Take Care of Yourself. Or Not. (January 28, 2020)

​One of the great things about writing a newsletter is that people can’t contradict you in real time, which kinds of lulls you into thinking that you’re smarter than you are. That doesn’t last long, though, because you leave your ivory tower (or, in my case, my ivory kitchen table) and start pontificating in real time about things to people, they do embarrassing things like ask questions. Especially sometimes questions you hadn’t thought about before, and fielding those isn’t as fun as writing a clever-sounding essay and sending it out into the interwebs. 

It happens that I like to talk about the federal guidelines on diet, exercise, weight, smoking and alcohol consumption in these newsletters quite a bit. That’s because I am so impressed with the fact that if you follow them, your chances of dying prematurely (meaning before your normal life expectancy) are decreased by about 80%. That is a big deal, and something that should make anyone who’d like to stick around as long as possible sit up and say howdy.

But if I blather about this in real time, you get all kinds of questions. There’s one I’ve heard so often that I can normally answer it pretty well, and because it’s common I thought I’d bring it up today. People often want to know that if they have a familial tendency to some class of disease, if there’s any point to them following lifestyle advice to try to derail what they feel is an oncoming train. Aren’t they doomed to an illness if it runs in their family?

If everyone in your family has something, aren’t you probably going to get it too? Well, as is so often the answer with science, the answer is “maybe”. Ah, MAYBE! The favorite weasel word of the health care practitioner. Also the best excuse in the world for taking care of yourself – or for not doing so. 

How much influence do genes really have on your health? Classically, Doctor Experts have said about 15-30%. Even if that is correct, though (and it may be a lot less than we’ve thought), it’s still not a satisfactory answer, because – well, WHICH 15-30%?

My own opinion is that, most of the time, if you’ve got a family tendency toward something, and there are known lifestyle changes that can mitigate that problem in the general population, that it makes following those rules even more important for you than it would for the average person. For example, if everyone in your family has had diabetes, it is MORE urgent for you to keep your weight in normal range and eat good food than someone with a clear family history. And living a healthier life is going to make anyone healthier, regardless of family history.

Lately, there’s been information to the effect that genes may NOT have as much influence on our health as generally thought.  For one thing, people tend to live a lifespan that is more similar to their spouse’s than it is to their biological family of origin. Lifestyle related? At least partly, but not completely.

Additionally, where you live has a big influence on your life expectancy. I wrote an essay a couple of years ago about a study that found correlations between the distance that a child lived from a major highway growing up, and health problems later in life (the closer to the highway, the more the problems). A recent study has found that life expectancies vary enormously, not just by state, but by zip code or even between blocks in certain neighborhoods. Lifestyle? Yes, but also access to supermarkets, nearby medical care, quality of air and water, etc. Very difficult to sort out all the different influences. It’s thought these days that genetic influence on an individual’s health may be less than 10%. 

Jim Fixx is the guy who started the jogging craze in the 1970s. which spawned the fitness craze of the 1980s, which has never really quit. The story is, of course, that he died at 52. which at first blush is really not a recommendation for fitness. Here’s the thing, though; his dad had died at age 43 of a heart attack. And Jim himself had a congenitally enlarged heart. Not to mention a history of obesity and smoking BEFORE he actually started running in his 30s. Did he extend his life by jogging, losing weight and quitting smoking? I can’t prove it. But I bet he did. And lacking any better information to the contrary, I’d say he was smart to do what he did, and anyone else who doesn’t want to lie down and have a family illness run them over ought to do the same.

--dr. diane holmes
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