They Told You It Was Genetic. But Is That the Whole Story?

Your family history may influence your susceptibility, but it need not dictate your destiny. Our extraordinary genetic inheritance deserves nourishment, protection and respect, not fear. You are a child of the Universe. Take a moment to think about that.

“Gary, I have [XYZ Disease], and I’m told it is genetic.”

People say this to me often. Very often indeed. Sometimes they do so with tears in their eyes, and despair in their voice. The condition might be cancer, cardiovascular disease, diabetes, arthritis, osteoporosis, cognitive decline, digestive trouble, hypertension or high cholesterol, to name only a few. The diagnosis varies, but the message taken home is usually the same: this was written into my body before I was born, so there is not much I can do about it.

I do not like hearing this. It is not because genes are unimportant, because of course they matter. It is because the word genetic can become strangely prophetic. It may land with the force of the old story about the witch doctor pointing the bone. Once a person accepts that disease, disability, decline or an early death is inevitable, they may surrender long before their body requires them to.

Being told that heart disease, diabetes or osteoporosis is genetic can feel rather like being handed a white flag and instructed to surrender to the diagnosis. The subtle message is that this is the family curse. Your parents had it, their parents probably had it, and now it is your turn. Take the medicine, undergo the procedure and make the best of whatever remains. That is a depressing and deeply disempowering message. When the word genetic is used casually, without explaining precisely what it means or what evidence supports the claim, I regard that as lazy medicine.

I am not arguing against medicine, surgery or appropriate medical treatment. These may be necessary and lifesaving. My objection is to any explanation that leaves a person feeling powerless and turns them into a passive passenger in their own healthcare. Good treatment should not remove agency. It should help restore as much of it as possible.

A diagnosis should not leave a person waving a white flag and surrendering to what they have been told is their genetic fate.

What do they mean by “genetic”?

When someone tells me that their condition is genetic, I usually ask a simple question:

“Have you had genetic testing that identified the gene responsible for your osteoporosis/heart disease/cognitive decline/high cholesterol?”

Ninety-nine times out of a hundred, the answer is "no". I then ask a more useful question:

“When they said it was genetic, what exactly did they mean? Has a particular inherited disorder been identified, or are they drawing that conclusion mainly from your family history?”

This distinction is important because genuine inherited disorders do exist, and some genetic variants can exert a powerful effect. Familial hypercholesterolaemia, Lynch syndrome, Huntington’s disease and certain BRCA-related cancer syndromes are examples. These deserve proper investigation, medical surveillance and, where appropriate, treatment. A strong family history, especially when disease appears unusually early, may also justify genetic counselling even before a specific variant has been confirmed.

However, carrying a significant genetic variant does not always tell us whether an illness will appear, when it will appear, how rapidly it will progress or how severely it will affect that person. The variant may alter the odds, sometimes substantially, but it does not necessarily write every line of the story. Risk is not the same thing as certainty.

Most of the chronic diseases filling our hospitals are considerably more complicated.

Rather than being caused by one defective gene, they usually develop from the accumulated effects of many genes interacting with physiology, ageing, nutrition, physical activity, infection, toxic exposure, smoking, alcohol, sleep, stress, social circumstances and chance. Reducing this immensely complicated story to “It is genetic” may be convenient, but it is seldom adequate.

The US National Human Genome Research Institute distinguishes between disorders caused predominantly by a single gene and multifactorial conditions involving several genes and environmental influences. Many common traits and diseases fall into the latter category. The World Health Organization similarly describes the major noncommunicable diseases as products of genetic, physiological, environmental and behavioural influences. That is a much more accurate and useful explanation than simply telling someone that their illness is genetic. Here is what they have to say:

A genetic disorder is a disease caused in whole or in part by a change in the DNA sequence away from the normal sequence. Genetic disorders can be caused by a mutation in one gene (monogenic disorder), by mutations in multiple genes (multifactorial inheritance disorder), by a combination of gene mutations and environmental factors, or by damage to chromosomes (changes in the number or structure of entire chromosomes, the structures that carry genes). As we unlock the secrets of the human genome (the complete set of human genes), we are learning that nearly all diseases have a genetic component. Some diseases are caused by mutations that are inherited from the parents and are present in an individual at birth, like sickle cell disease. Other diseases are caused by acquired mutations in a gene or group of genes that occur during a person's life. Such mutations are not inherited from a parent, but occur either randomly or due to some environmental exposure (such as cigarette smoke). These include many cancers, as well as some forms of neurofibromatosis.

