This month’s rant is brought to you by a sales package I received at the store a few weeks back. I was “triggered.”
Nothing irritates me more than junk mail, especially ones with fancy, expensive packaging, lots of paper, and plastic devices I’ll never use. Well, except maybe gimmicky products making false claims that come as junk mail with all that gross packaging.
This package, in particular, caused an audible “WTF!” from me followed by a mini-rant to the staff. myDNA Vitamins promises to unlock the secrets of your DNA by testing “15 genetic markers that will unlock your unique needs for Vitamins A, B6, B9, B12, C, D, as well as Calcium, Iron, and Omega-3.”
Wow. I can spit in this vial and learn all of that? To think about how much precious data I’ve loogied away…
What’s worse is the marketing copy was targeted towards practitioners (me), that highlights how we can leverage these tests not to do better by our patients, but to sell more supplements.
Just what we all need–more supplements!
Let’s get real ranty about customized vitamin regimens based on bogus testing methods.
Getting Excited About DNA
There’s been a growing trend of starting a company to leverage breakthroughs in DNA testing technology to sell people unnecessary and unhelpful information, all while keeping records of our most personal, identifiable information on the equivalent of a 26-year-old’s Chromebook computer.
The proliferation of these businesses from Theranos to 23andme and every little guy in between, shows it’s trendier to own a startup in the space than it is to be a consumer and actually use the DNA services.
Yes, I feel that strongly about this.
DNA testing conceptually has an appeal, though, doesn’t it? We’ve heard about breakthroughs in DNA tech since the 80s. Every time a new advancement came, each of the media outlets ran their story about how DNA testing will provide us with the information we need to “unlock” our secrets, personalize our treatments, and optimize our lives. Since there were only like 10 sources of news back then, the message was amplified greatly.
So now, when a company says, “All that DNA stuff you’ve heard about is real and you don’t even need to turn off your Stranger Things binge session to actually unlock the secrets of your history AND future,” we collectively go bananas like a room full of Hollaback Girls.
These DNA-based supplement companies are promising some very interesting things. “Hyper-personalization through wellness advice based on your unique DNA results” brags the very savvy marketer with a thesaurus.
Why? “Everybody is different, so how we manage our health and wellness should be too.”
That logic flows, and we buy-in.
One brand, myExome, gives you some weird health-related readouts based on your DNA. They’ll rank your caffeine sensitivity with a percentage score. They’ll even rate you on your risk of being lactose intolerant. Funny, I thought the test for lactose intolerance was to drink a glass of milk and check your underwear every 15 minutes…
Everybody’s getting in the game, even big retailers. My LinkedIn feed had an article with pharmacists oohing and ahhing over GNC’s launch of a custom supplement plan based on your individual needs. To kick it up a notch, you can do the GNC4U DNA test to look at “fat metabolism, to help personalize vitamins, supplements, and diet and exercise schedules.”
This is my reaction:
I’m so excited for GNC to lead here!!! You know, the same GNC that the NY Attorney General found to have no active ingredients in most of their herbal products not too long ago.
My excessive sarcasm levied at these brands speaks to the subtext of this discussion. Whether or not DNA testing or “hyper-personalization” of supplement recommendations matters, these companies are still selling you garbage supplements.
What a Vitamin DNA Test Will Show You
Before we beat up on the synthetic, isolated chemicals these brands repackage as “premium” and “custom” options, let’s beat up on DNA testing in general.
Your genes don’t tell you if you are high or low in vitamins. Blood, saliva, urine, and more can approximate what your levels of nutrients, hormones, and more are. With many, many caveats, of course.
Genetic testing, in reality, can identify if you have mutations or variants on key genes that code for enzymes that potentially process vitamins. It’s way more complicated than that, but the point is they’re only going to tell you a relative function of some genetic marker or enzyme.
The rest of it is just a bedtime story. They extrapolate out these findings and craft them in a consumer-friendly narrative that, at its core, gives us nearly nothing useful.
We’re made to be successful humans and survive even with an imperfect system. We’re going to be OK if our enzymes aren’t performing at 100%. Diseases rarely happen in people with common genetic variants. Humans that couldn’t survive because of these problems died a long time ago and the ability to thrive despite imperfection was selected for eons ago. Darwin and all that.
When they tell you your caffeine sensitivity is 32%, they mean that your enzyme that processes caffeine has a higher-than-normal rate of breakdown of caffeine in your blood. That’s it. The rest is creative writing and extrapolation.
When they tell you that you’re at risk for folate-related deficiencies, they mean that an enzyme for handling folate has a slightly reduced function. This is that MTHFR’ing MTHFR enzyme that quacks are blaming all modern problems on in an attempt to sell you multiple, high-cost B Vitamins.
The truth, as anyone with… what’s that thing called again?… Oh yeah, integrity! Anyone in the medical space with integrity that is educated on the subject will tell you the majority of DNA testing abilities consumers get involved in are nothing more than entertainment.
We have about 24,000 genes. We know the function of about 12,000. We can test for about 5,000. That context, I hope, will help people understand what these DNA testing companies are actually capable of. Something, but not much.
Geneticists often call at-home DNA testing “recreational genetics.”
