What Every Woman Should Know Before Pregnancy: Genetics, Family Planning & Hidden Toxins

In this episode discover how understanding your genetic profile can transform your health and overall wellbeing. In this episode, board-certified genetic counselor Lila Dayani uncovers how genetic insights can empower your health journey far beyond pregnancy and family planning.

In this episode:

-Learn how genetics can be a tool for prevention and personalized care.
-Explore why routine OB visits may not capture your full genetic story and how comprehensive counseling can uncover hidden risks. 
-Learn about the role of epigenetics and how lifestyle choices can influence everything from fertility to mental health.
-Discover the benefits of genetic testing, even without a family history, and how early insights can guide your choices.
-The power of genetic knowledge in everyday life
-Myths and misconceptions about genetics
-Comprehensive counseling and uncovering hidden risks
-Realities of carrier screening and preconception testing
-Inspiring patient stories and life-altering diagnoses
-Taking control of future health through genetic insights

Unlock the potential of your genes and redefine your future with informed, empowered choices.

Sara Firouz:  https://www.instagram.com/sarafirouz/
Lila Dayani: https://www.instagram.com/ldayani/
https://geneviehealth.com/

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Transcript

SPEAKER_02 0:03

Welcome to the Happy Go Lifestyle Podcast with Sarah Farooz, your destination for all things health, wellness, and mindset. Each week we explore ways to elevate your life through holistic living, self-growth, relationships, motherhood, divorce, and reinventing yourself after life's changes. My goal is that you leave every episode feeling inspired, empowered, and ready to embrace life with purpose, joy, and confidence in living your best life. Layla Diani is a board-certified genetic counselor and reproductive consultant and the founder of Genevieve Health, a private consulting practice redefining the role of genetics in modern medicine. Based in Los Angeles and New York, she brings over a decade of experience at the forefront of reproductive and medical genomics, offering highly personalized guidance in fertility, cancer risk, wellness genetics, and complex diagnostic cases. In this powerful and eye-opening episode, we dive deep into the world of pregnancy planning and genetic health, unpacking conversations that every woman should be having before and during pregnancy. We explore the true role of comprehensive genetic counseling and why a routine visit with your OB may not be enough when it comes to understanding inherited risk and long-term health planning. We discuss epigenetics, the science behind how your lifestyle choices and environment can actually influence whether certain genes are turned on or off. We talk about breast cancer risk, including the BROCA gene, and how understanding your genetic profile can empower early screening and prevention strategies. You'll also learn why reducing exposure to endocrine disruptors and environmental toxins matters for fertility and long-term health. What to do if you have a family history of cancer, cardiovascular disease, or other inherited conditions, how proactive genetic testing can guide personalized prevention, and how genetic counseling can be especially transformative if you're adopted and don't have access to your biological family history. This episode is a must-listen for anyone who is not only planning on getting pregnant, but who wants to take ownership of their health, understand their genetic blueprint, and use both science and lifestyle to shape a stronger, healthier future. Please enjoy my conversation with Layla Diani. Layla, welcome to the podcast. Thank you for having me. I'm so excited to be here. Thank you so much for being here. You and I go way back. Way back. Way back. I think I met you when I was 13, which is maybe even younger. Yeah. And we haven't seen each other in all these years, maybe once, but it's so nice to be able to reconnect with you in this way. It's so cool. Likewise. So excited. Yes. It's so good to see you again. So I was a psychobiology major in college. And one of the classes I took was genetics. And I just remember it being one of the most fascinating classes I took in college. Yeah. I just loved learning about the human genome and understanding why we look the way we do, why we act the way we do. And I just thought it was so interesting, but I also think that genetics can be a field that is really misunderstood because it's so complex and it's constantly evolving. What I love about what you do is that you not only educate people on learning about the thing about them that's most important, which is their genetics, but you really empower them and give them the tools to be proactive about their family planning and essentially to live a more optimal life. Right. I think then when most people think of genetic counseling, they think of pregnancy and that whole process. Right. What do you think is the biggest misconception about genetic counseling?

SPEAKER_00 3:38

Yeah, that's an excellent question. Um, I think that if someone has seen a genetic counselor in their life, it's usually been in the construct of something's gone awry, and oftentimes during a pregnancy. And unfortunately, that is often not a great experience. And it's so important to know that that's one facet of genetic counseling, prenatal genetic counseling, and one experience that one can have. It can be and is so much bigger than that, right? It can be proactive, it can be pleasant, it doesn't have to be such a traumatic experience as I know it can be when you're pregnant and you're receiving bad news from a provider. And it can really help you make actionable, helpful decisions throughout your life that feel empowering and help you have agency. It doesn't have to be so compartmentalized into pregnancy, bad news, having to make difficult decisions. And I think that's oftentimes what people think about when they think of genetic counseling.

SPEAKER_02 4:41

So to your point, if someone has no family history or no family history that they know of, they feel fine. Do they still need to seek genetic counseling?

SPEAKER_00 4:49

I mean, my opinion is always going to be yes, because we all have something, right? Like none of us have a perfect genome. And we all carry something in our family, and there's just so much that we can do about it. And what you don't know, you don't know, and therefore that can't help you, right?

SPEAKER_02 5:06

You don't know what you don't know. You don't know what you don't know. That's such a good point.

SPEAKER_00 5:09

You know, and obviously I look at everything through that genetic lens, which is good and bad. You know, anything from type two diabetes to cardiac disease to cancer, vision disorders, anything, there are things that you can do to take proactive steps, change your screening, change your routine management. So if you have type two diabetes in your family, instead of waiting until your A1C becomes high, there are things that you can do about that. Even if you don't have cancer in your family, that doesn't mean that you may not have a cancer predisposition gene. That may not mean that you don't need to change whether you have a mammogram or mammogram plus MRI or God forbid a mastectomy, just because it's not in your family history, right?