National Human Genome Research Institute | World Health Organization

A gene may alter the odds, sometimes substantially, but it does not necessarily write every line of the story.

Families inherit more than chromosomes

Family history is important, but it does not prove that genes alone caused the disease. Families inherit recipes as well as chromosomes. They may share the same breakfast table, occupations, water supply, financial pressures, attitudes towards exercise and ways of responding to stress. They may also share smoking, alcohol, highly processed food, mineral deficiencies, disrupted sleep, medical histories and decades of exposure to the same industrial or agricultural chemicals.

The shared environment begins before birth. A mother’s health, nutrition, stress, medical treatments and chemical exposures during pregnancy may influence the developing child. Following birth, families commonly share food, living conditions, infections, sunlight exposure, activity patterns and healthcare habits. These influences may be repeated across generations until they appear inseparable from the family bloodline.

Suppose a man tells me that his father died from a heart attack, his mother developed vascular dementia, two uncles died from cardiovascular disease and his brother now has a heart condition. Of course I take that history seriously. It may indicate inherited susceptibility, and it certainly justifies careful assessment. However, it does not tell us which genes are involved, how much of the risk arose from them or whether the same outcome is inevitable for him.

That family history may also reveal shared food, tobacco exposure, high blood pressure, chronic stress or metabolic problems that went unrecognised for decades. In some cases, a person’s occupational history may tell me more about the development of disease than family history alone. A disease running through a family is therefore a warning to pay attention, not necessarily a prediction of what must happen next.

Families inherit recipes, habits, environments and exposures, as well as chromosomes.

Our genes are God’s script

There is another way to think about our genes, and it begins with awe rather than fear. I have previously described DNA as our “GodScript”. Whether a person understands God in a religious sense, as the intelligence expressed throughout nature, or as a metaphor for the mystery of life, the central point remains. There are two great marvels that we know of: the universe itself and the living code carried within every cell.

Our genes are not an enemy lurking inside us, waiting for an opportunity to strike. Nor should we rummage through them chiefly in search of the genetic skeleton in the family closet. The modern tendency is to look for the defect, mutation or weak link and then define a person by it. That may sometimes produce valuable medical information, but it is an impoverished way to regard one of the most extraordinary inheritances imaginable.

The DNA entrusted to each of us is the product of an unbroken chain of life extending back through millions of years. Every one of our ancestors survived long enough to reproduce despite disease, hunger, injury, climatic extremes, childbirth, predators, conflict and countless other threats. We carry within us the biological record of that astonishing success.

The improbability of this inheritance is almost beyond comprehension. Every ancestor in your direct line had to survive until reproduction, and then, at the final moment, one particular sperm had to meet one particular egg. Change any event in that immense chain and someone else might be here, but you would not be. I explored this extraordinary sequence in The Incredible Odds of You.

When I describe our genes as perfect, I am not claiming that harmful variants or inherited disorders do not exist. They clearly do. I mean that the genetic system, taken as a living whole, possesses such intricacy, adaptability and resilience that we should approach it with humility. No computer, machine or medical technology devised by human beings comes close to reproducing the continual regulation, repair, adaptation and renewal taking place within a living person.

This inheritance does not belong solely to us. It was passed down by our ancestors for our safekeeping, and we are its temporary custodians. Our responsibility is to nourish and protect it and pass it to the next generation in good condition - maybe even slightly better. It is not merely something we possess. It is something entrusted to our care - not our abuse.

