by Dr. John Neustadt

When I’m talking with patients and they’ve resigned themselves to their situation, whether it’s difficulty losing weight, controlling blood sugar, struggles with depression or anxiety, or a host of other conditions, oftentimes they’ll fatalistically comment, “It’s genetic.” If you pick any chronic disease—depression, irritable bowel syndrome (IBS), anxiety, obesity, heart disease, cancer and osteoporosis to name a few—and blame it on your genes, I’ve probably heard it before.

People think their genetic fate is sealed. That within their cells are these little, all powerful things called genes that determine their health, put limits on what’s possible and there’s simply nothing anyone can do about it. While I’ve never liked putting limits on how we live in any area of our lives, on how much we can stretch and grow and become, do these people have a point when it comes to our health. Is it true that genes control our health and we have to resign ourselves to our fates?

I’ve heard this not only from patients, but well-intentioned doctors do it too. They blame someone’s health on genetics. When I ask them how they know its genetics and not something else, usually patients and doctors claim that it’s because everything else has been ruled out. Yet when I dig deeper, blaming it on your genes is usually more of an “I give up” attitude rather than something that’s scientifically been proven.

There are typically two justifications for blaming it on genetics. They actually believe everything else has been ruled out. Lacking any definitive explanation, they blame it on something they think is outside of their control, their genes. Kind of like blaming insurance policies that are exempt from covering an injury if it’s caused by “an act of God,” genetics is the new catch-phrase for having something out of our control and therefore not our fault.

However, more commonly people simply are using the old “it’s genetics” excuse as a way to rationalize poor health behaviors that are the root cause of their problems. They use it to justify not doing the hard work that’s required to explore potential solutions and get healthy. Their fatalistic and lazy attitude is a great combination for anyone wanting to stay sick, be miserable, have to take a lot of medications, spend an exorbitant amount of their hard-earned money on avoidable healthcare costs and die young.

How Can So Many Smart People be Wrong?

But let’s put all that aside for a moment and take a closer, more scientific look at the question of genetics and disease. Genetics is a huge industry, and because we’ve spent so much money researching genetics and so many smart people are working in this area, it intuitively makes sense that they must be right and our poor health is genetic. By the time the human genome project finished mapping the human genome in 2003, the US government had spent nearly three billion dollars on the project.  

And the investments and industry that has grown up around genetics since then is massive. Companies focused on DNA sequencing, DNA manipulation and bioinformatics have sprung up to provide genetic products and services. While I couldn’t find an estimate of the total size of the genetics market, one business alone, Illumina, a public company that produces DNA sequencing technology in my home town of San Diego, California, generated 2.75 billion dollars in revenue in 2017. As of July 13, 2018, was valued at more than 43.5 billion dollars.

In 2015, 23andMe, a private, direct-to-consumer genetic testing company, raised money from venture capital firms. According to a Reuters article at the time, 23andMe raised 115 million dollars, which implied a total valuation of 1.1 billion dollars.

Wall Street and venture capital firms are bullish on genetics, and the companies are spending boat loads of money convincing all of us that genetics is the underlying problem with our health. In February 2018, the MIT Technology Review published an article on direct-to-consumer genetic testing where it reported that in the previous year Ancestry.com and 23andMe spent $109 million and 23andMe in advertising, respectively. And it’s working. Last year the number of Americans who had their DNA tested more than doubled and now exceeds 12 million people.

Add to all these numbers the billions of dollars spent creating and retaining companies that have grown up to service the genetic testing market, providing ancillary services such as interpreting the data and providing recommendations. When you factor all of this in, you start to get an even better sense of how much of an economic impact genetics has.  

With such a large industry dedicated to genetics, of course blaming your chronic disease on your genes makes sense. After all, how could so many smart people be wrong?

While smart people can do brilliant work, just because someone has impressive titles after their name or has had a successful business career, doesn’t make them medically correct. After all, it was smart people and their enablers who bankrupted Lehman Brothers and drove Enron off the cliff, helping to destroy the financial lives of millions along the way.