SPEAKER_02 5:52

So you cannot have a family history of cancer, but still carry a cancerous gene. Correct.

SPEAKER_00 5:59

You could not have a family history of cancer, which oftentimes we see, but have a gene that increases your risk of developing cancer above the population risk, which would warrant further management and possibly prophylactic surgery.

SPEAKER_02 6:11

So we're gonna come back to that, but I want to talk about what prompted you to open Gen of, which is your practice in Los Angeles.

SPEAKER_00 6:18

So I've been practicing for almost 15 years, and most of that was in the preconception prenatal component. But oftentimes what I would see is that the genetic counseling referral indications and the reason I was seeing patients was so specific and there was so much that was being missed. Patients would come to me and I would say, but what about this in your family? And why did no one talk to you about this before you were pregnant? And why is this being missed? And it was like, no, no, we're just here to focus on this. And I felt that I was doing a disservice to my patients by not looking at them globally and not helping them globally. And I think from a preconception standpoint, there's so much that one can do to maximize their odds of a healthy pregnancy that we're not thinking about. You think like, okay, I want to start a family, I want to get pregnant. At the most, maybe you start taking a prenatal vitamin, but there is so much that you can do before you get pregnant on that standpoint. And then above that, like you would see me when you're, let's say, before 20 weeks pregnant, and I would see you have such a strong family history of cancer, you probably should have considered cancer genetic testing before you're pregnant. That's not something I really want to bring up to you necessarily when you're concerned about something going on. And I wish you had thought about that prior to pregnancy, or you have a family history of sudden cardiac death. You know, all of these things are better addressed in a less high risk, less sensitive setting than when you're 20 weeks pregnant. And that's when I decided like there is the gap in care. There isn't anybody really addressing these things from a 360 standpoint for you, because maybe you talk to your OB about one thing, maybe you have a primary care provider, you probably don't. And so, like a lot of those things in our family history are being missed. And so I started this practice to really help patients make those proactive decisions where you can sit down with someone and say, this is what I want to maximize, this is what I'm concerned about, this is the information I want to know. And most importantly, this is the information that I may not want to know. Because genetic testing is not a one size fits all. It can be very impactful. And there's some information that can be very sensitive. You may not want to know if you are at risk for having Alzheimer's disease, whereas somebody else may want to know that. That's a conversation, that's a relationship that people don't want to know that. I feel like I would want to know everything. Yeah. And you may be the perfect person to say, like, that would be very helpful information for me. Like there may be things that I would want to know and I would want to do something about it. And someone else would be like, Nope, that's gonna give me anxiety. I don't want to know that. That isn't helpful for me.

SPEAKER_02 8:58

I mean, I can see that, but I come from the perspective that knowledge is power. Right. And I always feel like, and we're gonna talk about this later as well with epigenetics, but there's always something that we can do. When is the best time if you're thinking about having a family? You would, you and your partner are like, okay, we want to get pregnant. When is the best time to seek a genetic counselor?

SPEAKER_00 9:17

Ideally, I would say a year before you're ready to start a year. Yeah. I mean, genetic testing takes a few weeks to come back, just like the whole process. And based on those results, it may change the course of how you decide to get pregnant, right? Whether you decide to get pregnant naturally but in a formed, or whether you decide to go down the IVF route. I mean, a year is is generous, but it gives you enough time where you're not up against the clock, right? Patients, like in their mind, are like, I'd like to get pregnant in September so that I can be on maternity leave by this time and so that I'm at this wedding, you know, and then if something goes awry in that plan, you're like, wait, everything has changed now. So just at least ample time where you're not up against the clock. There's not such a hard deadline.

SPEAKER_02 10:06

I love how you framed genetic counseling as like a holistic approach. I never thought about it that way. It's really looking at you as a whole instead of just going to all the different specialists. I mean, this is there's nothing more concrete than your genes. Right. So it makes such sense. And, you know, I had my kids over 10 years ago.

SPEAKER_00 10:26

Right.

SPEAKER_02 10:27

And it was never on my radar to seek a genetic counselor. I just thought, okay, I'm gonna go to my OBGYN, whatever testing I need to do, they're gonna do, that'll suffice. And I'm now hearing you say that there might be things that an OB could miss. What are some of the things that standard OB appointment could potentially miss that you're discovering in your practice?

SPEAKER_00 10:46

So many things. And I think it really depends on what is one, your goal, what's important to you, what's in your family history, and what's in your personal history. So, for example, when you see your OB, it's oftentimes not an exhaustive discovery of what's in your family history. There's usually like a checklist. Like, do you have this, this, this, this, and this, right? But it can go really beyond that. A family history can be very, very nuanced. If I'm taking your family history and I see that there is heart disease with onset at age 40, that's very different. I'm gonna say, like, whoa, let's pause on getting pregnant. I'm gonna have you see a cardiologist before you start pregnancy because pregnancy could put a really heavy burden on the heart. And before you're clear to try, I wanna make sure that your heart looks good. That's not gonna come up on the checklist that you do prior to seeing an OB. And that might not even be something that's on the top of your head. You're like, oh my God, yeah, I guess you're right. Like my uncle did have a stent put in before age 50. If he had a stent before age 50, then that means it probably started younger than that, right? But that's a conversation. That's not like a conversation that in your quick OB appointments that you're gonna be able to have. Genetic counseling is a relationship. Like you have to trust me enough where we can sit down and really like delve into those details and have the time to do that.

