Genes are not Destiny


Let’s shatter a myth.

Over the years, I have heard many people express a belief that is not only false but also dangerous.

I’ve heard it conveyed in many forms:

“I know I’m going to get a heart attack someday. Everyone in my family has heart disease.”

“I am so afraid of getting cancer. So many of my relatives have cancer.”

“There’s nothing I can do about my diabetes. It runs in my genes.”

These are disempowering beliefs. However—they are NOT TRUE. That’s right. These beliefs are incorrect.

To further explain, how about a quick lesson on genetics?

Deoxyribonucleic acid, or DNA (much easier to say, right?), is the molecule that contains our genes. Our genes, in turn, encode for proteins that determine our physical characteristics, such as our height, eye color, hair color, skin color, etc. Moreover, our genes can predispose us to develop many diseases. That part is true.

However, many times these disease-causing genes need to be activated in order to actually create a disease. There are “gene switches” that work to turn genes “on” and “off.” The question then becomes, “What determines whether a gene will become active?” The answer is the internal environment of the body. The next logical question is: “What determines the internal environment of a person’s body?” The answer to this question is the key to maintaining good health—lifestyle. 

Yes, lifestyle, which is defined by the foods we eat, the amount of physical activity we give ourselves, how well we sleep, how we manage stress, the strength of our relationships, and whether or not we use risky substances such as tobacco. These factors will define a person’s internal environment and, thus, what types of genes will be activated. In fact, it is thought that genes themselves account for only 10% of a person’s overall degree of health, whereas “gene switches” account for 70-90% of a person’s overall degree of health. 

To illustrate using an example:

Let’s say that you have a strong family history of heart disease. Your parents, one of your siblings, and several aunts and uncles have all suffered heart attacks. It is very likely that you also have the genes that will lead to the development of heart disease. However, given this genetic predisposition to heart disease, there are two possible health scenarios.

Scenario #1:

You eat a lot of fatty and processed foods and not many fruits, vegetables, or whole grains. You are relatively sedentary, have a stressful job, and don’t get adequate sleep. The chances are good that the heart disease genes will be turned on, and you will develop heart disease.

Scenario #2:

Your diet consists primarily of fruits, vegetables, legumes, and whole grains. You are a physically active person and exercise regularly. You handle your job stress well, sleep well every night, and have a happy family life. In addition, you don’t engage in risky behaviors such as tobacco use. The chances are pretty good that the heart disease genes in your cells will not be activated and that you will not develop heart disease. 

This is empowering information! Always remember that it is you that has control of your own health.  

The Magic Penny


Let’s say that a billionaire came up to you and offered you a choice: $500,000 given to you today or the sum of a penny doubled every day for 31 days. Which would you choose? Half a million dollars today is undoubtedly tempting. However, if you do the math, you will realize that the meager penny doubled every day for one month is by far the better deal. 

Many of you may have heard of the magic penny. This is what happens to a penny if you double its value every day. At first glance, it doesn’t sound like it would amount to much. So let’s take a closer look. The first ten days would look like this: $0.01, $0.02, $0.04, $0.08, $0.16, $0.32, $0.64, $1.28, $2.56, $5.12. On day 10, all you would have is $5.12. On day 20, you would have $5,242. On day 25—$167,772. A nice chunk of change—but not filthy rich. And certainly nowhere close to that $500,000 that you could have had right up front. But then, on day 30—$5.37 million. And finally, on day 31—$10.74 million. Now you are a millionaire!

For me, the story of the magic penny holds two lessons. First, consistency is essential. To see results for any objective you have set for yourself, you must take action on a consistent basis. Consistency is critical when it comes to accomplishing goals. The second piece of wisdom I have gathered from this magical piece of copper and zinc is that, even with consistent action, it may take time to start seeing substantial results in the quest to reach your goal. As exemplified by the penny, there were barely significant results on day ten and only modest results on day 20. However, the final two days were when the real magic occurred. 

If you have set a worthwhile goal, be consistent in your efforts towards attaining it. Appreciate that you may only notice regular, yet small, steps of progress on your journey. By all means, enjoy the journey. Stay consistent, and know that the real magic may take some time to occur. 

The Question

Leeloo Thefirst/

I have a question for you. But first, a brief introduction.

Imagine that you have a brand-new, shiny, high-performance sports car, and let’s say you have two choices as fuel to fill its gas tank. 

Option #1: High-octane, premium gasoline

Option #2: A bucket filled with soapy water

Which option would you choose?

I know; the answer is obvious (I hope): the premium gasoline, of course. Your car will run really well with that as fuel.

How well will your car run with soapy water in its gas tank? Not well at all. Actually, not at all. Moreover, you’re likely going to cause some engine damage.