Genetics 101

One of the things industries rely on to sell their expertise is complexity. The financial services industry has invented lots of terms to make investing more complicated than it is. In doing so, they make people dependent on experts who, by the way, rarely beat the market in the long term. For an excellent look at this and to help you with your own finances, read Tony Robbins’ book, Money Master the Game: 7 Simple Steps to Financial Freedom.

Similarly, the biotechnology industry has created a seemingly impenetrable thicket of terms and concepts. There’s DNA, RNA, exosome, transposon, telomere, allele, penetrance, phenotype, homozygote, heterozygote, chromosome, single nucleotide polymorphism, pleiotropy, recessive, dominant. And that’s the short list. All of this complexity makes it nearly impossible for people in the general public to have a simple discussion about the real impact genes have on our health.

To understand the value of genetics and its effects on your health, it’s important to have a basic understanding of what genes are and what they’re not. But don’t worry, I won’t use any of the technical mumbo jumbo terminology because it’s totally unnecessary and because I don’t feel the need to throw terms around merely to make myself sound smarter.

In 1953 James Watson, PhD, and Francis Crick, PhD, unveiled their double-helix model of DNA.  As an aside, while these two researchers shared the Nobel Prize for their discovery, one important name is unfortunately missing. That person is Rosalind Franklin, PhD. In the 1940s and early 1950s, Dr. Franklin was a pioneer in biology. In a field where she was the only woman, she not only was a pioneer for gender equality, but was a pioneer in generating X-ray images of frozen specimen, a field called X-ray Crystallography.

At the time no one knew the structure of DNA and a few teams around the world were working to figure it out. One of her DNA images, inauspiciously named Photo 51, provided some of the final, crucial pieces of information required to deduce the structure of DNA. She unfortunately died of ovarian cancer before the Nobel prize was awarded for the discovery, an honor many argue she would have, and should have, received.

Like any good British bloke might, on the day of their breakthrough discovery of the double-helix structure of DNA, Dr. Watson went to an English pub for a celebratory pint. As reported in the journal, Nature, Dr. Watson walked in and announced they’d “found the secret of life.” Their work revolutionized how scientists, physicians, and the general public view biology, and massive efforts were subsequently launched to decode the human genome.

Our cells—except sperm and egg—contain two sets of genes which are wrapped in the double helix strand in Dr. Franklin’s Photo 51. One set of genes we inherit from our father and one from our mother.

But genes by themselves don’t really do anything. To become activated and carry out their vital role in health, they require a biochemical soup of nutrients, including water, vitamins, minerals, proteins and fats. At the most basic level, the role of genes is to create proteins. Once activated, genes participate in one step of the process. Proteins include hormones such as thyroid hormone, serotonin, dopamine and epinephrine. They also include structural proteins such as muscles, ligaments, tendons and collagen.

Genes have been called the blueprint for life, and they are crucial. Without them none of us would be alive. And sick genes create sick people. But despite that, in many respects Dr. Watson’s assertion, and the overwhelming belief that seems to have taken hold in popular culture that genetics can explain away all of our problems, are naïve and just plain wrong.

Genetic mutations can cause diseases. You’ve probably heard of many of them, including Down’s Syndrome (Trisomy 21), Cystic Fibrosis, Duchenne Muscular Dystrophy, Sickle Cell Anemia, Tay Sachs Disease. These are genetic disease people are born with and show up when they’re young. Couples are commonly screened to see if either one is a carrier of some inherited genetic diseases and during pregnancy screening tests are typically ordered to see if the baby can she has one of the more common genetic diseases.

It’s understandable how people, having heard about those dramatic and dangerous childhood genetic diseases, can then extrapolate and believe that their adult diseases must also be caused by the genes they inherited from their parents. How much blame should your parents get for your adult problems? After all, one of the most important predictors of breast cancer in women is if the woman’s mother had breast cancer. Similarly, if a parent or a sibling had or has any cancers, diabetes or heart disease, you’re automatically in a higher risk category than people whose immediate family doesn’t have these conditions. Doesn’t it make sense then that we can blame our problems on our genes? Let’s take a closer look.