SPEAKER_02 12:09

What are you finding most people's goals are? Because I would imagine it's either for pre-preg, you know, pregnancy planning, or if someone does have a strong family history, I would imagine that they'd be like, okay, tell me everything I need to know. But it sounds like that's not the norm. So I'm curious what people are are really coming to you for and what what are they curious about?

SPEAKER_00 12:27

The goals really depend on the person. They're very varied. I have some patients, if their history has, for example, autism in the family history, like that's their number one goal. They're like, I don't care about anything else. How do I minimize the chance of this recurring again? Right. Whereas somebody else's goal may be like, how can I maximize the chance of having a perfect baby? And then we really have to have that discussion that there's no test. There's nothing I can do as much as I wish there's something I could do. But let's talk about what testing is out there and available to you. And then a lot of it is really dispelling myths. I have nothing in my family history. I have two healthy kids. I'm not concerned about anything. And that's a really fragile conversation to have that it doesn't work that way. And that's a balance because some people might be like, oh my God, I talked to the genetic counselor and she's just like filling me with anxiety. And it's a it's a delicate dance of trying to say, well, the odds are in your favor of having a healthy pregnancy, but I don't want your assumptions to be based on false information. Like, no, it's not true that just because you have two healthy children, that this third child will definitely be healthy. And it's not true that because there's nothing in your family history that this child will be healthy. Because I see it day in and day out. And the hardest part for me is when someone has a child born with issues or born with a birth defect or born with a learning disability, and they go, but no one told me. No one told me I could have done testing for this, and no one told me that this was a possibility. Everybody told me my ultrasounds look good. Everybody told me I didn't need an amnio. My OB told me I was low risk. Well, what does low risk mean? And then that's where I come in. My job is to have that conversation with you. So you are informed. You are in the driver's seat. And that is applicable not just to pregnancy, but to cancer screening, Alzheimer's, what whatever it is that you're concerned about, my goal is that you're the informed person. You're not depending on your clinician or somebody else to tell you, don't worry about it. That's low risk. That's fine as long as you understand what low risk means and you're the person deciding what to do.

SPEAKER_02 14:38

I have so many questions. Okay, so someone comes to you and says, I just had a baby, there's some birth defects, there's genetic issues. Are there things that they could have done? I mean, you can't really avoid autism, right? Right. But are there things that you can do for other genetic issues?

SPEAKER_00 14:54

Yeah, and even for autism, there are some things. You know, autism is necess is like an umbrella term of a symptom that could be a constellation of some underlying etiology. But yes, sometimes there are things we could have done and there are things we could have screened for and tested for during the pregnancy or before the pregnancy. Not always, but sometimes there are- Can you give us an example? Yeah, for example, um, I have a friend who called me after their child was born and their child was born with birth defects and severe intellectual disability. And she was like, How was this missed? And it's a really difficult case. And I looked over her ultrasounds, and there were some really mild features on her ultrasound. Like the growth was lagging, the head size was a little bit small. And had she done an amniocentesis, it would have been identified on the amniocentesis. Now that's not every case. There are some cases where we cannot find the genetic etiology or the genetic testing is so nuanced that it's not standard of care. It wouldn't have been offered on a CVS or amnio. This case would have. But the point is that she should have had a conversation with a provider to say, what would an amniocentesis offer me? What are the risks and benefits? What does this lagging in growth mean? What could it be associated with? And that is my goal that you are in control.

SPEAKER_02 16:17

And the provider never mentioned, oh, this ultrasound looks slightly off.

SPEAKER_00 16:22

It was mentioned in that, like, oh, it's small, but it's fine. It's small, but it's fine. Oh. And she was never offered a CVS or an amniosynthesis. Or there are patients who do, like, you know, which I'm sure you probably did, like carrier screening to see if you carry any disorder, right? But patients don't understand that that testing becomes outdated between your first and second pregnancy. The panels change, the sensitivity changes, the specificity changes, the number of genes change. The testing I did with my boys 10, 12 years ago, I I would need to do a whole nother panel now. People aren't aware of that either. That, like, oh, I did that testing, it was normal, it's fine. I don't need to do an updated one. Well, you don't need to, but it's a conversation you should have so you understand what's being missed, the limitations of what you had, and the benefit of what further testing could provide you.

SPEAKER_02 17:10

So speaking of carrier screenings, if you and your partner are thinking about having a child, you get screened, you each healthy, not necessarily any strong family history of anything. You get screened for different carriers, you find out that you're both a carrier for a certain genetic condition. Does that raise a concern in the pregnancy?

SPEAKER_00 17:30

Yeah. So for example, you both find out you carry cystic fibrosis or tasax. And it's common. We're all carriers of something. Whether or not that disorder shows up on the carrier panel that we have is a different question. But we're all carriers of multiple different conditions. Um, and that's why sometimes doing a bigger carrier panel is more likely to show the disease you're a carrier for. Like if you do a 14 disease carrier screening panel, whereas now I'm ordering 800 to 2000 gene carrier panels, the bigger the panel, the more likely I am to pick up what you're a carrier for, right? But if I have a couple and they're both carriers for the same condition, then I know that there's a 25% chance or a one in four chance that they're gonna have a child affected with that disease. And if I know that before they're pregnant, now the clock stops. It's paused. There's no pressure, there's no emotions in it. Like we have all the options laid out for us. We can decide to get pregnant naturally, take our chances, and discuss doing invasive testing during a pregnancy, like a CBS or an amnio to see if the pregnancy is affected or not. Or we can decide to do IVF and we would do what's called PGTM, where we test the embryos to see if the embryos are affected or not, and then transfer an unaffected embryo. You could decide to use an egg donor, a sperm donor, so many different options there for you. But do you, if you do that carrier testing once you're pregnant, which is what the majority of people do, now you really have one or two options, and now you're up against the clock, which are what? You can either not test, take your chances, or test at the pregnancy once you're pregnant and then decide to continue if you want to continue, or not. But it's a different journey.

