your family history, it's also important to know that you can't change your genes, but our environment has the potential to change our gene expression and our function, which is a field of study called epigenetics. We talked about this on a prior podcast. It's that light switch, Chuck, that you mentioned, which was a really good analogy. Because those genes are there. But if they're turned on or off by external factors like our environment, that really plays a role in our health.
Chuck Gaidica:
And this idea of genetics, I've never done a genetic test, although I appreciate that whole idea fully. But many of us, whether we haven't done, it's too expensive to do, we sometimes don't know, doctor, about our genetic history until something flared up in a parent or a sibling, somebody, my aunt had something. So all of a sudden, you're on guard. So, that can be scary enough. But it seems like the way we can deal with that history is to not be fatalistic, but to just be realistic.
Dr. Angela Seabright:
I love that. To be realistic, check with your doctor, let them know your family history and your concerns, and take it from there.
Chuck Gaidica:
So, what are the best ways for us to know that we've got certain genetic factors that put us at higher risk of let's say, cancer or diabetes or heart disease?
Dr. Angela Seabright:
So, there are genetic tests and screening that can be done to identify those who may be at higher risk for certain diseases. But there usually needs to be an indication for genetic testing. It's not as simple as walking into your doctor's office and getting a screening for everything. The testing is usually targeted. So we take a detailed family history, we go based off of your own medical history, and that will guide the genetic testing, what genetic testing, if any, should be done.
And then the question is, once you have the results, now what? What is the significance of a particular genetic variation? Is there a significance? And what proactive interventions can be done, whether from a medical standpoint, from a surgical standpoint, specifically in cases of breast ovarian cancer, where a woman may choose to have a prophylactic mastectomy? Or then behavioral factors to mitigate the potential risks of disease.
So, there are some direct to consumer testing for genetic testing. That is a tool that is available. But in practice, genetic testing should be reserved for those suspected of having an inherited disease or those who are at high risk. Because those tests really don't offer any genetic counseling, there's little oversight. And there can be concerns, privacy concerns, and what happens to your data. So, I would really recommend speaking with your doctor if you are looking to pursue any type of genetic testing.
Chuck Gaidica:
So, there's another angle to this that I've experienced anecdotally. And to be honest, I've not had a genetic test for this. I have a brother and a sister, so there are three of us. And our mom sadly, wound up with Alzheimer's later in her life. And it was about a seven-year journey for her and she passed in 2019. But then all of a sudden as the children, we start asking this question.
And what is fascinating is while I still haven't gotten a test to see if I have any genetic makeup or predisposition for Alzheimer's or dementia, when asking that question of siblings and even my wife, and then you broaden it out to anybody else you ask, you get a lot of head scratching like, would I really want to know? In other words, it's not a guarantee that I'm going to get it because mom had it. But do you really want to know that you've got that or do you just want to live the best life you can live? And so, that's a really intriguing question.
Dr. Angela Seabright:
Yeah, absolutely. And first off, I'm so sorry to hear about your mom. Alzheimer's is difficult for not only the person who has it, but for everybody who loves them. And that's a really difficult one too because exactly what you said. Genetic testing, there are some genes that are associated with an increased risk of Alzheimer's. But just because you have the gene, it doesn't mean that you'll get Alzheimer's. And there are people who don't have the gene and get Alzheimer's. So, the interpretation of those tests can be tricky.
And because there's no good way to prevent the disease, the testing is controversial because of the distress that it can cause. And it could make you feel doomed. And I think the effects on your mental health, I think outweigh the benefits of knowing. Because your mental health and having a positive outlook on life can be protective for your brain health as well.
Chuck Gaidica:
That's really a good point. And I've turned in my life toward that direction, knowing that heart health equal sign brain health. I'm practicing things in my own life, maybe that is that flipping of light switches around my genetics that I think are providing overall better health. And I'm hopeful that that's what it leads to down the road. But even though that one may be tough, what other health conditions do you see that are more likely to be influenced by family history? And then how do we manage those risks?
Dr. Angela Seabright:
And just to reassure you too, with Alzheimer's, the younger the patient at diagnosis, some earlier onset Alzheimer's, so those in patients who are under the age of 65, that would be more of a clue that there may be some inherited risk. Yeah.
Chuck Gaidica:
I've never heard that. Yeah.
Dr. Angela Seabright:
And so, I think a lot of people ask about diabetes. There are genetic risks for both type 1 and type 2 diabetes, more so with type 2. But what researchers has found is that people who inherit the predisposition, the majority of them actually don't get the disease. The ones who do is because something in the environment triggers it. And in the case of type 1, which usually occurs in children, oftentimes that's due to a virus. So, it's that combination of genetics plus the environmental trigger. There are some certain genetic markers, some autoimmune markers that can be done, particularly for children who have siblings with type 1 diabetes.