Honouring this inheritance means supplying the body with nourishing food, essential minerals, clean water, movement, sunlight, sleep, emotional security and a healthy environment. It also means limiting unnecessary exposure to substances and technologies, like mRNA vaccines, that may interfere with biological processes, especially where their longer-term consequences remain uncertain. The first question should not always be, “Which gene is defective?” It might be, “Have I provided my inherited biology with the conditions it requires?”

This is not an argument against genetic testing or every form of genetic medicine. Used carefully, genetic knowledge can identify serious inherited disorders, guide surveillance and sometimes save lives. However, there is a profound difference between studying our biology respectfully and assuming that we understand it well enough to manipulate it without unintended consequences. Scientific capability and scientific wisdom are not always the same thing.

My dear friend Dr Guy Hatchard has devoted much of his life's work to examining the relationship between genetics, nutrition, biotechnology, health and our wider environment. His writing asks whether technological intervention is advancing more rapidly than our understanding of the interconnected living systems upon which health depends. Readers wishing to examine his work can do so through The Hatchard Report.

The value of Guy’s work is that he does not treat DNA as an isolated piece of biochemical machinery. He asks us to consider the whole person within the whole environment, including food, agriculture, pollution, medicines, behaviour and the accumulated effects of our choices. His recurring caution is that our ability to alter a biological process must not be mistaken for complete knowledge of the consequences. Guy has taight me a lot.

Rather than placing our genes in the dock as the accused, we might first ask whether we have treated them properly. Have we nourished the body? Have we protected it from avoidable harm? Have we honoured what was handed down to us, or have we neglected that inheritance and then blamed it when disease finally appeared? Our genes are not merely a collection of possible family curses. They are a family treasure deserving respect, protection and care.

Our genes are not a family curse. They are a family treasure, passed down through millions of years for us to nourish, protect and pass on.

Susceptibility is not destiny

We should think of many genes as influencing susceptibility rather than dictating destiny. One person may tolerate a poor diet, little exercise and years of stress without obvious illness, while another exposed to similar conditions becomes unwell. Genetic differences may help explain some of this variation, but that does not mean the more vulnerable person is helpless. It may simply mean that person has less room for error and must take better care of the biological hand they were dealt.

I sometimes compare this with an old vehicle. One engine may tolerate years of neglect, while another requires regular servicing, clean oil and a sympathetic driver. Complaining about the engine’s ancestry will not get us very far. Looking after it properly might. The sensible response to an inherited vulnerability is therefore neither denial nor surrender. It is to determine what can be measured, treated, corrected or managed.

If cardiovascular disease runs through the family, take blood pressure, blood lipids, blood glucose, smoking, exercise capacity, body composition, sleep and nutrition seriously. Where the family history is particularly strong, or disease appears unusually early, discuss formal genetic assessment with an appropriately qualified clinician. The family history should encourage earlier investigation and better prevention, not passive acceptance.

If osteoporosis runs through the family, do not merely wait for the first fracture. Examine bone density where appropriate, but also consider resistance exercise, protein intake, calcium and vitamin D status, hormones, digestive health, medication use, smoking, alcohol and the years of physical loading that help persuade bone to remain bone. A familial tendency may increase the need for action, but it does not remove the value of that action.

If type 2 diabetes is common in the family, that is another reason to act early rather than declare defeat while continuing along the same road. The most intelligent time to invest in health is perhaps twenty years before there is any obvious disease. Waiting until the doctor announces, “Houston, we have a problem,” is a rather foolish life strategy.

A family vulnerability may mean that we have less room for error, but it does not mean that we are helpless.

A word of caution about epigenetics

Epigenetics is sometimes presented as proof that we can think, eat or supplement our way around any inherited problem. That goes too far. Epigenetics refers broadly to processes that influence how genes are regulated without changing the underlying DNA sequence. Nutrition, ageing, physical activity, illness and environmental exposures may affect these processes, but this does not mean that every genetic vulnerability can be switched off through positive thinking or a particular supplement.