SPEAKER_02 19:17

That is so powerful. You take two individuals who think they're totally fine, right? And it just so happens that they're both carriers for the same genetic condition, and now you're dealing with a totally different situation. Correct. And the fact that that's preventable or that you have options, I mean, you have a couple that may not even be considering IVF, correct, not even on their radar, and now that's actually on the table because they've discovered this. Correct.

SPEAKER_00 19:42

And same with the cancer genes. So if you are of a high-risk ethnicity or if you have a family history of cancer and you do a cancer gene panel and you find out you carry a BRC one or BRC2 cancer gene, then that is a discussion for you. Like, is that something you want to pass down to your offspring? You know, you have a chance to not pass it off to your offspring. And therefore you could do IVF and only implant, let's say, a female that doesn't have that cancer predisposing gene. So that's another option for you as well. So it's not just even if you and your partners are curious, even if you carry a high-risk gene, there are things you can do about that as well.

SPEAKER_02 20:22

So you mentioned the BRCA gene, the BROCA gene. And I wanted to bring that up because it's really important for women to understand this gene. And I don't think a lot of women know what it is.

SPEAKER_01 20:30

Yeah.

SPEAKER_02 20:31

I actually recently had a mammogram and um they had me fill out a little questionnaire prior to the appointment. And they asked me if I had the Brachogene. And I had no idea because I've never been to a genetic counselor. And I know that having or not having this gene is a big part of your higher acusic score, which is your overall lifetime risk of developing breast cancer. Talk to us about what the Bronca gene is. It's BRCA, what the Bronca gene is, and does every woman need to test for this?

SPEAKER_00 20:59

Good question. So there are two genes. There's BRCA1 and BRCA2. And having a pathogenic or disease-causing variant or typo in that gene increases your risk of breast and ovarian cancer and theoretically other types of cancers in both men and women. Men who have that gene can also increase their risk of breast cancer, which men don't always think about. So men might think my mom died of breast cancer and my mom's sisters died of breast cancer, but I don't have breasts, so I don't need to think about it. No, you should still think about it. You still have a risk of breast cancer.

SPEAKER_02 21:33

I never knew that. I mean, I knew men can get breast cancer, but I never thought about them thinking about their mother or their aunt or their grandmother.

SPEAKER_00 21:41

Yeah.

SPEAKER_02 21:42

So if you know that your husband's family has a history, you should advise him to also get tested.

SPEAKER_00 21:47

That's a great point. And it's not just breast cancer. It can also increase your risk of prostate cancer and skin cancers. You know, there are certain groups where testing is to be considered, like if you're Oshikanazi and Jewish ancestry. If you have a strong family history of cancer, if you have ovarian cancer in your family, there's the NCCN guidelines. They really list it out who should consider testing and who shouldn't. Ultimately, it's a very personal decision.

SPEAKER_02 22:13

And is it true that people with Ashkenazi Jewish descent have a higher risk of the Bronchogene? Correct.

SPEAKER_00 22:18

Yeah. Okay. That's why they should definitely have that discussion with a genetic counselor or their primary care physician or their OB guy.

SPEAKER_02 22:26

I want to kind of go back to just the basics on what a visit with you looks like. So someone comes to your office, they have either a family history of cancer, cardiovascular disease, or maybe they just want to really be informed and get ahead of their health. What is a visit or is it multiple visits? What does that all that process look like?

SPEAKER_00 22:42

Yeah, great question. So the relationship really depends on the indication. So for example, if they have a family history of cancer, the first thing we establish is what type of information do they want? Sometimes I'll listen to what their goals are, we'll take a family history and I'll tell them that based on your family history, based on your goals, this is the type of testing that I think would be the most applicable and the most helpful for you. And sometimes that's not just cancer genetic testing, but for example, there's a test called Gallery by Grail. Have you heard of this test?

SPEAKER_02 23:18

Yeah, and actually, that's a gift I was gonna give myself this year. Yeah. Um, and I wanted to do that test. What do you think about it?

SPEAKER_00 23:25

I like it. I like it. I mean, it's important that patients understand that it does have a high sensitivity, it does have a high specificity, it has a low false positive rate, but it is not a substitution for your annual mammogram colonoscopy. It's that whatever your routine screening is that's recommended to you by your providers. Some people will think like, oh, my gallery testing was negative, so I don't need a mammogram. No, that's not what that means. This is supplemental. Correct. So we'll provide the care plan and recommendations plus testing will then be scheduled, ordered. I often send a phlebotomist to their home. We get the results back a few weeks later and we schedule another phone call to review those results, any implications or recommendations based on those results. And then I meet with their provider. So whether that's the dermatologist or referring them to an oncologist, I meet with their care team to discuss next steps and recommendations. So that would be like kind of a classic cancer model. Whereas a preconception model, sometimes I work with those patients from beginning of when they think they want to get pregnant until delivery. I work with them from the entire journey and I'm kind of their medical liaison throughout that process. So it just really depends on the indication.

SPEAKER_02 24:36

I have to say, I am really fascinated by all this because, like I said, this was never on my radar when I was getting pregnant. And I, you know, that chapter has closed for me. I'm not having any more kids. But I really hope that whoever's listening to this episode today and is thinking about starting a family or is thinking about having another child, this is such invaluable information. And I really do think that this is kind of a white space and that there's a real need for having this information. And pregnancy can be such a scary time. Like I just remember always wanting to eat the right foods and do the right things and just want to like take care of this baby that, you know, that's growing inside of you. But it's so nice to hear that there's so many things that we can do proactively and preemptively to really protect ourselves. And I hope the takeaway is that whoever's listening that they should meet with a genetic counselor and really learn as much as they can about their genetics.