Type 2, it's a little bit more complex because there are multiple genetic variants that can predispose to type 2. But they only increase the odds by a small percentage. And we know lifestyle is so important with type 2 diabetes. You mentioned cardiovascular health, that definitely, a lot of cardiovascular conditions can be inherited, aneurysms, arrhythmias. Lipid or cholesterol disorders, that's another big one. So the key for your cardiovascular health is go in for your preventive screenings, get your biometrics. That's very important.
Chuck Gaidica:
And I think that's part of the way I relate to life, and I think a lot of people probably do too, is that they want to know thyself. They want to know a little bit more about themselves, which then for me at least, empowers me to say, "Oh, well look, I changed this and now I'm seeing results." Or, "I'm kind of stuck." Or maybe there's a coach or a doctor I can go to and say, "Well, what can I do now to move the needle with this lifestyle choice or change?" So I think knowing a little bit more from the inside out is empowering, often.
Dr. Angela Seabright:
Yep. Knowing yourself, and if you can have your family tree and know what health conditions run in your family. Some people unfortunately don't know that, but if you do have that information, that can empower you as well.
Chuck Gaidica:
Do you see light bulbs go off in very specific, as common sense as they may be, very specific ways that you would call preventative that are things that you would say, "Man, this ranks way up there on the top three or five list of things that you can make in lifestyle change that can really help with whatever your genetic predisposition may be."?
Dr. Angela Seabright:
Yeah. So going back to heart disease, heart disease impacts so many. And I think one of the biggest things you can... And that your lifestyle can really play a role, that and type 2 diabetes. So maintaining a healthy weight, regular exercise. We call it cardio for a reason, because it's good for your heart, and other parts of your body, but certainly your heart health. Not smoking, eating a healthy diet with more whole foods, plant-based foods. Doesn't mean you have to become a vegetarian or a vegan, but eating less red meat and incorporating more vegetables, lean protein, whole grains, this can have a huge impact on your cardiovascular risk.
There are those that they're doing everything right and their cholesterol can still be through the roof. That's when we start thinking about some of those familial cholesterol disorders or lipid disorders. That would be the clue to do the screening for those disorders. At that point, that person may need to incorporate medication to reduce their risk of heart attack and stroke. But that's more of the exception rather than the rule. Most cardiovascular conditions, you really do have some control over your lifestyle, which can certainly affect your chances of getting the conditions later on in life.
Chuck Gaidica:
And it seems like cancer is the one that comes to mind for whatever reason right now, for me. And oftentimes, you'll hear somebody say out loud, "So-and-so has lung cancer and they've never smoked a day in their life." And you immediately assign value, at least I do, well, maybe it's in their genetics. But you mentioned something so important that the environment could be where you live or a factory you worked at. I mean, there are so many other influencers here that you can sort of think is a genetic issue, and maybe it's not. It really is something that you've been exposed to. Right?
Dr. Angela Seabright:
Right. Cancer, by its nature, is a genetic disease because there are some mutations that occur in the genes. But it doesn't necessarily mean you inherited those genes. Those genes can be altered due to carcinogens in our environment, whether that's chemical exposures, UV radiation, cigarette smoking, et cetera.
Chuck Gaidica:
So when you're looking at advancements and now, and even if you want to take it way out to rocket science level, something that you see coming down the path, what advancements in genetics and testing maybe are helping us better understand and even manage these inherited health risks?
Dr. Angela Seabright:
It's an evolving field. It has advanced tremendously over the past few decades. We know so much now that we didn't know 10 years ago, five years ago, and it's continuing to advance. I think eventually, we'll get to the point where your genetic information is coupled with your clinical information for a better risk analysis and also for treatment of disease. So even right now, a lot of cancers, they have targeted therapies based on the genetic makeup of the cancer. So having this information can really cut down on the diagnostic journey, which is often long and involves a battery of testing, sometimes testing before getting a diagnosis, especially for people who have rare conditions.
So, we're also seeing advancements in gene therapy where mutated genes can actually be fixed or edited and the disease can be cured. And we see this in conditions that have single gene mutations like sickle cell anemia. So, it's really groundbreaking, it's highly complex, it's the future of medicine. It goes up there with AI. So this whole conversation is about things we can't control, but we may actually get to the point where we do have control over things like our genetics. Which it sounds very sci-fi, but I think that's where we're headed.
