Transcription:

Scott Webb: Knowing our family medical history is one of the keys to diagnosing medical conditions, illnesses or diseases early and, ultimately, to living longer lives. And joining me today to discuss family medical history and genetic predispositions to hypertension, high cholesterol and diabetes is Dr. Joseph Lach. He's the Chair of Family Medicine for Franciscan Health Olympia Fields, and the Associate Program Director of Family Medicine Residency.

This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time today. We're discussing the role that family history or genetic predisposition plays in chronic illnesses and diseases. So just broadly speaking here at the beginning, why is knowing our family medical history so important?

Dr. Joseph Lach: The family history of a patient's current health status can not only give you insights into why any individual may have current issues, but also give you ideas about predispositions for future problems. Lots of things, sometimes skip generations are more genetically linked than others and to know that those are likely going to be risks for you in the future often give you the ability to make changes or become more aggressive about either conservative management or even medication managements.

It really informs our decisions. But what it really does is give patients the opportunity to look at themselves and decide, "If I am likely going to head to this disease continuum because of my genetic history, then maybe I don't wait until I have that diagnosis. I start, you know, doing things about that now." And oftentimes, it's something that has to be said to a patient from a physician in order to really comprehend the implications of your genetic history.

Scott Webb: I guess I'm wondering, you know, if family members have passed, how do people do that? How do they gather the family history information they need if family members have passed?

Dr. Joseph Lach: So it's a great question. And it is one that we deal with quite often, because as medicine has evolved, the things that we're able to test for and even treat and recognize now are vastly different from where they were even 20, 30 years ago. And I say things to patients often like, "Oh, your father, grandfather died in, you know, 1992." It's not a million years ago and, yet, we do not have the access to the same information. Obviously, we can be told what we have and then convey that to someone else personally. But even 30 years ago, you had to pick up a phone or go have a conversation with that family member and tell them what happened.

These days, being able to link your genetic history to, say, your children's current medical history is very simple, because now it's all electronic. It's all passed back and forth. You can access it and get instructions on it. And with the internet and access to information, people are more interested in what they have. Thirty years ago, if you told somebody they had type 2 diabetes mellitus, they would have to go to the library or a specialist or read some news articles or go to really learn about it.

Now, with the touch of a few buttons on your phone in the waiting room, you can understand more about your disease process than somebody who was diagnosed with that 30 years ago. So the understanding is so much better now. So when you go back and try and identify what happened to somebody else, we have to be detectives with our patients sometimes and ask them, "Well, what kind of doctors was your grandfather seeing? When they went to the hospital, what were their symptoms?" Sometimes we have to make retroactive diagnoses if we can't access that person's medical history directly.

And a lot of times patients don't even know where their grandparents were treated or how they were treated. And we have to go based on, "Well, did they have trouble moving around? Did they have trouble walking up a flight of stairs? Were they using a cane or a walker near the end of their life? Did they have trouble holding their bladder? Did they have major surgeries near the end of their life? Were they losing weight? Were they gaining weight?" we have to use some of those context clues to help determine what this person that we're seeing in our office might be more predisposed to.

"Did your aunt, uncle, grandfather, grandmother have to give themselves injections? Or how many pills did they take? Did they take them twice a day? Once a day?" All sorts of things like that can give us some contextual evidence as to sometimes exactly what medications and dosages. We are able to draw that out of basic history and, because of that, we're able to apply that information to what we're looking at right in front of us.

Scott Webb: Yeah. That's such a great way to put that, detectives. And I'm sure that's sort of fun in a way to do that detective work. Do you find that some families have sort of like an aunt or somebody who's kind of the keeper of the family, you know, medical history?

Dr. Joseph Lach: In some cases, absolutely. In all of our families, we kind of have that cousin or aunt or uncle that stays in touch with everybody. They may be seen as the big gossip queen or king of that family. But oftentimes, they may have valuable information. I find this often in younger patients in my clinic that, oftentimes, they are not as self-aware about their risks.

They have not spoken to their parents or grandparents about their health. And when patients come in, again, younger population, 20s, 30s, 40s, and they don't know what their family history is, I say, "Well, is there somebody you can talk to?" You know, "Do you have to go to your mom, your dad? Can you tell me about what you do know and who might be best at doing that?"

So for instance, I had a patient not too long ago that didn't know what their grandfather died of, but died in his early 60s, which would be very relevant to this patient as they're currently seeing me in their forties. But his grandmother is still alive. She's 88. But he says she sharp as a tack. I said, "She was with him through all of it. And if you go and talk to her about what happened, it may absolutely give us some insight into why you have, in your early 40s, some borderline high cholesterol and how aggressive we should be. If he died of a massive heart attack in his early 60s with a known history of high cholesterol, we may want to be more aggressive with you because of that."

