23andMe has been offering genetic
testing since 2006 but have re branded
their services to focus on ancestry services with the health information as a
combined package.
The idea of knowing you have genetic markers for a specific
condition can be very unsettling, since just having a gene doesn’t mean you’ll
go on to develop it. So is Geisinger and 23andMe helping or making people
unnecessarily alarmed? Geisinger has stated they will only provide information
for genetic markers that patients can do something about.
Ancestry alone can offer some genetic clues. For example Asheknai
Jews are genetically at higher risk for Tay-Sachs Disease; Asians and Hispanics
are at greater risk for thalassemia; Caucasians have a higher incidence of
cystic fibrosis; and African Americans have a higher risk of sickle cell anemia.
Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly
affects women during their childbearing years, and is more common in
African-American, Native American and Hispanic patients.
In the United States, race and ancestry are often confused,
as skin color is used in place of a genetic understanding of what a person’s
actual genetic ancestry might be. For example, many identify as “black,” but
their genetic profile may have more European ancestry than African. Interestingly,
among Americans of African descent, even though 95% will be of West African
origin, within that population there is far greater genetic variation than
among Europeans. Untangling Race and Health Risks Through Genetics
Ethnicity is another important variable. While ancestry
relates to your actual genetic make up, ethnicity refers to culture, customs and often lifestyle choices.
Diet can vary drastically among cultures, which can have a marked impact on
health. For example, many Hindus and Buddhists are vegetarians while fasting is
part of various religious groups including Muslims who do not eat food during
the day light hours of Ramadan. How one dresses can even have an impact. In
Northern hemisphere climates, cultures that require full coverage dress can
result in vitamin D deficiency.
For centuries, health research has been heavily male
focused. Even in health research male animals can outnumber the females nearly
sixfold. Needless to say, this is a problem as men and women can present
differently with the same diagnosis, and respond differently to medications and
treatments.
Not only does weight differ between men and women, but other
factors such as body fat and hormones makes a difference. Certain drugs, such
as antidepressants, are “fat soluble,” meaning that they dissolve in fat before
going to the brain. Given women’s naturally higher level of body fat then men,
the drug is distributed differently in women then men.
Heart medications affect women differently than men. Women
tend to have a greater potential for bleeding so the recommendation for low
dose aspirin to reduce the risk of a heart attack is not necessarily
recommended. The blood thinner warfarin, used to prevent strokes and blood
clots is one example where smaller doses are recommended for women than men. In
2013, the FDA issued new dosage requirements based on sex, for Ambien and
Sublinox since women metabolize the drug much slower then men.
Interestingly gender is linked to sex, but not defined by it.
Yet, it affects health.
For example, a 2016 study from a group of Canadian
researchers suggested that successful recovery from acute coronary syndrome (a
term describing a blockage of blood flow to the heart, as happens during a
heart attack) was dependent not on whether the patient was male or female, but
rather, on each person’s gender characteristics: Patients with more
traditionally feminine traits, such as responsibility for caregiving, were more
likely than those with more traditionally masculine traits, such as being the
primary income earner for their households, to suffer another coronary episode
or die within the following year, regardless of their biological sex. Of Mice,Men and Women
Understanding that ancestry, ethnicity, gender and sex can
all make a difference in your medical condition is important. Consider the
Following:
• Genes can be turned on and off by our environment (e.g.
food, supplements, geography, exercise). Just because you carry a gene doesn’t
mean you’ll develop a condition.
• Develop your family health history, which includes ancestry
and ethnicity. It may not be apparent to
your provider what your ancestry or ethnicity might be so be sure to let them
know.
• If you’re part of a group with a higher genetic risk, you
often can reduce that risk by making better lifestyle choices.
• Pharmacogenetics is a new field of understanding how
genetics impacts your reaction to medication. Based on your DNA, it’s possible
to know what your body can tolerate. If you are having problems with
medication, it might be worth having this test. Talked to your provider about
whether this testing would be beneficial for you.
• When reading health studies, understand the make up
of the study population. It may not be as relevant as you first think.
• Precision Medicine is an emerging approach for disease
treatment and prevention that takes into account individual variability in
genes, environment, and lifestyle for each person." This approach will
allow doctors and researchers to predict more accurately which treatment and
prevention strategies for a particular disease will work in which groups of
people.
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