Chuck Gaidica:
And it does give me hope, and I hope it does for everybody else too. It should give us hope that the future can be brighter. And I know some people who are dealing with debilitating things right now who are finding those kinds of treatments that are hyper-focused. Right? It's not just the testing, it's the, you're not receiving chemo that just blasts everything. It's very targeted. So, that's something to be hopeful about too.
Dr. Angela Seabright:
Absolutely.
Chuck Gaidica:
Yeah. Well, Dr. Seabright, any other takeaways you want to leave with the audience in this episode? I know we're talking about what you can't control, but there is hope that there are some things we can work on.
Dr. Angela Seabright:
It's important to know your family history. And genetic testing certainly has its role in some diseases, but your destiny is more than your genes. And you can certainly take control by living a healthy lifestyle.
Chuck Gaidica:
Good stuff. Well, good to see you again. Thanks for your time.
Dr. Angela Seabright:
Thank you.
Chuck Gaidica:
Dr. Angela Seabright is Care Management Physician of Blue Cross Blue Shield of Michigan. And while we can't change our genetics, aging brings its own sets of challenges. And interestingly enough, the word aging sometimes implies, "Oh, you're much, much older." No, we're all aging. We're all tripping into the next demographic every couple of years. And in our next episode, we're going to talk about how to embrace the changes that come with age while focusing on what we can all control to thrive and be resilient at any age and any stage. I'm Chuck Gaidica. Be well.
This is A Healthier Michigan podcast. I'm your host, Chuck Gaidica. And in this series we're exploring the balance between what you can and can't control when it comes to your health. Continuing now with episode 175, we're exploring the role of genetics, family history on your health, on my health. And back again to continue our conversation is Care Management Physician of Blue Cross Blue Shield of Michigan Dr. Angela Seabright. Good to have you back again.
Dr. Angela Seabright:
Thank you.
Chuck Gaidica:
We're sort of like the mafia on this podcast. You can never leave, so we'll keep bringing you back. Good to have you.
Dr. Angela Seabright:
Well, I'm happy to be here.
Chuck Gaidica:
Good. So, we know this idea of lifestyle change. We talked about that in our last episode. We're going to be unpacking more about that in the next episode as well. But lifestyle changes can play a significant role in our health. No escaping though, the influence of how we've been wired through genetics and family history. Some of that we're aware of, and for some we're not quite sure what may have happened to a mom or a dad along the way. But there are certain things that we all know we're born with that can increase the risk for certain diseases or even health conditions. So understanding our genetic makeup, it seems, doctor, can empower us to make informed decisions about our health. So let's get into it, this idea of how much of our health is actually determined by family history. And can we literally take control of that then?
Dr. Angela Seabright:
Yeah, it's a great question. Great topic. Your DNA is the code, it's the blueprint of your life. So it tells your body, every cell in your body how to function. And it's so much more than what eye color you're going to get, it's really a set of instructions. And it also can increase your risk for disease, depending on what the instructions say. So if there's an error or a mutation in the DNA, it gives your body bad instructions and can lead to diseases. But genes are only part of the story.
So the majority of our risk for disease comes from our environment, our behaviors, and our lifestyle. So while it's important to know your family history, it's also important to know that you can't change your genes, but our environment has the potential to change our gene expression and our function, which is a field of study called epigenetics. We talked about this on a prior podcast. It's that light switch, Chuck, that you mentioned, which was a really good analogy. Because those genes are there. But if they're turned on or off by external factors like our environment, that really plays a role in our health.
Chuck Gaidica:
And this idea of genetics, I've never done a genetic test, although I appreciate that whole idea fully. But many of us, whether we haven't done, it's too expensive to do, we sometimes don't know, doctor, about our genetic history until something flared up in a parent or a sibling, somebody, my aunt had something. So all of a sudden, you're on guard. So, that can be scary enough. But it seems like the way we can deal with that history is to not be fatalistic, but to just be realistic.
Dr. Angela Seabright:
I love that. To be realistic, check with your doctor, let them know your family history and your concerns, and take it from there.
Chuck Gaidica:
So, what are the best ways for us to know that we've got certain genetic factors that put us at higher risk of let's say, cancer or diabetes or heart disease?
Dr. Angela Seabright:
So, there are genetic tests and screening that can be done to identify those who may be at higher risk for certain diseases. But there usually needs to be an indication for genetic testing. It's not as simple as walking into your doctor's office and getting a screening for everything. The testing is usually targeted. So we take a detailed family history, we go based off of your own medical history, and that will guide the genetic testing, what genetic testing, if any, should be done.
