BENGALURU: Gone are the days when a heart attack or cancer were associated with stress, unhealthy lifestyle and bad eating habits. Genetics always played an underlying role, and medical experts point out that early testing of one’s genetic pattern will now be beneficial in choosing the right and healthy lifestyle to control diseases at the right time.
And age is no factor in this. “I always knew that Type-2 diabetes is genetic, and there was no such case in my house. My parents are not diabetic. I love my sweets. However, over time, I started repeatedly falling ill. I used to get tired at college and work. My workouts were also becoming strenuous. I started undergoing multiple tests and treatments for my deteriorating health. Doctors advised me to get a genetic test done after I complained of severe pain in my back. I suffered a mild heart attack,” said Prajesh (name changed), a 25-year-old software professional in Gurugram.
His genetic tests revealed that he carried a strain of Type-1 diabetes, which is rare. Discussions during treatment revealed that his grandparents had a history of diabetes, and his parents were carriers of the strain. He is now undergoing treatment with a doctor at All India Institute of Medical Sciences (AIIMS), Delhi.
Another similar case was cited by Dr Nitin Kapoor, Professor and Head (Unit-1) Department of Endocrinology, Diabetes and Metobolism, Christian Medical College (CMC), Vellore. He said that during his course of treatment of a patient suffering from thyroid cancer, he learnt that the family had reported a cancer case earlier too. The patient had a one-year-old child. Wasting no time, a genetic test was done on the child and cancer cells were found. Thus, an immediate operation was done to address the issue. It was better than waiting till it developed.
The Indian Council for Medical Research (ICMR) in its 2023 report on non-communicable diseases noted that heart ailments and diabetes cases have been on the rise for a decade. The recent cases of multiple incidents of heart attacks among people of different age groups in Hassan, Karnataka, has also raised concerns among experts, pointing to the need for genetic testing.
Dr RV Asokan, Immediate Past President of the Indian Medical Association, said genetic study and customised treatment based on a person’s gene type is the future of Indian medicine. “We are looking at customizing treatments, against the present one-size-fits-all. Focussed treatment is the need of the hour, and over time, medical professionals have also realised it. But for this, the genetic report of patients is needed. Not many are doing it because of a lack of awareness. It is an emerging area,” he said, cautioning that not everyone needs genetic analysis and it should not be exploited.
Dr Priya Ranagathan, medical geneticist, Apollo Hospital, said, genetic study is a gradually growing field. Awareness and need for testing genetics is rising, especially among cardiologists and endocrinologists. In case of heart ailments, it is needed, as cases are on the rise.
Dr Ramesh Menon, Associate Director, Genomic Medicine and Personal Genomics Division, Bioinformatics Department, at MedGenome - a lab offering genetic testing across India - said they get over 500 samples annually. Genetic testing is presently being done for coronary heart diseases, diabetes, obesity, high Body Mass Index (BMI), Parkinson's, Alzheimer’s and age-related eye disease. With changing trends, genetic testing for heart diseases has advanced. But awareness among clinicians advising patients to take up the tests has not.
Dr Menon said there are instances where people show no symptoms and suddenly suffer a heart attack or a mild stroke. This is because of a family history. Thus, just like people undergo annual health check-ups or tests for health insurance or jobs, they can undergo a genetic test, which is done only once for the entire lifetime. It helps in understanding, and early diagnosis and deciding the right course of treatment. He added, interestingly, during a series of genetic tests for a study, it was found that there is a 70 per cent rise in cases of Parkinson's. Such data helps state and Union health departments in chalking out medical policies.
He also pointed to the historical data and study reports which show that people in south Asian regions- India, Sri Lanka and Pakistan, are genetically more prone to heart ailments because of the MYBPC-3 gene which plays a role in the making of the protein called cardiac myosin-binding protein-C, which regulates heart muscle contraction. People in olden days carried the gene, but didn’t suffer ailments because of an active lifestyle and healthy eating habits. Now, with poor eating habits and improper lifestyle, more cases are being reported. Improper sleeping patterns, sitting for long hours, smoking, drinking, and stress are just the trigger points.
Dr Manohar KN, Lead Consultant, physician and diabetologist, Sparsh Hospital, said, “Genetics play an underlying role. It is simple if genetics loads the gun, then lifestyle pulls the trigger. Thus, people should concentrate on improving their lifestyle by early testing and having healthy activities, for nothing can be done about the genes.”
Dr Vedam Ramprasad, CEO MedGenome, said that gradually awareness is increasing. Earlier, it was only for rare diseases, but now it is being tested for common diseases also. But not as much as it is the US, and other Western countries. It is now mandatory in some countries like Abu Dabi and other Middle East countries. In India, the mindset of people, economics and other factors play a role. People simply think about what the need is.
Interestingly, with rising IVF treatments, a rise in genetic testing is being noted. However, the ethics of this is still debated in the medical fraternity. While genetic analysis to ascertain underlying diseases like down syndrome or other health markers is good, screening for good embryos is not.
Explaining the need, Dr Animesh Maiti, Head of Department, Endocrinology, Government Medical College, Kolkotta, added that genetics playing a role in diabetes in Type-2 diabetes is globally known. It is only now that cases in Type-1 diabetes are being reported and many are in Finland. Gene therapy, which is on the rise in other countries, needs to pick up in India. The facilities for testing are also rising gradually. Like private labs, hospitals too have started their in-house genetic testing centres. The cost of testing has also reduced from earlier. It has gone down from Rs 15,000-30,000 to Rs 7,000-10,000 depending upon the type of test. But government hospitals are yet to start it. Government doctors refer patients to private labs, which adds to their cost of treatment.
Dieticians have also started taking note of the need for genetic testing. A lead sports dietician, not wanting to be identified, said, “Genetics studies also help in choosing the right type of diet not just for patients during and after treatment, but also on a daily basis. Like allergy tests are done before surgeries, genetic tests before treatment can tell the type of medicines person can be prescribed, the type of food a person can eat and the diet that needs to be maintained, especially for diabetics and heart patients, instead of just saying reduce or no sugar or the sports they can play. But clinicians still need to understand this.”