I’d like you to take this example with the fuel comparisons and use it as an analogy for your body. Yes, your body is with you 24/7 and, like your car, gets you everywhere you need to be.

Here is the question:

What type of fuel (food) do you need to feed your body every day so that it will run in its most optimum state?

I would love to hear your answers to this question.

Which types of food should you eat each day to help keep your body fit and healthy?

Please send me a message via email or the contact page of this website.

Let me know your thoughts and, if you like, why you feel the way you do.

Let’s stir up some conversations. 

Is Your Food a Risk Factor?

Panuwat Dangsungnoen/

In my last post, I spoke about how coronary artery disease can be considered a food-borne illness. I discussed how the modern Western diet, filled with fried foods, processed foods, meats, oils, and dairy, contributes so much to the development of heart disease. Moreover, there is an abundance of data demonstrating this connection. For me, even though the data is there, I don’t need it to appreciate that the foods we eat are harming us. I see this demonstrated every day I go to work. I care for many people suffering from diabetes, hypertension, heart disease, cancer, and stroke. Maybe you do as well. Do you have family or friends living with one or more of these illnesses? They are indeed diseases of lifestyle.

Reflecting on my work as an Emergency Medicine physician, I began thinking about how I evaluate a patient with chest pain. In the Emergency Department, we certainly try to make a diagnosis whenever we can with the resources at our disposal. At a minimum, however, we need to do our best to ensure that no immediate life or limb-threatening process is occurring in a patient, and the questions we ask a patient are often a critical part of our evaluation. 

Getting back to the patient with chest pain, there are several conditions that we need to assess for, including coronary artery disease, which may be causing an acute decrease in blood flow to part of the heart. While interviewing the patient, we ask many questions about their symptoms as well as their risk factors for heart disease. Typical risk factors include diabetes, hypertension, high cholesterol, cigarette smoking, and obesity. Then I began to ask myself: why don’t we ask about a  person’s diet? It is clear that what a person eats can either contribute to or protect from heart disease. Perhaps in the future, a person’s diet should be officially added to the list of heart disease risk factors. Moreover, raising the subject of diet may allow us to create awareness and educate our patients on this essential component of health and wellness.

A Food-Borne Illness

Jonathan Borba/

As an Emergency Medicine physician, when I hear the term “food-borne illness,” it immediately conjures images of people with vomiting and diarrhea secondary to consuming undercooked or spoiled food contaminated with bacteria or their toxins. However, I recently learned of a new usage of this term. In his article, “Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?” Dr. Caldwell Esselstyn ascribes a new meaning to the phrase “food-borne illness,” referring to coronary artery disease as this type of illness. According to the CDC, coronary artery disease (CAD) is the most common type of heart disease in the United States. It is the narrowing and blockage of blood vessels supplying blood to the heart, which can eventually lead to heart attacks. The CDC also states that in the United States, over 20 million adults over age 20 have CAD and that someone has a heart attack every 40 seconds.

Those are some pretty frightening statistics. But luckily, doctors have treatments for heart disease. We have an armamentarium of medications as well as procedures such as coronary stents and coronary artery bypass surgeries. These are remarkable advances that are lifesaving for those that are having a heart attack. However, as Dr. Esselstyn states, “…none of the present therapies targets the cause: the Western diet.” Yes, our Western diet—filled with processed foods, fried foods, meats, oils, and dairy. He describes cultures that consume a plant-based diet in which CAD is almost non-existent. Moreover, the converse is also true. When plant-based cultures adopt a Western diet, guess what? Yes, that’s right, they develop CAD. Thus, it seems as though heart disease really is a food-borne illness. 

History also teaches us this lesson. Between 1939 and 1945, Norway was occupied by Nazi Germany. During this time, the Germans removed all animal livestock, forcing the population to subsist on whole grains, legumes, fruits, and vegetables. Following this, deaths from heart attacks and strokes fell. When the war ended, and animal products became available again, deaths from these illnesses rose to prewar levels. Thought-provoking, isn’t it?

In his article, Dr. Esselstyn mentions a study he conducted on very ill patients with CAD that he placed on a plant-based diet. These patients have thus far been followed for twenty years, and the results are fascinating. A plant-based diet not only stopped the progression of heart disease but even reversed it! Yes, reversed it. Furthermore, this study and its follow-up showed that people with CAD would stick with dietary changes for decades. If provided with an understanding of the link between diet and disease, I believe that people will want to take control of their own health and give themselves the opportunity to be better.

Running a Mile in Less than 4 Minutes

Lukas Hartmann/

I love the story of Roger Bannister. He was a runner that ended up becoming famous. You see, for the centuries that track and field records had been kept, nobody had ever run a mile in four minutes. It was deemed impossible for a human to run so fast for such a distance. It was an obstacle that no person could overcome. That was, until May 6th, 1954. Roger Bannister had resolved to be the first person to run a mile in four minutes, and on that day, he ran a mile in three minutes and fifty-nine seconds, breaking through barriers that had stood for centuries. 