And then the question is, once you have the results, now what? What is the significance of a particular genetic variation? Is there a significance? And what proactive interventions can be done, whether from a medical standpoint, from a surgical standpoint, specifically in cases of breast ovarian cancer, where a woman may choose to have a prophylactic mastectomy? Or then behavioral factors to mitigate the potential risks of disease.
So, there are some direct to consumer testing for genetic testing. That is a tool that is available. But in practice, genetic testing should be reserved for those suspected of having an inherited disease or those who are at high risk. Because those tests really don't offer any genetic counseling, there's little oversight. And there can be concerns, privacy concerns, and what happens to your data. So, I would really recommend speaking with your doctor if you are looking to pursue any type of genetic testing.
Chuck Gaidica:
So, there's another angle to this that I've experienced anecdotally. And to be honest, I've not had a genetic test for this. I have a brother and a sister, so there are three of us. And our mom sadly, wound up with Alzheimer's later in her life. And it was about a seven-year journey for her and she passed in 2019. But then all of a sudden as the children, we start asking this question.
And what is fascinating is while I still haven't gotten a test to see if I have any genetic makeup or predisposition for Alzheimer's or dementia, when asking that question of siblings and even my wife, and then you broaden it out to anybody else you ask, you get a lot of head scratching like, would I really want to know? In other words, it's not a guarantee that I'm going to get it because mom had it. But do you really want to know that you've got that or do you just want to live the best life you can live? And so, that's a really intriguing question.
Dr. Angela Seabright:
Yeah, absolutely. And first off, I'm so sorry to hear about your mom. Alzheimer's is difficult for not only the person who has it, but for everybody who loves them. And that's a really difficult one too because exactly what you said. Genetic testing, there are some genes that are associated with an increased risk of Alzheimer's. But just because you have the gene, it doesn't mean that you'll get Alzheimer's. And there are people who don't have the gene and get Alzheimer's. So, the interpretation of those tests can be tricky.
And because there's no good way to prevent the disease, the testing is controversial because of the distress that it can cause. And it could make you feel doomed. And I think the effects on your mental health, I think outweigh the benefits of knowing. Because your mental health and having a positive outlook on life can be protective for your brain health as well.
Chuck Gaidica:
That's really a good point. And I've turned in my life toward that direction, knowing that heart health equal sign brain health. I'm practicing things in my own life, maybe that is that flipping of light switches around my genetics that I think are providing overall better health. And I'm hopeful that that's what it leads to down the road. But even though that one may be tough, what other health conditions do you see that are more likely to be influenced by family history? And then how do we manage those risks?
Dr. Angela Seabright:
And just to reassure you too, with Alzheimer's, the younger the patient at diagnosis, some earlier onset Alzheimer's, so those in patients who are under the age of 65, that would be more of a clue that there may be some inherited risk. Yeah.
Chuck Gaidica:
I've never heard that. Yeah.
Dr. Angela Seabright:
And so, I think a lot of people ask about diabetes. There are genetic risks for both type 1 and type 2 diabetes, more so with type 2. But what researchers has found is that people who inherit the predisposition, the majority of them actually don't get the disease. The ones who do is because something in the environment triggers it. And in the case of type 1, which usually occurs in children, oftentimes that's due to a virus. So, it's that combination of genetics plus the environmental trigger. There are some certain genetic markers, some autoimmune markers that can be done, particularly for children who have siblings with type 1 diabetes.
Type 2, it's a little bit more complex because there are multiple genetic variants that can predispose to type 2. But they only increase the odds by a small percentage. And we know lifestyle is so important with type 2 diabetes. You mentioned cardiovascular health, that definitely, a lot of cardiovascular conditions can be inherited, aneurysms, arrhythmias. Lipid or cholesterol disorders, that's another big one. So the key for your cardiovascular health is go in for your preventive screenings, get your biometrics. That's very important.
Chuck Gaidica:
And I think that's part of the way I relate to life, and I think a lot of people probably do too, is that they want to know thyself. They want to know a little bit more about themselves, which then for me at least, empowers me to say, "Oh, well look, I changed this and now I'm seeing results." Or, "I'm kind of stuck." Or maybe there's a coach or a doctor I can go to and say, "Well, what can I do now to move the needle with this lifestyle choice or change?" So I think knowing a little bit more from the inside out is empowering, often.
Dr. Angela Seabright:
Yep. Knowing yourself, and if you can have your family tree and know what health conditions run in your family. Some people unfortunately don't know that, but if you do have that information, that can empower you as well.