Non-Genetic Factors are Your Real Problems

Health is a sense of wellbeing that fluctuates over time and feeling healthy and vibrant is defined by three different elements. The past defines what illnesses your family and you have had and may provide information about your future risk. It also provides the historical context about how you were raised and the influences that can have on your choice and health.

It may be that you have a genetic predisposition to these conditions, but more likely it’s because family members tend to follow the same lifestyle and dietary patterns which they tend to inherit from how they were raised—lack of exercise, poor diets and high stress.

While genetics are important, as we age lifestyle, dietary factors and environmental toxin exposure become even more important. Research suggests that 80% of large bowel, breast, and prostate cancers are caused by poor nutrition, physical inactivity and obesity. And the predominant causes of heart disease and diabetes are the same—poor nutrition, physical inactivity and obesity.  

Eighteen drinking water studies have toxic metals such as aluminum to elevated risks of Alzheimer’s disease and cognitive impairment in the elderly. Between 50,000 and 100,000 synthetic chemicals are being produced commercially around the world, most of which have never been tested for their health effects.  

Not only are non-genetic factors the most important risks for chronic diseases, but non-genetic factors (and non-pharmacological approaches) are also some of the most powerful ways to heal from and prevent many chronic diseases. If you have a history of cancer and you follow a whole-foods, plant-based diet; exercise; and practice stress reduction, you may reduce your risk of another cancer. Clinical trials Dean Ornish, MD of the Cleveland Clinic have shown that with diet and lifestyle changes heart disease can be reversed. And Dale Bredesen, MD has shown how similar approaches can reverse Alzheimer’s disease.

When I hear people exhibit a fatalistic attitude by saying that their heart disease or any other condition is just “genetic,” most of the time they’re simply rationalizing not taking responsibility for their own health. Rationalization is an under-appreciated dynamic and is far more powerful than people realize. Rationalizations allow people to explain away their responsibilities for taking care of themselves and helps them feel comfortable with their self-destructive habits and lifestyle.

Not only that, all the emphasis on genetic testing is making healthcare delivery worse. According to a 2008 article in JAMA that evaluated the usefulness of direct-to-consumer personal genome testing, the authors concluded that direct-to-consumer genetic testing does not improve patient outcomes. In fact, with genetic testing, physicians end up spending the limited and precious time they have with patients explaining the tests instead providing other more helpful information and treatments. The authors go on to state, “…the time spent following up on [genetic testing] with patients detracts from time spent on other activities more relevant to the health of the patient. Worse, it could result in a cascade effect, in which ambiguous, incidental, or false-positive results lead to further workup that creates anxiety, cost and potential harm.”

The genome is, indeed, the blueprint for biological life; however, the reason that genetics is not the ultimate determinant of most chronic diseases is because our bodies take the proteins make by genes and modify them. In fact, a surprising finding of the Human Genome Project is that there are far fewer protein-coding genes in the human genome than there are proteins (thirty to forty thousand protein-coding genes vs. approximately five hundred thousand proteins). Our genes are just the starting point, but our diet, lifestyle and environment are the most important determinants of chronic diseases such as cancer, diabetes, depression and heart disease.

In fact, if someone claims their depression is genetic, ask them which gene is causing it? There is no gene for depression. Does that mean genes don’t play any role in chronic disease? Not at all. They can be involved and in very limited cases there might be good reasons to test someone’s genes. But the overwhelming emphasis about genetics is that for the vast majority of people and chronic diseases, genes just aren’t as important as most people seem to think and many companies want to convince you to think.

Blaming your health problems on your genes is like blaming your adult problems on your parents. Yes, how you were raised does effect you and your health. After all, most people seem to continue living with the same bad diet and habits their parents modeled for them as kids. But if you truly want to be healthy and feel incredible, it’s time to take responsibility for yourself and do the hard work and seek out helpful, empowering answers until you find them and do the consistent work necessary to create the best you possible. Don’t let a wrong-headed belief that the best you is determined by your genes. You’re much better than that and worth so much more. Instead, focus on the Four Pillars of Health, which are the factors most associated with long term health and ones that you can do something about. 

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