SPEAKER_00 25:31

Thank you for saying that and for recognizing that. I think that, I mean, obviously that's how I feel, but there's just so much that one can do. And oftentimes I think in this day and age, people are like, oh, I found out which prenatal vitamin to take by going on TikTok and Instagram. I surveyed a few of my younger friends and cousins before I started my company. And I said, if you want to change your skincare before getting pregnant, like, where do you find that out? And they were like influencers. And I was like, you know, why not go to someone with like science who are getting paid to say those things? Right, correct. Like, how do you trust that resource? For example, I really believe in uh decreasing your exposure to endocrine disruptors prior to conception. And I I work on like a scientific basis. You tell me I'm using these skincare products and this shampoo, and I use these plastic bags. And there are healthy swaps that you can make that really do make a significant decrease in your exposure to these plastics and endocrine disruptors that not only can improve your fertility, but actually do improve the health of the pregnancy and the outcome. And people may not be aware of that, right?

SPEAKER_02 26:34

Yeah, that was actually one of my questions. We're in this era now that everyone is hyper aware of environmental toxins. Right. We know it's in the air, we know it's in our skincare, it's in our makeup, it's in our cleaning products. Right. But if a couple is trying to conceive and they're having a hard time, I don't think they're thinking, oh, well, I have these toxins or endocrine disruptors in my, you know, nightly eye cream. Can those things actually affect fertility?

SPEAKER_00 26:58

A lot of the research lately is pointing to the thought process in the rise in infertility could be associated with the heightened exposure to endocrine disruptors. So it's not that I would tell a couple that's struggling with infertility that instead of seeing a fertility doctor, let's, you know, substitute your cutting boards to stainless steel. But I would say, in addition to seeing a fertility doctor, what other substitutions can we make? Because we've seen that making those substitutions, along with improving sperm count, motility, morphology, has also shown to improve markers in anatomical growth of the fetus during development. So some people think like, well, I can't do everything, so I'm gonna do nothing. And part of my motto in genetic counseling is we want to make better choices. It doesn't need to be perfect.

SPEAKER_02 27:48

I have to say, I love that you incorporate that as part of your practice, that you actually consult with people on how to minimize their toxin exposures. What would you say are the top three toxin exposures that people should avoid?

SPEAKER_00 28:02

I think the swaps that I often make that I think have the highest effect and are the easiest swaps are scented products, um, especially as women. It's hard, but like, you know, that's an easy swap to make. Like swap your shampoo, your body wash, conditioner, et cetera, hand soap to be unscented. You remember the days of Bath and Body Works? I mean, I still buy the mall and you can smell it like miles away. Miles, miles away. There's a reason that that scent lingers. And the longer it lingers, like think that like the higher the chemical concentration of that product is, right? So scent unscented is kind of my quick go-to. And then the second thing is like your cookware. So easy substitutions are like nonstick.

SPEAKER_02 28:46

I actually just did that this weekend. Really? I just, it's so funny that you mentioned that. And I'm so happy because I just eliminated all my pots and pans, all my cookware. I've been on this health kick and I started with my skincare. Yeah. And actually, I went into my, you know, I have a 13-year-old and these girls are obsessed with Sephora and skincare. I literally went into her bathroom when she was at school the other day, and I took a big bag and I just threw everything in there, all the bath and body. I mean, not to not to bash any certain brand, but I went in there and I just threw all the scented products. I also use the Yucca app. I don't know if you're familiar and I and I'm not affiliated with Yucca in any way, but it's Y UKA. I basically scan everything on the Yucca app and it gives you like a percentage on its city. And now I'm on my cookware. So I've eliminated all the cookware to stainless steel. And I just believe in minimizing risk wherever we can. Wherever we can.

SPEAKER_00 29:42

And it can feel so overwhelming at the beginning because once you get into these apps, you're like, oh my God, everything has something. I know. It's almost like make better choices. It doesn't have to be perfect because then people will start and then they'll just give up. Or they'll start with a stainless steel pan and they'll be like, I don't know how to make eggs. I don't know how to do this. Like, I can't do this. I give up. Take time, learn it. You know, I love cast iron. I'm really a big cast iron fan. I love stainless steel. And then avoiding plastic bags and like Tupperware. I hate Tupperware, you know, making those changes to like glass Pyrex and those things. Like these are huge improvements that you can make. Your cutting boards using stainless steel, different types of wood, like birch wood is really helpful. Essentially, you want to use wood that's like not layered because the layers within that can have certain types of toxic glues. So a single ply of wood, there's certain wood brands that are helpful. Those are like kind of the big ticket items that my clients can make changes really quickly and that can have a big effect.

SPEAKER_02 30:43

And then we can, it seems a little daunting, I think, when you think about it as a whole. But if you kind of break it down and say, okay, this week I'm gonna spend, you know, a few hours on Sunday, I'm gonna go through my skincare and I'm gonna really simplify it to the bare minimum of what I need and eliminate all that extra crap that we don't need.

SPEAKER_00 31:00

Really? Yeah, look for fewer ingredients. That's always a sign that you're going in the right direction. Um, and there are also companies that I work with that I'll send a test to your home that will give you a baseline of your exposure to phthalates and BPAs, and then we'll make these substitutions, we'll retest them in a few months, and you'll see like real critical decreases in those numbers to see like, my gosh, it did work. You know, I made these substitutions and it did work. And it feels really good to know that it made a difference. I might want to do that actually.

