By Nelly Bosire
Christmas holidays are generally a time for family and catching up.
For many, the travel upcountry to spend time with family is a tradition that is inherently African. Last year’s was one such holiday for me, with the added simplicity of staying at home due to the Covid-19 safety measures. This was an opportunity to reflect on my history and genealogy. What an eye-opening moment it was. We were able to trace our maternal and paternal family trees all the way to the fifth generation.
What was interesting was noting how strong and healthy my paternal side is. Many lived well into their 90s and those who died young were victims of accidents or short-term illnesses such as tetanus. Non-communicable diseases were unheard of in this family but mental illness was fairly common, with instances of suicide sprinkled over the generations.
My maternal side was not so lucky. This is where non-communicable diseases resided. Hypertension and diabetes were common and claimed many unknowingly. To date, many continue to live with these illnesses. This caught me off-guard as I have always prided myself in carrying a great set of genes. I have had to re-adjust my risk profile in terms of my health.
Maximise disease-free years
Why is this important? We do not choose our genes. We are descendants of people gone before us, who have demonstrated how our gene pool looks. We have inherited a mix of genes over the years that come with mutations that may be mostly harmless yet singly or in combination, can result in risks to our health, which may range from mild to life-threatening.
This has been demonstrated over the years in a myriad of patients that doctors attend to. Physicians bear the brunt of this, most especially in conditions such as cancer, diabetes, hypertension and heart diseases. Many of us have no idea that we are on a collision course with non-communicable disease as imprinted in our DNA. In our 20s, we believe we are too young to suffer the diseases of old people. We never realise how much we need to do in this decade, so as to forestall the onset of these conditions.
I have had to sit with young women in their 20s and demonstrate the risk they carry for diabetes so that we can work as a team to maximise their disease-free years. Saumu* was such a case. She is a 23-year old college student diagnosed with polycystic ovarian syndrome. Her parents are both diabetic and her mom is also hypertensive.
During our visits, I asked about her family history of these conditions and she was blissfully unaware of anyone’s health beyond her nuclear family. She attended her next visit with her mother and we learnt that almost everybody in her mother’s family was diabetic, including her late grandmother. Her father’s family was no better.
With this history, Saumu was shocked by just how serious her diabetes risk was, keeping in mind the strong family history and the magnified risk profile caused by her polycystic ovarian syndrome. Test results showed she was already insulin-resistant, a step away from full-blown diabetes. It has been a satisfying experience to watch Saumu transform her lifestyle, lose weight, adopt a healthy diet and take up swimming and professional dancing for fitness.
Francine* weighs a measly 48kg at 32 years. She came for a routine checkup and based on her family history of hypertension and stroke, we decided to check her cholesterol levels. We were both surprised by how elevated her LDL-cholesterol levels were.
Things were not looking great and she required an immediate referral to the physician for further care. She was in utter disbelief because all her life she had always imagined her small frame was all the protection she needed from the family problems. We were just happy she could get a proper evaluation and follow-up in the right time.
Our genes have been passed down over multiple generations. They have been blended across gene pools, incubated through various conditions, some have been suppressed while others have being up-regulated. This is why some people manifest the conditions and others do not, but can pass them on. The end product is who you are. You cannot change that, but you can modify your lifestyle to improve the outcome.
You may not stop diabetes by living healthy, but you can delay the onset from 40 to 70, resulting in a wholesome life for the most part. You cannot compare the person who starts treatment for diabetes at 30 and the one at 70. By 70, the 30-year old will be requiring dialysis because the kidneys have finally caved in. The 70-year old may be 95 before that happens, having lived a better quality of life.
The next time your doctor asks whether you have a family history of chronic disease, now you know why it is important.