By Jalen Robinson
Personalized medicine is increasingly becoming recognized as a necessary evolution of the standard of care. One key aspect of this shift is a dual understanding: that medical care based on race, ethnicity, or outward appearance is inaccurate and can lead to harm, and at the same time knowledge of genetic, cultural, and environmental factors together provide a more nuanced and complete picture of a person’s health risks and potential intervention strategies.
In this article, we explore a few health conditions—uterine fibroids, metabolic dysfunction-associated steatotic liver disease (MASLD), gestational diabetes, and atrial fibrillation—that have meaningful connections with ancestry, environment, or cultural factors. We also examine diseases such as G6PD deficiency and Tay-Sachs disease—conditions that are primarily genetic and therefore closely linked to genetic ancestry. By understanding different ways in which their unique background might influence their health, individuals and their healthcare providers can make more informed health decisions for themselves and their families.
Uterine Fibroids: An African Connection
Uterine fibroids are non-cancerous growths that develop in the wall of the uterus. These growths can vary in size, ranging from small, undetectable nodules to large masses that distort the uterus. Symptoms of fibroids include heavy menstrual bleeding, pelvic pain, bloating, and complications with fertility and pregnancy. Risk factors include race and ethnicity, age, family history, hormonal factors, obesity, diet, environmental toxins, and stress.
While many women may experience fibroids at some point in their lives, this condition affects women with African ancestry more commonly and severely. African American women have a three-times higher risk of developing fibroids than women from other groups. Black women are also more likely to be diagnosed at younger ages, experience more severe symptoms such as infertility and pregnancy loss, and face worse outcomes, including higher rates of hospitalization. Although there are likely many contributing factors, vitamin D deficiency may play a role: this nutrient helps regulate how cells grow and divide, but people with darker skin produce less vitamin D from sunlight.
Maintaining a healthy weight, limiting processed foods and red meat, and managing stress are beneficial in reducing risk for uterine fibroids, but there are also specific proactive steps women can take. These include reducing exposure to endocrine-disrupting chemicals like those found in personal care products and hair relaxers, and ensuring adequate levels of vitamin D in their diet. As with any health condition, regular medical check-ups are important for early detection and management of fibroids and for maintaining overall reproductive health.
Liver Disease: An Indigenous American Connection
Metabolic dysfunction-associated steatotic liver disease (MASLD, also known as non-alcoholic fatty liver disease or NAFLD) is the most common liver disease worldwide, marked by excess fat in the liver unrelated to alcohol use. While often silent, it can progress to metabolic dysfunction-associated steatohepatitis (MASH), which can lead to cirrhosis and liver cancer. MASLD is strongly linked to metabolic syndrome—a group of conditions including a large waist circumference, high blood sugar levels, high blood pressure, and abnormal cholesterol levels.
Indigenous peoples of the Americas are disproportionately affected by MASLD and MASH. This elevated risk is influenced by both genetic and environmental factors. A genetic variant in the PNPLA3 gene, known as I148M, has been linked to a higher risk of developing MASLD, and is particularly common in Indigenous populations and regions with high proportions of Indigenous American ancestry. Indigenous communities also report higher rates of metabolic syndrome compared to other groups.
Historically, many Indigenous societies had diets and lifestyles that may have protected against metabolic diseases. These societies typically consumed diets high in fiber, with a wide variety of seasonal plant-based foods, and maintained regular physical activity through subsistence living. However, the rapid shift away from these traditional patterns, especially in North America—driven by violent colonization, forced displacement, and systemic marginalization—has created a potential mismatch between genetic predispositions and modern environments.
Addressing the risk of MASLD today may benefit from restoring access to healthy foods, revitalizing traditional food systems, and encouraging physical activity in ways that respect Indigenous culture. Additionally, ensuring culturally respectful, community-led healthcare is essential for addressing MASLD risk and improving long-term outcomes for Indigenous populations.
Gestational Diabetes: An Asian Connection
Gestational diabetes mellitus (GDM) is a form of diabetes that develops during pregnancy when the body cannot produce or effectively use enough insulin. This leads to elevated blood glucose levels, which increases the chances of preeclampsia (dangerously high blood pressure), preterm birth, and complications during labor. People who experience GDM are also at higher risk of developing type 2 diabetes later in life, while their children are more likely to develop obesity and metabolic disorders.