SPEAKER_02 31:31

I'm happy to talk to you about it. Yeah. I want to talk about epigenetics and the role it plays and whether or not our genes are turned on or off. We're talking about all these environmental toxins and lifestyle changes and habits and behaviors. Can those things actually affect whether a gene is expressed or not?

SPEAKER_00 31:51

Yeah, absolutely. I like to think of the analogy of our genes like a huge wall of switchboards of lights. Um, all of those genes are lights that can be turned on or off. So it doesn't change the actual gene, but it changes whether that switch light is on or off, right? And absolutely, we know things in our environment and our exposures can change the expression of those genes. Nutrients, vitamins, toxins, pollution, all of these things play a major role. It expresses itself in behavioral disorders, in autism, in fertility, in so many different aspects of our culture.

SPEAKER_02 32:28

So if let's just say someone has a family history of depression or obesity or alcoholism, you're saying that they can actually make a difference in their lifestyle changes, behavior, nutrition, and actually change whether or not those particular genes are expressed.

SPEAKER_00 32:45

It's a tricky. And I know it's a big statement. Yeah. It's a tricky question. I mean, obviously, if you have a strong family history of depression, there is going to be a strong genetic load there. Because we know that there are genetic variants that are associated with mental illness. You might be able to change the expression of some of those genes, but there are some core genes that are going to be expressed. Having some core genes expressed doesn't mean that you can't influence the other genes because those things are multifactorial diseases. For example, depression is not one gene that causes depression. It's going to be like thousands to millions of markers that cause depression. You're not going to be able to take a million genes and turn them on or off. But could you take some of those genes and turn them on or off? Could you take the genes that help minimize the effects of depression, turn those genes on, and take the genes that that make depression worse and turn them off? Yeah. So you change the overall lighting. Instead of the lighting being much darker, you've made it a little bit lighter. But I don't think you can turn the room from being off to on. Yeah.

SPEAKER_02 33:45

Yeah, yeah, absolutely. And I really like that metaphor of the switchboard. But they're all there. The lights are there, but it's whether they're turned on on or off. But I do think that's powerful because oftentimes people will have a family history of something and they kind of throw their hands up, they surrender and say, Well, this is me. These are my genes. There's nothing I can do. But the truth is there are things that we can do. There are ways through behavior, lifestyle, nutrition, decreasing environmental toxins. There are things that we can do. And it's really important to acknowledge that because we don't have to just accept things the way they are. We can actually somewhat control them.

SPEAKER_00 34:21

Correct. DNA does not have to be determinative for many different things. It's not destiny for many of these multifactorial disorders. So, like with that switchboard, if we think of depression as a dark room, like with nutrition, diet, exercise, and all of these other changes, you can lighten that room. You can make it much, much brighter. It doesn't have to be your absolute destiny, which is why I think genetic testing can be so proactive. People may say, well, I found out with this genetic test that I have a very high risk of type 2 diabetes. That does not mean you will develop type 2 diabetes. And now that you know that, there's so many proactive changes that you can make to minimize the chance of that expression.

SPEAKER_02 34:59

It's interesting because it sounds like there's a huge psychological component to your practice. And you have a tough job. You have a really tough job uncovering these things for people. But like I said, I believe that knowledge is power. And I think if you go in with the mindset that I want to know about myself as much as I can, and I want to be able to control the things that I can control. We can't control everything in life, but I always say you can control what you can control. And if there are things and changes that you can make, then why not learn about them sooner than later? Absolutely. You know, my major, I was psychobio, so I took a lot of psych classes and I took genetics and this concept of nature versus nurture. I have two girls raised in the same household, but they couldn't be more different. They have different temperaments as babies. They're they're totally different. And I have two sisters, we're all so different. How much of who we are do you think is our genetics versus our surroundings and our environment? It's such a good question.

SPEAKER_00 35:53

I mean, who knows? But I would say the same thing as you. Like, I have two boys who are so different and I raised them the same. I mean, obviously, there's like the theories of birth order and how we are different parents to our children based on birth order. So I understand that concept. But now looking back at my boys, like they were who they were since the minute that they were born. So I have to believe that that personality was strongly genetic from the beginning. And my response to that as a mother is I was responding to their personality that they were showing to me from the very beginning. So I really do believe that a lot of personality is hereditary and not hereditary necessarily pace passed down from generation, but an expression of those genes from the beginning. And then a lot of that is like is your expression of it and nurtured from what you're given through parents and surrounding and environment. And then there's an expression of that. But I think there's a strong foundation of that's how you were born. I see my boys, who they are now, I would have predicted at three months of age. Totally.

SPEAKER_02 36:56

You know, I remember my daughter, she's now 13, but I remember she was like, I don't know, I want to say like a year and a half, and she wouldn't let me dress her. He had to choose her outfits. And I wasn't used to that because my older daughter could care less about her outfits. And sure enough, here they are, 13 and 15. They're the same way.

SPEAKER_00 37:13

I mean, it's exactly a little example, but that's just who they are. It's so my 12-year-old would still let me dress him if I wanted to. Whereas my nine-year-old at 18 months before preschool, he would have to lay out his clothes to pick them out. And he's still the same way. And that was not a nurture thing. That was just how he was born. I think some personality traits are just very inherent, and then some are nurture.

SPEAKER_02 37:41

And what about someone who's adopted? I was thinking about someone who has no idea about their family history. Are you seeing patients like that? I would imagine that your counseling would is so integral in their process.

SPEAKER_00 37:53

Good question. So for adopted patients, the counseling is very interesting, especially when we have no family history to work with at all. With those patients, we really lean into doing very large carrier screening panels because we try to capture as much genetic testing, carrier screening as we can. Larger than 800? Sometimes larger than 800. Yeah, yeah. Sometimes it depends on what they what they want. Also depends on their ancestry, on their reported health. Um, so it's like a whole picture. And then we curate what we think would be the best thing based on their goals and needs.