Scott Webb: Yeah. And I'm wondering, do you recommend sometimes bringing in family members to be tested themselves with respect to certain conditions or diseases, especially as you say, we're dealing in the present here? So if I were to come in, would you recommend bringing my kids in to also perhaps be tested?

Dr. Joseph Lach: So based on how much risk you are truly at and what type of disease processes we're talking about, absolutely. Whether it be with me or with their own physicians, their own family practitioners, I will sometimes ask patients that, specifically when they are at high genetic predisposition, both parents are say diabetic, and I've just diagnosed this patient with diabetes at a very early age, late 30s, early 40s, I'll often ask them, "Do you have children? How is your children's health? Have they been tested for diabetes? Are they overweight? Do they have trouble with their diet, exercise, tolerance? What is going on with them? Because this is happening to you at a very early age, maybe it's something we can help protect your children from as well."

And actually, I've had that go both ways. I've actually had patients that I've unfortunately diagnosed with breast cancer, is the one that comes to mind most frequently, where I have a woman in her 40s or 50s who wants to pay very close attention to her health. So she's going for her mammograms and pap smears and we ended up finding breast cancer. And I ask about, "Is your mom-- do you have any aunts, sisters? Do they get themselves checked? If not, you really may want to reach out to them. And if they need a doctor, they're local to the area, let them know, I can help them get screened too."

Scott Webb: Yeah, this is such a fascinating topic. And I want to get into some specific conditions. So I want to ask you specifically about hypertension. We'll start there and the role that family history or genetic predisposition plays in the diagnosis and treatment of hypertension.

Dr. Joseph Lach: People have a very mixed opinion publicly about hypertension and how controllable it is with things like diet and exercise. People, because of major campaigns by the American Heart Association in the '90s and 2000s and by different public health entities have become aware of hypertension as being a salt-based diet disease, overweight, smoking, alcohol, these things play a role. So when people have questions about their own blood pressure, they don't look at their genetic history quite as often.

I unfortunately or fortunately am able to utilize something that's very personal to me to help explain to patients that, yes, diet and exercise plays a role, but statistically you're far more likely to develop hypertension if you have a family history of it. I use myself as an example. I find myself multiple times every week telling patients, "Hey, 10 years ago, I was 70 pounds overweight. I was going through medical school and residency, high stress jobs, positions. I was drinking coffee all day long. But I developed hypertension when I was 28 years of age and I had to be started on medication." I changed everything. I lost 50 pounds. I did better, took better care of myself. I found ways to de-stress that were healthier for me. I did all of those things and yet I still have to be on medication.

Now, why is that? Well, the reason for that is that both my parents, all four of my grandparents, all had high blood pressure. It was inescapable for me. I was predisposed to it. And even though I was in medical training, I did not put one and one together to say, "I should be keeping a better track of my diet. I should be doing more cardiovascular exercise. I should be taking better care of myself, because I am so strongly linked by all of my family to this disorder, that it is almost an inevitability for me that if I don't take care of myself, I'm going to end up with this disease process." But it also incentivizes me to stay on top of everything else to make sure that anything that has come before me in my own family is something that I address now in my own life and with my family and children going forward.

Scott Webb: Yeah. Literally, it's a case of a doctor taking his own medicine, which is kind of interesting. Now, I want to ask you about dyslipidemia, although most of us probably refer to it as high cholesterol.

Dr. Joseph Lach: Cholesterol levels are tied to a genetic history, even more so than high blood pressure. Dyslipidemia is a generic term that we use to describe whether you have elevated bad cholesterol, now also known as LDL cholesterol, or too low of HDL cholesterol, also known as high density cholesterol. These factors both play a role in cardiovascular risk.

So cholesterol by and large is something that very many people are aware of and know that it's something that is very commonly checked. Most people understand that who go see their doctor periodically as the reason why they have to go further lab work, fasting, having not eaten for 10 to 12 hours, plenty of water's still okay, but not eating anything with fat or sugar as it can affect your cholesterol and triglyceride levels, which is something we check.

But this is a disorder that, I can tell you from personal experience, has a very strong genetic link. And while it is able to be affected by things like diet and exercise, it is so much stronger in a hereditary fashion passed down throughout your family, to the tune where I have patients that are, you know, 150, 200 pounds overweight, they're pushing 350, 400 pounds and they have cholesterol levels better than mine. They have perfect cholesterol.

And it's really quite interesting because I also have patients who are triathletes, marathon runners, who do everything they can to stay healthy and are on no other medication except cholesterol medication. And it's because they have a strong genetic predisposition. Their father died of a heart attack at 54. Their mother has high cholesterol and diabetes. They develop fatty liver in their 30s because their cholesterol was so high even through their teenage years.