Though GDM affects pregnancies globally, rates of GDM are highest in individuals of East and South Asian descent, despite generally lower BMI. This heightened risk may be linked to both genetic predisposition to type 2 diabetes as well as greater insulin resistance and a tendency to store fat in the abdomen (also known as visceral fat, associated with cardiometabolic disease) even at lower BMIs. Dietary patterns may compound these risks, and limited access to healthcare and low awareness of GDM may further contribute to poorer outcomes in some communities.
Prioritizing a diet high in whole grains and vegetables, avoiding refined carbohydrates and sugar, and incorporating regular physical activity—even modest forms like daily walking or yoga—can significantly improve the body’s ability to control blood sugar. Awareness and early screening are also important, especially given the higher rates of GDM even among those with lower BMIs.
Atrial Fibrillation: A European Connection
Atrial fibrillation (AFib) is the most common heart rhythm disorder, marked by an irregular and often rapid heartbeat that can reduce blood flow and increase the risk of stroke, heart failure, and other complications. Symptoms may include palpitations, fatigue, shortness of breath, or dizziness, though some people remain asymptomatic. AFib risk rises with age, and conditions such as high blood pressure, obesity, diabetes, and excessive alcohol use are major contributors.
In multiple studies, AFib shows the highest prevalence in White populations, Scandinavian countries, and countries with high proportions of European ancestry. The higher prevalence does not appear to be explained by differences in lifestyle risk factors or by differences in diagnosis rates. Although the genetic variants identified to date are not especially frequent in European populations compared to other groups, one intriguing study has shown an association between AFib risk and degree of European genetic ancestry. Additionally, individuals with Northern European ancestry tend to be taller on average, and increased height and body size are associated with a greater risk of AFib, perhaps due to greater load on the heart.
To help mitigate the risk of atrial fibrillation, there are several strategies people can adopt. Maintaining a healthy weight, engaging in moderate physical activity, managing other health conditions, limiting alcohol intake, and avoiding smoking are all important. Since rates of AFib remain high even in Scandinavian countries known for healthy lifestyles, individuals with known genetic risk factors or a family history of AFib should consider regular heart rhythm monitoring and consult with a healthcare provider for personalized screening.
Genetic Ancestry and Health
Some health conditions are primarily genetic, meaning they are caused by inherited changes in specific genes rather than lifestyle or environmental factors. Because these variations are passed down through families, the risk of developing or carrying certain genetic disorders can vary significantly depending on one’s ancestry. These inherited conditions often reflect patterns shaped over thousands of years by human migration, geographic isolation, and natural selection—making genetic ancestry a powerful lens through which to understand personal health risks.
Take glucose-6-phosphate dehydrogenase (G6PD) deficiency, for example. This inherited condition affects how red blood cells function, potentially leading to fatigue, jaundice, or anemia—especially when triggered by certain foods, medications, or infections. G6PD deficiency is particularly common in people of African, Middle Eastern, Mediterranean, and Southeast Asian descent, with prevalence rates as high as 25% in some regions. Just like sickle cell trait, the high frequency of G6PD deficiency is thought to stem from a genetic advantage: people who carry a G6PD variant are more resistant to certain forms of malaria, an infectious disease that historically plagued these areas. Similarly, Tay-Sachs disease is a rare but serious neurodegenerative disorder that is more prevalent in Ashkenazi Jewish, French Canadian, and Cajun populations. This is largely due to what geneticists call a founder effect, where a small ancestral group passes on a limited set of genes—some of which may carry disease-causing variants.
In communities where certain genetic risks are more common, genetic screening and counseling have already made a major impact. However, understanding your genetic ancestry—rather than making assumptions based on appearance, social identity, or cultural heritage—is what really matters for identifying these inherited health risks. As our knowledge and the cost of mapping genetic ancestry and health predispositions continues to improve, so does our potential to address inherited health risks in more personalized and proactive ways.
Personalizing Health
Our DNA plays a key role in health, offering insights into inherited traits and potential risks. Together with cultural background and lived experiences, these factors all shape our health in ways unique to each of us. Understanding both your genetic ancestry and cultural context can support proactive care through early screenings, personalized lifestyle choices, and more informed conversations with healthcare providers. As populations grow more diverse, moving beyond outdated assumptions based on race and focusing on the full picture—biology, ancestry, and culture—can help improve care and reduce health disparities.