SPEAKER_02 38:28

And what are your thoughts on those at-home genetic testing kits, the popular ones that everyone?

SPEAKER_00 38:32

Yeah, like direct consumer testing. Yeah. It's tricky because sometimes they give you a lot of information, and sprinkled in that information can be some real serious information. For example, patients would give me their 23andMe results, which would have like a lot of information that I'm not going to do anything with as a clinician, but sprinkled in that would be like, and I'm a carrier of K Sachs disease. And I'd be like, whoa. But they were not a CLIA-approved laboratory at that time. So then I would have to CLIA approved? Yeah, which would be like a laboratory that would be certified in testing for genetic diseases, like a real laboratory. So then I would have to reorder their testing at a real diagnostic laboratory to make sure they were indeed a TASACs carrier. So I couldn't throw away the entire test. There would be things in there that are important. So I think that if you want to do direct-to-consumer testing for fun, great. If you have a real health concern or something serious like cancer genetic testing, then you need to speak to someone and have that discussion with a clinician.

SPEAKER_02 39:35

And it sounds like even if they do do that test, ultimately, if you really want to understand the test, you're gonna have to have a genetic counselor look over it. So you might as well just go to someone in the first place.

SPEAKER_00 39:43

Yeah. I mean, I have people who are like, oh, I took that data and then I put it into Chat GPT and now I understand it. But still it's nuanced, right? I still think it's beneficial to talk to somebody. Chat GPT has become uh everyone's doctor now. Everyone's doctor. Yeah.

SPEAKER_02 39:58

Yeah. Okay. So my last question is can you think of an example of a patient? Is there someone that stands out to you that came into your practice, really had nothing on their radar, maybe was there for pregnancy planning or not, but discovered something really significant and you were able to then help them and guide them through that process? That's a great question.

SPEAKER_00 40:18

For example, I had a couple who was newly married. They had a family history of what they thought was muscular dystrophy. They came to me and showed me their muscular dystrophy results that they were screened for this. And I looked over the results and I was like, Do you have records on that person with muscular dystrophy? Someone in their family. Someone in their family, yeah. It was like an uncle who had died of muscular dystrophy. And they were like, No, but we can get them, but we tested at this other place and we're both negative. So we're here for carrier screening, actually. And I was like, but can you get me the records of this person with muscular dystrophy? And they're like, well, we can, but it's kind of an awkward conversation. It's always like awkward to ask. It is awkward, you know? And I was like, absolutely. If you can get them, great. If you can't, I understand. But without seeing that person's records, it's hard for me to give you the green light and say, you guys screen negative. There's no concern about this. So I ordered their carrier screen. Their carrier screening came back fine. They came to me a few weeks later. They were able to get the records. And indeed, that person had a rare disorder that was not what they were tested for. So they had planned to get pregnant. Wait, sorry. So it was not muscular dystrophy? It was a different type. There's so many types of muscular dystrophy. When I saw them again, they were pregnant. And they're like, by the way, we got my uncle's results. And the uncle had what was called limb girdle muscular dystrophy, completely different gene. They were not tested for that gene. So then I tested the mom for it. It was a mom's uncle, and she had the same gene, and so did her husband.

SPEAKER_02 41:59

Oh my God.

SPEAKER_00 42:01

So yeah, then we did a CVS on them. And thankfully the baby was not affected. Sorry. What is a CVS? Good question. CVS is a chorionic villi sampling. That's a procedure we do early in the pregnancy, between 11 to 14 weeks. You insert a needle either through the abdominal wall or through the cervix. You take a small piece of tissue from the placenta and you can test it. And thankfully the baby was not affected in that situation. But the moral of that story is that they kind of could have gone through that pregnancy and then subsequent pregnancies, thinking that we were tested and were not affected. And then after that pregnancy, they decided to do IVF for the future pregnancies to ensure that they would not have a child with limb girdle muscular dystrophy.

SPEAKER_02 42:45

So I have two questions. So you're saying that it just so happened that the husband also had that gene? Yeah. Yeah, it's just random. And if they were unable to get this uncle's documents, because that is a very awkward conversation. Yeah. Let's assume that you don't have access to your family's documents. Could they have just screened or just done a more comprehensive screening panel?

SPEAKER_00 43:04

Possibly. We could have done like a muscular dystrophy multi-gene panel. It still could have theoretically been missed. This was like 12 years ago. Now I could have done whole genome. Before, no, they would have been very limited with what they could have done.

SPEAKER_02 43:18

So you could have now advised whole genome, even though they were adamant about not needing it, and that could have been discovered.

SPEAKER_00 43:24

And they were just so certain because they're like, no, my parents told us that this is what he had, the familial beliefs that go in, and you know, I'm normal and my Obi ordered this. All of these things go to show you like sometimes it's just worth having someone sit down, look over everything, take that family history and really have that conversation with you.

SPEAKER_02 43:43

Yeah. And my takeaway also from this entire conversation that we're having today is the importance of open communication with your family members. Yeah, I know. And I probably should have a good sit down with my own parents and really understand their history and ask about their. Siblings. And yeah, I can imagine it being very awkward to have these conversations with family that maybe you're no longer close with. But this is important and it can be detrimental.

