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Family History: The Key to an Effective, Individualized Healing Plan

Genetic testing has come a long way in the years since Dr. Bhavna Vaidya-Tank first became intrigued with it as a young medical student. At the time, her interest was piqued by an unusual pattern of cardiovascular disease in Asian-Indian men.

Dr. Vaidya-Tank

“Being Asian-Indian myself,” she says, “I saw a lot of Asian-Indian men who weren’t obese, but who were having heart attacks in their forties. Additionally, other population groups seemed more prone to diabetes than traditional risk factors would suggest.” Curiosity led her to work with the Berkeley Heart Lab then, and later, to use genetic testing with her own patients. “I think more people are aware of it now, but 20 years ago they weren’t,” says Dr. Vaidya-Tank. “We’ve been using genetic information to help our patients for a long time.”

But genetic testing is not the only testing she uses in her practice. “Figuring out the root cause of a symptom can be a tall order, but by looking at specific genes, small variations in hormone levels, antibodies, and neurotransmitters, it is a task the integrative approach can certainly accomplish,” she says.

Such comprehensive testing is only one aspect of the individualized care she provides with her team at Regenesis MD in Raleigh. Family history, genetic background, and environmental influences together inform her very individualized approach to medicine.

Scientific Advances

Genetic testing has evolved over time, Dr. Tank notes. “Some tests can illustrate how people metabolize different medications, or whether they have addictive tendencies. Others can highlight increased risk for heart disease, Alzheimer’s disease, and cancer. In addition to the more well-known BRCA gene tests, there are now, for example, multiple tests that assess genetic predispositions for breast and ovarian cancer, lung cancer, colon cancer, and melanoma.

“MTHFR testing, another common genetic test, can identify a methylation defect found in 60 percent of people,” says Dr. Vaidya-Tank. “This is important, because the MTHFR gene defect is not something most people are familiar with, although it actually is implicated in many common health problems. It can hamper vitamin B processing and use,” she explains, “which can lead to inflammation, depression, and other negative health effects.

While those with the defect can take supplements to counteract risks, they first have to know about it. “The advanced testing will reveal what the risk is for a patient,” Dr. Vaidya-Tank explains, “even if they haven’t yet shown any symptoms.

“My research with Berkeley Heart Lab on Asian-Indian men and heart disease,” she says, “did reveal a genetic predisposition to higher levels of coronary artery calcification and harmful fat storage patterns. So, statistically speaking, even a thin, vegetarian Asian-Indian man faces increased chances for a heart attack.

“And below the surface, this group faces higher rates of elevated blood sugar and higher ‘bad’ and lower ‘good’ cholesterol—even at seemingly normal body-mass-index (BMI). There is such a distinct difference that the threshold for worrisome BMI in this population has been lowered from 25 to 23.”

Data-Driven Insights

Studies like these, says Dr. Vaidya-Tank, “illustrate the value of genetic information in understanding a patient’s unique risks and challenges. Genetic tests aren’t blueprints guaranteeing an outcome, but rather roadmaps offering insight into possibilities.

“A lot of what we have is genetic,” she says, “but you can change your risk. Each individual can respond to environmental factors differently according to unique body chemistry, genetic background, and specific challenges or needs.”

“For example, with most of the one in eight women who will get breast cancer, environmental factors play a larger role than genetic linkages. Diet, lifestyle, and environmental estrogens can all impact risk, and require more than genetic testing. It’s not technically a genetic test,” Dr. Vaidya-Tank explains, “but looking at the way you break down your hormones will help us see how you’re metabolizing estrogens in your body. So-called ’bad’ estrogens can predispose an individual to breast cancer, with or without a genetic propensity. But this risk hinges on diet and lifestyle factors, making it much more actionable.

“With Asian-Indian men, the studies that showed a genetic predisposition to heart disease also identified several controllable risk factors. Even a vegetarian diet can contain unhealthy fried foods and artery-clogging saturated fats that these men may react more strongly to than other groups of people. Changing dietary habits can improve cholesterol levels and blood sugar, two of the major risk factors for heart disease frequently found in this population—even at BMIs considered ‘normal’ by broader standards.”

Small Changes, Big Results

Dr. Vaidya-Tank has her patients work with a health coach to make small but significant changes over time. And they add up! “Even a one- or two-inch reduction in waist circumference can substantially reduce cardiovascular disease risk, as can lowering blood pressure by as little as five or 10 points.

“While genetic risks can’t be changed, nearly everything else can,” she emphasizes. “For example, one patient of mine had multiple genetic risk factors for heart disease and a father who had stents and a heart attack in his forties. We worked with him to reduce inflammation and to reverse his heart disease, using targeted nutritional supplements and a diet optimized for his genetic background. The result: his risk is going to be decreased significantly compared to his dad.”

Dr. Vaidya-Tank digs deeper than any one test, while still leveraging the clues testing can provide. Certain markers even illuminate how patients will respond to different treatments and medications—so genetic information can play an important role not just in understanding health risks, but in designing the most effective treatment plans.

Listening: The Real Gold Standard

Still, Dr. Tank stresses that all the testing in the world is no substitute for talking to—and listening to—her patients. Many times, Dr. Vaidya-Tank can recognize risks through body type or from family history alone. “I can often predict it just by talking to a patient” she notes. “You often don’t need to have 20 expensive tests done.”

Although she likes data, it’s not always a specific genetic test—or any test—that holds the key to restoring wellness. “Always ask about family history,” Dr. Vaidya-Tank emphasizes. “If you’re a good historian, you’re a good physician— because it tells you more than any genetic test!”