Genes Are Only Part of the Story

When I first began doing these studies, I thought that younger patients with milder disease who didn't have a strong family history of heart disease would be more likely to show improvement, but I was wrong. The primary determinant of the degree of improvement was not age, disease severity or genetics; it was the degree of change in diet and lifestyle. In other words, the more people changed, the better they got. We found similar findings with prostate cancer.

In short, you have a spectrum of nutrition and lifestyle choices. Your genes are only one factor that determines where you are on this continuum.

For example, how efficiently—or inefficiently—your body can get rid of dietary saturated fat and cholesterol is regulated in part by your genes. Some people are genetically lucky; they are so efficient at metabolizing the saturated fat and cholesterol in their diet that it almost doesn't matter what they eat. Their blood cholesterol levels remain low even on a high-fat diet. On the other end of the spectrum are those who are so inefficient, they have high cholesterol levels even when they eat an optimal diet. In the middle of this spectrum are most everyone else.

So, let's say your doctor tells you that your cholesterol level is elevated. You can begin by making moderate changes in your diet (eat a little less saturated fat, trans fats, dietary cholesterol and refined carbohydrates), exercise a little more, practice a few minutes a day some stress-management techniques, and spend a little more time with your friends, family and other loved ones. If that's enough to get your cholesterol level down far enough, great; if not, then you can make progressively bigger changes until you achieve your goal. Or, you can start taking cholesterol-lowering drugs such as Lipitor.

If you're trying to reverse heart disease or prevent the recurrence of cancer, you may need the "pound of cure"—bigger changes in diet and lifestyle than someone who just wants to lower their cholesterol levels a few points. If you have a strong family history, or if genetic testing shows you to be at higher risk, then this information can be a powerful motivator to make bigger changes in diet and lifestyle than you might have otherwise made. Also, it may be possible to tailor pharmacologic interventions more effectively and efficiently.

If you're like me, basically healthy, then you can thrive on the "ounce of prevention." And if you're somewhere in between—if you have some worrisome risk factors for heart disease (high cholesterol, high blood pressure)—then you can begin by making moderate changes in diet and lifestyle, progressively more intensive as needed.