SPEAKER_00 44:10

Yeah, it's hard. There's so much secrecy in the family. People don't talk about things. I'm sure there's a lot of shame. Out of shame, especially depending on your culture and the society. Oftentimes, if there is something in the family history, people are not doing follow-up testing for that. They just kind of want to not think about it, which does a disservice to other people in the family. Sometimes I'll tell people, even if you don't want to do genetic testing, think about banking your DNA, because in the future your children may need that DNA to understand what they may be at risk for. Is that a thing? You can bank your DNA. Absolutely. So I will tell patients if they have a parent that is going through something devastating and that parent doesn't want to do any genetic testing, I'll say, would they consider banking their DNA? So in the future, if you want to do genetic testing, it may be helpful as a comparison to see what was going on there. So it's an awkward conversation, but something to consider. Yeah.

SPEAKER_02 45:05

So interesting. Okay, so I end every episode with three questions that I ask every guest. And it can be work-related or personal, but it's really meant to just encourage a growth mindset and inspire others with a new perspective on things. So my first question is what habit do you think everyone should try for 30 days?

SPEAKER_00 45:26

As corny as this is, is meditation. I think it's really life-changing. Yeah. It's really hard to do it. I do it in the morning. I listen to an app. I started with five minutes. What's the app? Uh Waking Up. It's called Waking Up. Okay. And they have all different kinds, but I really like it. And it sounds corny, but I think No, that's it's not corny at all.

SPEAKER_02 45:48

Actually, that's something that I've been trying to adopt. And I did meditate today.

SPEAKER_00 45:52

Oh god. I'm happy to say that. You know what made it easier? And this is going to be like so cheesy, but I have a red light mask and I never get to use it because I was all like, oh, I'm going to use it in the evenings. And I one kid needs this and another kid needs that. And my red light mask turns off at 10 minutes. And I was like, what if I put on the red light mask and then I meditate at the same time?

SPEAKER_02 46:11

That's brilliant. Talk about multitasking. I mean, we're such as women, we're such multitaskers.

SPEAKER_00 46:17

I'm like, okay, we do both things at the same time. And then my husband is like, what is on your face?

SPEAKER_01 46:21

Like I just thought of the funniest thing. Yesterday I was lying in bed. I had the red light mask on. I was listening to a podcast about like some spiritual stuff. My 13-year-old walks in the room and she gasps and she's like, What the hell's wrong with you?

SPEAKER_00 46:42

I'm so crazy. The dog started barking at me when he first saw the red light mask. He was growling at me. It was like a whole thing. And no one liked the red light mask. So I have to do it in the privacy where no one is around.

SPEAKER_02 46:54

But we do it in the name of vanity, right? Okay. What is one belief you let go of that completely changed your life?

SPEAKER_00 47:01

That perfection is the enemy of progress. I am a Virgo. I am a perfectionist. I think that there were so many things that I would give up on if it couldn't be perfect, if I couldn't do it all the way. And just like small amounts of progress every day is so much better than just being like, if I can't take this all the way, then I'm just not going to do it at all. Just because you can't do it absolutely perfectly doesn't mean you just shouldn't do it at all, because there can be some benefit net effect of it.

SPEAKER_01 47:30

Yeah.

SPEAKER_00 47:31

Um, and I think that's been a belief system that's been very helpful for me. Even just as moms putting an effort in how we look in the mornings. Just because I didn't blow dry my hair doesn't mean I can't put on a little bit of makeup and put on a pair of jeans. It doesn't mean that I should look like Adam Sandler leaving the door, right? You know?

SPEAKER_01 47:49

Yeah.

SPEAKER_00 47:49

It's some because I it would become like all or nothing. I'm either gonna look like Adam Sandler or I'm gonna look like the queen.

SPEAKER_02 47:56

So funny. I actually saw him two days ago. I was working out next to him and he comes in. He's so nice, actually. It was like He's so nice. I love Adam Sandler. And he was like, he had his neon orange shoes, like neon like purple pants, like red hat. I mean, he's just like an eccentric outfit. But I love that. And actually, that resonates with me a lot too, because I'm also a perfectionist. Even starting this podcast, it's just about just doing it, and doing it is better than feeling like you need to have it perfect. And then lastly, what is one thing you want to do that you haven't done yet? I like to ask my guests that because it's actually partly for you. I have obviously a lot of accomplished people come on my podcast. But I like to always strive for more and like what's the next thing? And and you've accomplished so much and you've opened up this amazing practice in Los Angeles. But is there something else left for you?

SPEAKER_00 48:48

Last year, I was having dinner with my sister-in-law for my birthday. And on the back of a receipt, she handed me the receipt and she's like, Write 10 things that you want to accomplish this year. And then for my next birthday, she sent me a picture of the receipt and she's like, How many of these things did you accomplish? And I accomplished so many of I had forgotten about that receipt. It's amazing. I love that. It's such a great thing. And I'm thinking about the receipt and I'm thinking about the things I didn't accomplish yet. And the biggest thing that I did accomplish was opening my practice, which I'm so thankful for and happy for. But I guess what I haven't accomplished yet is I'd like to expand it to New York. We've already started a little bit with working with the IVF practices in New York, but that would be my biggest goal is expansion in New York.

SPEAKER_02 49:31

Yeah. Amazing.

SPEAKER_00 49:32

And tell us where people can find you. You can find us on Instagram at geneviealth.com or our website at geneviealth.com.

SPEAKER_02 49:41

Amazing. This was such an insightful conversation. And I'm certain that it's going to help a lot of people and guide them in just really understanding themselves better and being more proactive about their health. Thank you. Thank you so much for having me.

SPEAKER_00 49:56

This was so much fun.

SPEAKER_02 49:57

Thank you for being here. Thank you so much for listening to the Happy Go Lifestyle podcast. If you enjoyed this episode, please share it with your friends, and I would be so grateful if you could rate and review it on your podcast app. You can watch the full video version of this episode on Spotify or YouTube. You can also follow me on Instagram at Sarah Faruz for more wellness, mindset, and lifestyle inspiration. And I'll see you next time.