Q: Half my family health history is a mystery because I never knew my father. I’m in good health, but should I be concerned about carrying a genetic predisposition to heart disease?
A: Good news: You control about 75 percent of your heart disease risk factors. The remaining 25 percent comes from your parents’ genes. So even though you may not know your total genetic history, you can reduce your risk through lifestyle choices, which are the main determinants of health.
To keep your ticker strong, walk 10,000 steps a day, do strength-training exercises (e.g., lifting weights), avoid tobacco, keep alcohol intake to a moderate level (one drink a day for women, two for men), and maintain a healthy weight. When it comes to diet, you can trim your risk of disease by avoiding the big food felons: trans fats, saturated fat, refined carbohydrates (think: white pasta, doughnuts), simple sugars and syrups, and excess sodium (ask your doctor how much salt is OK for you).
Each day, try to eat a handful of nuts and 4 to 6 cups of fruits and vegetables (combined). Also include some healthy oils (such as olive oil) as well as beans and legumes in your diet. Try to eat fish high in DHA (a type of omega-3 fatty acid), such as salmon and trout, two or three times a week. DHA lowers triglycerides, which can contribute to heart disease. And learn a stress-management technique to do anytime you encounter a stressful situation—deep breathing and meditation work wonders.
If you are still concerned, you can undergo genetic testing (some kits cost about $100 now, and some insurance may cover part of the testing), and you can begin routine tests such as cholesterol at an earlier age than the general population (all men should do this at age 45 and women at 55, perhaps earlier if you have risk factors for heart disease). Do these things, and your actions will lead you to your healthiest possible destiny.
Q: I try to eat healthfully to control my weight, but my husband brings all sorts of junk food into the home (he can eat truckloads of potato chips and not gain an ounce). How can I stick to my diet despite daily temptation?
A: One of our favorite tips for couples and diet is to develop a shared vision. Just as you discussed whether to have children or where to live, it’s important to talk about new issues as your relationship evolves—including behaviors that affect your health. Smart dietary choices are key to your health and happiness. Let your spouse know that eating well and losing weight are priorities for you and that making healthy choices is too difficult with constant temptations. Ask him for his support and negotiate a compromise. Maybe he can hide his junk food in a separate (locked, even) cabinet or, better yet, remove most junk food from the house. (Regardless of whether your husband experiences weight gain from his poor eating habits, they can negatively affect his heart and health.)
We know healthy habits can be as contagious as unhealthy ones, so by being your own advocate and committing to a healthier life, you might inspire your husband to turn his eating habits around.
Q: My mother developed Alzheimer’s around age 80, and I’m terrified that I will, too. How can I lower my risk?
A: The only risk factors for Alzheimer’s disease that are not modifiable are your age and your genes. If you want to see whether you carry the genes for it, you can be tested for APOE4, one of the few genes that are definitely associated with Alzheimer’s. But even a genetic risk is modifiable by your choices. For example, the spice curcumin has been found to increase the activity of the immune system, which can reduce the risk posed by the gene that might have been passed down to you from your mom.
So while you can’t change your inherited genes, you can control which ones are turned on and off with certain lifestyle choices like maintaining a healthy weight, eating well, exercising and reducing stress. All of these factors are associated with the risk of cognitive dysfunction, and you can stack the deck in your favor by incorporating the following tips into your daily routine:
1. Pop a 162 mg aspirin and a 900 mg DHA (omega-3) supplement daily. These decrease inflammation, so they lower the risk of Alzheimer’s and improve your cognition. Recent studies have also found that DHA increases the size of your hippocampus, aka the memory center. (Tip: Take daily with a half-glass of warm water before and after you pop the pill to help dissolve the pill faster and reduce stomach upset.)
2. Eat flavonoid-rich fruit such as berries, tomatoes and watermelon. Strawberries and blueberries are especially good for the brain, and consuming two servings of them a week is linked to a delayed cognitive loss of up to 2.5 years.
3. Get on your feet and move. Exercising for even 15 minutes three times a week can lower your risk of Alzheimer’s. For better memory protection, incorporate cardio exercises into your routine for 20 minutes, three times a week. Physical activity increases hippocampal size. So buy a pedometer and start walking—try to hit 10,000 steps a day for overall health.
4. Start playing mental games. No, not the kind of mental games that psych a person out, just a good old-fashioned board game such as chess or checkers. Or try bridge, crossword puzzles or Sudoku. Research shows that people who regularly played games that challenged the brain (which builds neural connections) have a lower risk of Alzheimer’s. Playing a musical instrument and gardening are brain builders, too!
5. Stay engaged. Strengthen your social ties with loved ones and your community. Being social is also associated with a lower risk of developing Alzheimer’s disease.
Q: Are there any good online tools our family can use to compile a family health history? Should we worry about the security of our personal health information with digital tools?
A: By gathering your family health history, you and your doctors can collaborate on a personalized care plan. But remember, genetics aren’t as important as your choices in determining how long and how well you live (see the first and third questions in this column). They are still important, though—especially if someone in your family developed cancer or heart disease early. So we encourage patients to get to the roots of their family health history to determine whether they are at an increased risk for any inherited or genetic diseases.
The Cleveland Clinic Health Hub provides a downloadable toolkit for families to track their family histories. You can access the toolkit and other forms online at goo.gl/veekXN. A second resource is an online tool from the U.S. surgeon general called My Family Health Portrait (goo.gl/Ebv78b), a link that allows you to enter your family health history and share your family health history with your doc.
The security of digital health records has been improved, but there is always the risk of a security breach. Before using any online tools, check the privacy settings and read other patients’ reviews. Print all of your medical information at home rather than on a public or work printer. And shred old medical documents and the prescription labels on old pill bottles.