Chuck Gaidica:
Do you see light bulbs go off in very specific, as common sense as they may be, very specific ways that you would call preventative that are things that you would say, "Man, this ranks way up there on the top three or five list of things that you can make in lifestyle change that can really help with whatever your genetic predisposition may be."?
Dr. Angela Seabright:
Yeah. So going back to heart disease, heart disease impacts so many. And I think one of the biggest things you can... And that your lifestyle can really play a role, that and type 2 diabetes. So maintaining a healthy weight, regular exercise. We call it cardio for a reason, because it's good for your heart, and other parts of your body, but certainly your heart health. Not smoking, eating a healthy diet with more whole foods, plant-based foods. Doesn't mean you have to become a vegetarian or a vegan, but eating less red meat and incorporating more vegetables, lean protein, whole grains, this can have a huge impact on your cardiovascular risk.
There are those that they're doing everything right and their cholesterol can still be through the roof. That's when we start thinking about some of those familial cholesterol disorders or lipid disorders. That would be the clue to do the screening for those disorders. At that point, that person may need to incorporate medication to reduce their risk of heart attack and stroke. But that's more of the exception rather than the rule. Most cardiovascular conditions, you really do have some control over your lifestyle, which can certainly affect your chances of getting the conditions later on in life.
Chuck Gaidica:
And it seems like cancer is the one that comes to mind for whatever reason right now, for me. And oftentimes, you'll hear somebody say out loud, "So-and-so has lung cancer and they've never smoked a day in their life." And you immediately assign value, at least I do, well, maybe it's in their genetics. But you mentioned something so important that the environment could be where you live or a factory you worked at. I mean, there are so many other influencers here that you can sort of think is a genetic issue, and maybe it's not. It really is something that you've been exposed to. Right?
Dr. Angela Seabright:
Right. Cancer, by its nature, is a genetic disease because there are some mutations that occur in the genes. But it doesn't necessarily mean you inherited those genes. Those genes can be altered due to carcinogens in our environment, whether that's chemical exposures, UV radiation, cigarette smoking, et cetera.
Chuck Gaidica:
So when you're looking at advancements and now, and even if you want to take it way out to rocket science level, something that you see coming down the path, what advancements in genetics and testing maybe are helping us better understand and even manage these inherited health risks?
Dr. Angela Seabright:
It's an evolving field. It has advanced tremendously over the past few decades. We know so much now that we didn't know 10 years ago, five years ago, and it's continuing to advance. I think eventually, we'll get to the point where your genetic information is coupled with your clinical information for a better risk analysis and also for treatment of disease. So even right now, a lot of cancers, they have targeted therapies based on the genetic makeup of the cancer. So having this information can really cut down on the diagnostic journey, which is often long and involves a battery of testing, sometimes testing before getting a diagnosis, especially for people who have rare conditions.
So, we're also seeing advancements in gene therapy where mutated genes can actually be fixed or edited and the disease can be cured. And we see this in conditions that have single gene mutations like sickle cell anemia. So, it's really groundbreaking, it's highly complex, it's the future of medicine. It goes up there with AI. So this whole conversation is about things we can't control, but we may actually get to the point where we do have control over things like our genetics. Which it sounds very sci-fi, but I think that's where we're headed.
Chuck Gaidica:
And it does give me hope, and I hope it does for everybody else too. It should give us hope that the future can be brighter. And I know some people who are dealing with debilitating things right now who are finding those kinds of treatments that are hyper-focused. Right? It's not just the testing, it's the, you're not receiving chemo that just blasts everything. It's very targeted. So, that's something to be hopeful about too.
Dr. Angela Seabright:
Absolutely.
Chuck Gaidica:
Yeah. Well, Dr. Seabright, any other takeaways you want to leave with the audience in this episode? I know we're talking about what you can't control, but there is hope that there are some things we can work on.
Dr. Angela Seabright:
It's important to know your family history. And genetic testing certainly has its role in some diseases, but your destiny is more than your genes. And you can certainly take control by living a healthy lifestyle.
Chuck Gaidica:
Good stuff. Well, good to see you again. Thanks for your time.
Dr. Angela Seabright:
Thank you.
Chuck Gaidica:
Dr. Angela Seabright is Care Management Physician of Blue Cross Blue Shield of Michigan. And while we can't change our genetics, aging brings its own sets of challenges. And interestingly enough, the word aging sometimes implies, "Oh, you're much, much older." No, we're all aging. We're all tripping into the next demographic every couple of years. And in our next episode, we're going to talk about how to embrace the changes that come with age while focusing on what we can all control to thrive and be resilient at any age and any stage. I'm Chuck Gaidica. Be well.