The useful lesson is more modest. Our genes operate within a complex biological environment, and improving that environment in tiny ways may influence how a vulnerability is expressed even when it cannot change the underlying sequence. This gives us a sound basis for hope and practical action, but it is not a licence for promises or magical thinking.

Our biological environment may influence how genetic vulnerability is expressed, but that is a reason for intelligent action, not extravagant promises.

Become an active participant

My response to someone told that their illness is genetic is never, “Your genes do not matter.” My response is: “Let us find out what can still be changed.” That begins by clarifying the diagnosis and the evidence supporting it. Does genetic mean that a specific inherited disorder has been confirmed, that there is a probable inherited tendency, or merely that several relatives developed a similar condition? Is the diagnosis that it is genetic misleading: is it "lazy medicine"?

The next step is to test rather than guess. Appropriate investigations will depend upon the condition and may include a medical examination, careful family and occupational histories, blood testing, imaging, cardiovascular assessment, bone-density measurement or referral for genetic counselling. Nutritional and complementary investigations may add useful context, but they should not replace necessary medical testing. Consistently, I find that HTMA testing is more valuable than just about any other test when it comes to determining support to live a long and healthy, productive, and satisfying life.

Once the useful information has been gathered, concentrate on the factors offering the greatest potential return. Eat nourishing food, maintain muscle, exercise sensibly, avoid tobacco, keep alcohol modest, sleep properly and attend to blood pressure, blood glucose and metabolic health. Take some supplements, but ones guided by HTMA testing. Persistent symptoms should be investigated rather than dismissed as ageing, bad luck or bad genes.

Medication and surgery may still be necessary. Active participation does not mean rejecting conventional medicine, nor does it mean blaming someone for becoming ill. It means using medical care intelligently while doing everything reasonably within one’s control to improve the terrain in which health or disease develops.

My response is not, ‘Your genes do not matter.’ It is, ‘Let us find out what can still be changed.

Be the tortoise

There is rarely one heroic intervention capable of reversing decades of accumulated risk. Health is more often rebuilt through numerous modest decisions repeated over many years. This is where the tortoise has the advantage over the hare.

The hare becomes excited, buys a cupboard full of supplements, adopts a punishing exercise programme and attempts to change everything by Monday morning. Three weeks later, exhausted and disappointed, the hare has returned to the couch. The tortoise chooses changes that can be sustained. It walks regularly, lifts sensible weights, improves breakfast, goes to bed earlier, attends appointments, repeats important tests and adjusts course according to the results.

None of these actions appears miraculous when viewed in isolation. Their cumulative effect over ten or twenty years, however, may be worth its weight in gold. Prevention and restoration are generally long games, which is why patience, consistency and regular reassessment matter far more than a brief burst of enthusiasm. On a personal note, my last 20 to 30 years have been those of the tortoise. I have absolutely no regrets, not for anything I've patiently done - not for what I have spent as investment in my health. The rewards have been gobsmackingly wonderful. Long may this continue.

We cannot choose our parents, although some teenagers appear determined to try. Nor can we rewrite the DNA they gave us. We can, however, often influence the conditions in which that inheritance is expressed. Genes matter, family history matters and medical treatment matters, but so do food, movement, sleep, environment, metabolism, purpose, patience and the willingness to remain involved in one’s care.

A family history should prompt intelligent action, not the waving of a white flag. Our genetic inheritance is not something to fear or blame. It is something to study wisely, nourish carefully and honour through the way we live.

Genetic susceptibility is not necessarily one's destiny.

Health is seldom rebuilt through one heroic intervention, but through modest decisions repeated faithfully over many years.

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Medical disclaimer

This article is intended for general education and does not diagnose or treat disease or replace personalised medical advice. Some inherited disorders carry substantial health risks and require medical assessment, genetic counselling, surveillance or treatment. Do not discontinue prescribed medication or delay necessary investigation because of anything contained in this article.