Self-Care With Dr. Shermaine: “Did You Inherit Your High Cholesterol?”

During her first year of graduate school in the U.S., Susan Addis got two things from her mother back home in the U.K.: a care package of European treats and a warning about extremely high cholesterol.

“She sent a letter that said, ‘If you haven’t eaten all the goodies I sent you for Christmas, you need to eat them now, because once you have your blood tested, you’ll probably be told you can’t have them,’” Addis recalls.

Addis’ mother had just learned she had very high cholesterol: 500 mg/dL. (Anything over 200 is considered high.) The doctor had recommended that all three of her children be tested as well.

Addis, who was 24 at the time, says she practically had to beg the doctor at the student health center for the test. She was young, in good health, and not overweight. But she insisted.

The result: Her total cholesterol was 350 mg/dL. She says the doctor downplayed the number, saying it was “a little higher than he’d like to see.”

When Addis found a book at the campus bookstore that showed Americans’ cholesterol levels, she realized hers was nearly off the chart.

It turned out that Addis had inherited a rare condition called familial hypercholesterolemia. The disorder allows cholesterol to build up regardless of your weight, diet, and exercise.

But people who don’t have this genetic condition can still inherit a predisposition for high cholesterol or for developing risk factors for the condition. Or you may simply pick up your parents’ habits that can promote high cholesterol, even if it’s not in your genes.

When It’s in Your Genes:

Almost 1 in 3 adults has high cholesterol. Only 1 in 300 people has familial hypercholesterolemia. Anyone who has one of the 1,500 possible gene variants that cause the condition has a 50% chance of passing that gene on to their children.

Addis got the gene from her mother. Addis’s daughter has it, too, but not her son.

Most of the gene variants that cause hypercholesterolemia involve a protein known as the LDL receptor. This protein clears the blood of LDL, or “bad,” cholesterol. But in most people with familial hypercholesterolemia, that protein doesn’t do its job.

People with this condition have high cholesterol starting at birth. Untreated, it can cause heart attacks at an early age.

The treatment for the condition -- a low-fat diet, exercise, and cholesterol-lowering medications -- is the same as the treatment for anyone with high cholesterol. But even with treatment, cholesterol may still remain high if your genes are in the driver’s seat.

“Someone with a genetic disorder may not respond like another person who doesn’t have a genetic form of hypercholesterolemia. So their efforts may prove less fruitful, and that’s a really frustrating point,” says Erica Spatz, MD, a general cardiologist and professor at the Yale School of Medicine.

While she was still in graduate school, Addis adopted an extreme diet and worked out every single day just to keep her cholesterol at 240 mg/dL, which is still too high. The lifestyle was unsustainable after she finished school and started her career. Now 54, Addis controls her cholesterol with medication and a sensible diet.

Even if you don’t have a rare genetic condition, many things that make high cholesterol may be genetic to some degree. Obesity, a high body mass index (BMI), a high waist measurement, and a high waist-to-hip ratio: Each is a risk factor for high cholesterol, and each may be driven in part by your genes. Some people may also have a genetic predisposition to overeating, which can lead to obesity. Diabetes is also a risk factor for high cholesterol, and genetics plays a role in who gets it and who doesn’t.

But in those cases, your lifestyle can make a big difference in whether your cholesterol steps over the line. To do that, you may want to start some new family traditions.

Your “Inherited” Lifestyle:

Your genes aren’t the only thing you inherit from your parents. You pick up some of their habits, too, both the good ones and, unfortunately, the not-so-good ones.

“Nature and nurture -- so your genetics and what’s taught at home -- play a role in high cholesterol,” says Mike Sevilla, MD, a family doctor at Salem Regional Medical Center in Salem, OH.

Your parents’ eating habits can start to influence your habits and preferences even before you are born. Studies show that when women eat a variety of flavors during pregnancy, their babies are more likely to accept those flavors later on. The aromas of garlic, curry, cumin, and other spices make their way into amniotic fluid, which the baby swallows in the womb.

In one experiment, women drank either carrot juice or water during pregnancy. After the babies were born, those whose mothers drank carrot juice were less likely to make distasteful faces the first time they ate carrots. The same was true in a study of women who drank carrot juice while breastfeeding.

Your parents influenced your eating habits and preferences as you grew up simply through what they ate in front of you.

“Families tend to eat similar foods. Many people’s eating habits are reflective of what they grew up with, what their comfort foods are,” Spatz says.

The foods your parents may have rewarded you with and the foods they may have forbidden you to eat also play a part. Ironically, if you were never allowed to eat sweets or fatty foods growing up, you may have a tendency to overindulge in them now.

Similarly, you’re more likely to be physically active if your parents were. On the flip side, parents who are smokers are more likely to have children who smoke. And that drives up cholesterol.

“When it comes to bad nutrition, not exercising, or smoking, it can be very hard to break that family cycle,” Sevilla says. But it’s still possible.

How to Face Your Family History:

Lifestyle choices and medications can help undo the damage of faulty genes and deep-seated family traditions.

“I grew up eating lots of cheese, and I love cheese, but now I avoid high-fat dairy products,” Addis says. “And I choose not to eat red meat and whole eggs.” She wears an activity tracker to keep her motivated to stay active. Her medications help with what diet and exercise can’t do.

Today, her cholesterol holds steady between 220 and 240 on her current medications.

What keeps her going, Addis says, is thinking in positives, rather than negatives. “When your doctor says you have high cholesterol and you need to do something about it, you think you’re not supposed to have this, you’re not supposed to have that. But I thought of the new things I could try,” she says.

“It really helped me to start exploring cooking more, to think more about using spices, interesting ingredients, and trying new recipes. There’s a lot of really good stuff out there that doesn’t have to be high in fat. You can eat healthier food and still have really tasty food.”

That’s a legacy anyone would love to pass on.