It is so much a genetic based disorder that I tell people, I said, "Even if you are perfectly strict with everything, diet and exercise wise and completely optimize your good fat intakes, your cardiovascular exercise and outputs, even if you do all of that, you're really only going to change your cholesterol by about 10% or 15%. And if your levels are double where they should be, medication's really one of the only ways that we can do that, really one of the only ways that we can control that and keep your risk of cardiovascular disease and cerebrovascular disease down."

So it's not something that, you know, you need to beat yourself up about. Should you do better? Should you try harder? Absolutely. Because the goal is always to be on the lowest dose of medications to control these disorders, but you still need to recognize that in some ways, trying to deny your genetic predisposition until gene therapy is perfected and made a standard of care, you're going to lose out that battle nine times out of 10. So to work collaboratively with your physicians, to try and optimize your health from a conservative diet and exercise standpoint and also with a pharmacological supplementation or nutrition plan to try and combat these disorders, you can absolutely stand and fight against these genetic predispositions. You do not have to give in to them.

Scott Webb: Let's talk about diabetes lastly here. Is that also something where family history and genetic predisposition is a factor?

Dr. Joseph Lach: It very much is. And this is the one where I believe so much more responsibility lies with the patient earlier on in their life, because unlike, you know, hypertension or cholesterol, which can take 20, 30, 40 years of having mild dyslipidemia, mild hypertension, before you start having a really severe systemic side effects of those conditions, buildup of plaques in your heart, buildup of plaques in your renal arteries, your peripheral vasculature, and with hypertension, having say a renal disease where your kidneys start to fail.

With diabetes, I have again plenty of patients whose family members are diabetic, who, because they did not take the risk factors and their genetic predisposition seriously were diagnosed with diabetes in their 20s and 30s. And these are concerns when I talk to those patients that if, "Well, my mom was diabetic, but she wasn't diagnosed until she was 60." I said, "Absolutely. But what have you done to avoid becoming diabetic even sooner?" I won't do a deep dive on the physiology of how insulin sensitivity starts to occur, but that predisposition for it can be basically egged on. It can be brought forth much faster if you are not paying attention to it.

So for instance, if mom was diagnosed with diabetes in her 50s or 60s, and it led to complications of heart disease and cholesterol issues and renal problems in her life, if you, as a teenager, are completely ignoring that when she was diagnosed and making changes for yourself and continue to eat large quantities of carbohydrates and gain weight and not exercise, not take care of yourself or follow up with your physician, that is an absolute recipe.

So you are being given the blueprint, the map on how to avoid becoming that even sooner, but without utilizing that information and then applying it in a way that you are counteracting those factors in your own life, that you do have some control over. Again, are you going to probably become diabetic at some point in your life? Yes, but there's a huge difference between becoming a diabetic at 50 or 60 as it is becoming diabetic at 20 or 30. Also, there's a huge difference in being diagnosed when you are 30 or 40 pounds overweight versus 80 or 90 pounds overweight. You have to try and do the best you can to minimize your risk. And looking into your genetic predispositions with a physician can be incredibly enlightening and, like I said, give you that map to avoiding major complications later on down your life.

One of the things I say to my patients all the time is I'm here to take care of you as you are right now. But my actual priority is to help improve your health for that five-years-from-now-you, that 10-years-from-now-you. Because right now, we're dealing with a mild or minimally invasive type problems, but if we don't take care of those adequately now, 10 years from now, you may not be here to deal with them. And that's a realistic possibility with some of these disorders.

Scott Webb: Doctor, as we wrap up here, anything else you want people to know about family history, genetic predispositions for conditions, illnesses, diseases. What else do we need to. You know, what are the takeaways?

Dr. Joseph Lach: I think the ultimate takeaway from identifying what is going on starts in your primary care doctor's office. Every time somebody comes in for the first time, we are asking about family history. We are asking about what is going on behind the genetic scene, so that when we are doing our basic physical and doing our basic labs, we can then apply those risks to your current life and give you active up-to-date, well-researched feedback on how to go about really combating these issues so that they do not become major problems for your health in the future.

My goals for my patients are always to try and attain a happy, healthy, long life. If you're not going to be happy and healthy, then the length of your life is really of little consequence. Life is worth living when you add value to those people around you and to your life as a whole if it brings joy to yourself and others. That can’t occur if you are sick all the time and decisions made now affect who you are in the future.

Scott Webb: That is a great way to finish a great period at the end of the sentence. And you're so right, you know, that a happy, healthy, long life, all good things, things we want for all of us and our family members and for you, doctor. So thank you so much for your time today. You stay well.

Dr. Joseph Lach: Thank you very much. Appreciate it.

Scott Webb: For more information, go to FranciscanHealth.org/conditions-and-services/primary-care.

And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.