However, the truly incredible part of this story is that his record lasted for only forty-six days. Moreover, within the following ten years, 336 other runners had also broken the four-minute mile record. 

How could it be that no human could run a four-minute mile for centuries, and then suddenly, over 300 people can do it within ten years? The answer lies in the fact that the barrier was not a physical one—it was a mental one. It existed only in the minds of runners, and it crumbled as soon as Mr. Bannister proved that it could be done.

Often, our own barriers do not exist outside of us but within us.

What Goes Around Comes Around

Min An/

 “What goes around comes around.” 

I’ve heard that phrase my whole life. However, it wasn’t until later into adulthood that it took on greater meaning for me. 

Some days, I “wake up on the wrong side of the bed.” I don’t give my wife a smile or a good morning kiss. Sensing something amiss, she distances herself. I may be impatient with my boys. As my morning progresses, I can’t seem to find paperwork that I was planning to work on. I try to do some work online and discover that the computer has “frozen.” Other small things seem to go wrong during the course of the day.

Conversely, life seems much easier when I am in a good mood. My day is pleasant when I choose to have feelings of gratitude and cheerfulness towards those around me. I wake up with a smile and take a moment to make coffee for my wife. She smiles and hugs me. My boys laugh with me. Whatever tasks I have planned usually go well. And if they don’t, it’s okay because I’ve already chosen to be happy and thankful.

So, “what goes around” does indeed “come around.” Hostility begets hostility. Kindness begets kindness. What we send out into the world will come back to us.

The Balance of Nature

Michael Block/

If you’ve been reading my posts for any length of time, you know that one of my interests is wellness and the importance of healthy lifestyles. I wanted to share that I am also vastly interested in sustainability and our environment. I developed this fascination several years ago, and it has continually grown. 

We are blessed to have a beautiful planet to call home. It provides us with the resources necessary for survival and inspires us with nature’s miracles. There are times when I leave my home for work in the mornings and stop my car to admire the orange-tinted sky as the sun makes its way above the horizon. Forests, mountains, rivers, and oceans are teeming with an abundance of life, with each of the thousands or millions of individual organisms going about their daily activities without disturbing the overall balance of their ecosystems. Left to its own intelligence, nature will maintain equilibrium across the globe. 

Unfortunately, that picture changes when human beings enter the equation. With our superior intellect and reasoning capabilities, we have built civilizations and developed technologies that have allowed us to become the dominant species on Earth. However, in the process, we have disturbed the balance of nature. Please don’t misunderstand me—I am a fan of progress. Over the past decades, advancements have allowed innumerable people to live better lives. More people now have clean water, electricity, mobile phones, and internet access. As a matter of fact, according to Hans Rosling in his book “Factfulness,” over the past 20 years, the proportion of the world population living in extreme poverty has almost halved. These are remarkable achievements, and I am elated that we have come so far. 

My hope is that modern societies will learn from nature. We have figured out ways to care for our growing population, which is wonderful. However, we must maintain balance. We are not the only species living on this beautiful blue and green sphere—we share it with trillions of other beings. We have already begun moving in the right direction, as countless dedicated people are working on solutions to the many environmental imbalances that we have created. In the meantime, I know there are so many seemingly small things that I can do to help out. A few things that come to mind are planting a garden, picking up litter, turning off the lights when I leave a room, and not leaving the water running continuously while washing dishes. I have faith, and I look forward to a better and healthier planet in the future. 

A Bandage Culture

It’s a typical busy day in the Emergency Department. Physicians, nurses, and other staff members are bustling about doing their best to care for those that came through our doors. I walk into the room to greet my next patient and find an uncomfortable appearing man sitting up on the stretcher holding his chest. 

“Hi, I’m Dr. Piriano. How long have you been in pain?”

“Hi, doc,” he replies after a long exhale. “For about an hour.”

“What exactly are you feeling?”

“It feels like someone is standing on my chest.”

“Do you have pain anywhere else?”

“Yeah, my left arm is kind of aching.”

“Any other symptoms?”

“I’m having some trouble breathing, and I’m also a bit nauseous.”

Before I have a chance to speak again, a technician rolls an EKG machine into the room and begins placing stickers onto the patient’s chest. 

“We’re going to take care of you,” I tell him. “We’re going to do our best to make you feel better.” 

I start my physical exam while the technician enters the patient’s information into the EKG machine. 

After the EKG prints out and I review it, I note some worrisome findings. Although the EKG does not reveal evidence of a heart attack, it does raise concerns about a possible blockage of a blood vessel supplying his heart with oxygen and essential nutrients.

An IV is started, blood is drawn, and medications are given to my patient that help to alleviate his discomfort. He is eventually admitted to the hospital for further monitoring and evaluation by a cardiologist. 

As I sit down at my computer and reflect on my patient, I have a bittersweet experience. I am happy that we were able to make him feel better and admit him to the hospital so that he may receive further care. I am also sorrowful that he had this experience. Thinking about him more, I feel that this episode could have been prevented. 

He is fifty-three years old. He also takes five prescription medications as “treatment” for diabetes, high blood pressure, and high cholesterol. Given his underlying conditions, it was likely only a matter of time before a complication manifested itself. 

The truly unfortunate thing is that the gentleman with chest pain is not alone. He is representative of so many patients that I care for in the Emergency Department. I see patients with conditions such as diabetes, high blood pressure, high cholesterol, heart disease, stroke, and cancer many times in a shift. These individuals have lists of prescription medications numbering three, five, ten, or even more. 

Is this really what we have come to? We appear to be a society where so many of us take poor care of ourselves and subsequently develop lifestyle-related diseases. We then take multiple prescription medications to “treat” our illnesses. Many times, of course, the medicines do their jobs and help us manage our afflictions. However, are they addressing the actual underlying cause of our condition? For instance, if you have diabetes due to a poor diet and being overweight, are prescriptions correcting the underlying cause of your diabetes? If you have high blood pressure secondary to obesity, physical inactivity, and excessive salt intake, are your blood pressure medications fixing the root causes? Are medications truly healing you, or are they just bandages attempting to prevent things from getting worse?

There is an abundance of scientific research telling us that living a healthy lifestyle can help to prevent and even reverse many of the diseases mentioned above. Wow!—eating wholesome foods, including an abundance of fruits, vegetables, whole grains, and legumes, and getting adequate physical activity can prevent and reverse diseases. This is remarkable knowledge. Believe me, I appreciate that it is so much easier to take some pills than to change your lifestyle. I also understand that many people are trying to change, and that’s fantastic. I applaud you, and I know that we can all be better. 

My one parting thought is this: Is your wish to give your wounds the opportunity to heal, or are you satisfied with keeping them as they are and just covered up with a bandage?

***As I said, living a healthy lifestyle can help to prevent and reverse many illnesses. However, it is essential that if you are a mostly sedentary person or are currently under a doctor’s care, that you speak with them about your desire to change and do it under their guidance. Furthermore, never change or discontinue any prescription medications without your doctor’s approval.

My Hope for the Future of Healthcare

Medical stethoscope with red paper heart on white surface

As I walk into the Emergency Department at the beginning of my shift, it seems like it will be another day typical of the new era of health care. Over the past few months, I have been treating fewer and fewer people for complications of chronic diseases. I rarely encounter patients suffering from the acute effects of illnesses such as hypertension, diabetes, heart disease, and cancer. Most people are coming to the hospital seeking treatment for injuries and infections.

Since the COVID pandemic ended a decade ago, so many more people have been genuinely focused on taking better care of themselves. It seems as though there has been a major paradigm shift. Almost everyone I speak with has told me that they have changed their diets for the better. So many people are eating increased amounts of fruits, vegetables, and grains and much lesser amounts of processed foods. In addition, people have become so much more physically active. Countless individuals I have encountered during my shifts in the ER have told me that they have been able to discontinue several, if not all, of their medications because their conditions have been cured or stabilized. Perhaps the best thing, though, is that they feel great. People are always telling me how energetic and focused they are. I am loving this. 

Moreover, I am overjoyed to know that these wonderful improvements in the health of so many are not just localized to my little corner of the world. Reviewing statistics from the CDC and medical journals confirms that this has become a near-global phenomenon.

Health care has shifted from a predominantly symptom and disease management model to one that emphasizes the importance of promoting and maintaining excellent health. Providers of health care spend significant amounts of time counseling their patients on the importance of good nutrition, regular exercise, adequate sleep, and coping well with stress. Rather than prescriptions for drugs and procedures, patients receive guidance on eating well and giving themselves sufficient physical activity. 

Not only are innumerable people grateful for this new era of health care and the wonderful feeling of vitality that they experience every day, but governments have been reaping the benefits as well. Health care spending has been spiraling downward. I’m no economist, but I think that’s a good thing. Lost workdays due to illness have remarkably decreased, and productivity has consequently increased. These factors have proven to be an excellent boon for economies worldwide. 

I had hoped for such a world for many years, and it has finally come to be. I am delighted to be taking care of such a healthy population in my professional life as an Emergency Medicine physician. Even many of my older patients are less frail and more energetic than I remember. In my personal life, I am thrilled to be part of a healthy family whose members I know will live not just long lives but energetic and joyful ones.