An aside: I’ve met one such geneticist! On the Big Mouth Pharmacist podcast, I’ve been lucky enough to get some great guests. In a few weeks, we’ll have on Dr. Kimberly Chapman, Geneticist and Metabolist at Children’s National Rare Disease Institute talking about all of what I’m ranting about today. Subscribe to my podcast today and keep an eye out for that episode.
It’s important we take this information and use it correctly; the experts that dedicate their lives to understanding genetics, metabolism, and human disease and spend all day around equipment much more fancy than the $100 at-home-mail-back kits take a very sarcastic view of at-home DNA testing.
I’m laying it on thick. DNA testing, especially for supplements, is a fruitless endeavor.
As with all of my rants, in the end I’m never really ranting about the thing you think I am. DNA-based supplementation is rant-worthy, but the real discussion is around our compulsion for customization.
Our Obsession with Customization
I don’t know if this is uniquely American and our highly consumerist society that stresses individualism, but we are obsessed over being unique.
From bumper stickers on our cars signaling our virtues, to our tramp-stamp tattoos, to the patches we put on our cute little leather motorcycle vests, we’re constantly striving to flag to the world that we’re our own, special creature.
It’s not inherently bad. People just love customized stuff.
Though tattoo design is vital, our healthcare takes priority in our obsession for individualism.
A basic tenant of our pursuit of the healthy: if the causes of our problems are well defined, then the solution is attainable.
DNA testing kicks this up to eleven. Through an intense analysis all the way to the core of our coding, then, we’ll have our problems even more precisely defined, making our fixes efficient and final. At least we reason it to be that way.
Whether or not it’s real, we certainly believe it to be so. You’re about three times more likely to follow an individualized recommendation. Said another way, highly individualized recommendations are highly valued, and you’re more likely to part with big bucks based on those recommendations.
This is a flaw in the system that companies want to exploit. Be aware and patch up your software.
Maybe it’s because I’m a skeptic and cynic at heart. I always feel like these big companies are up to something. I feel like our desire for customization blinds us to manipulation in the name of profit. With DNA testing for supplement advice and regimens, I’m correct.
Charlatans profit by giving people made up diagnostics to prove they have made up conditions because most of us want to know our health-related problems are fixable. Most health-related problems are, but not from snake-oil-salespeople tricks. They just require a load of work, including tight control over healthy habits.
Today it’s DNA, but the idea of a customized supplement regimen from fake tests is decades old.
Supplement Customization Isn’t New
The idea of “hyper-personalization” of a supplement regimen using some flawed testing logic isn’t new. Companies are advertising on your Instagram feed every 3rd post, “Take our quiz to get your personal supplement recommendations!”
Blood tests, offered by unsavory labs and “practitioners” have long promised individualized results far superior to the traditional methods.
One company, Baze, offers you custom vitamins based on blood work. Woopty doo! Any doctor can technically tell you if you’re low on folic acid.
Baze kicks it up a notch. They compare your results against some arbitrary system and actually score you.
Yes, you get a rank or a grade based on your blood test results. Your whole life your old man told you that you’d not amount to anything, and now your supplement company can prove it to you.
Don’t forget to hit that share button and tell all your friends how you are a “suboptimal” human.
Incoming sarcasm bomb: “Let’s hope that after you take their customized supplement regimen that your grade goes up.”
OF COURSE IT WILL! They want you to buy their stuff and think that it works.
Welcome to the new world, where we’ve reduced human interactions to diagnostics and an algorithm. At least the algorithm can’t be manipulated for the profit of the algorithm keeper! /s
Nevermind the fact that the supplement products these types of companies send end up in our “meh middle” we described in The Three Types of Dietary Supplements article.
For example, let’s say you have a low magnesium score so they send you magnesium citrate, a form of magnesium that has less than 6% absorption because no one read my magnesium article, obviously. How are you going to get your grades up?
Even if the recommendations were accurate, the quality of the products is still the biggest problem.
Blood tests are flawed because they focus on only a few vitamins that we can measure accurately. These tests, like DNA testing, tell an abbreviated story.
Blood testing seems to make sense, but unfortunately, it rarely helps more than general recommendations of healthy habits. Remember, vitamins are just a single compound that when removed from the body can cause a disease of deficiency. There are only a handful that we can actually measure accurately. If you had low enough blood levels to actually be of concern, though, other red flags and symptoms would have come up way earlier.
Here’s an example: On your annual physical you tell your doc you’re tired. She tests your blood and finds mild anemia. Further testing shows your B12 levels are low. You can cry over spilled milk all day long, but we have to correct a deficiency. We can use a supplement or medicine if our intake is adequate from our diet. But what if your dietary intake WAS NOT ADEQUATE? Eat some more B12-rich foods like Brewer’s yeast!
Here’s super-simplified the flow: eat healthy and if you feel bad, get checked out and figure out what could be wrong. Or, eat unhealthy, feel bad, get checked out and figure out what could be wrong, and then eat healthy.
Measuring levels of these specific compounds, whether from blood or a cheek swab, tell you no story beyond this: at the moment of the test, your levels are ______.
Vitamins are NOT nutrition. Healthy people (read: no real medical problems) that test to micromanage micronutrients prior to symptoms is unnecessary. Eat a well-balanced, healthy diet and you probably won’t have diseases of deficiency.
These companies recommend the lowest hanging fruit that are easily taken in with a good diet.
I’m not done beating up on this company with the health GPA. The scores take your blood tests on different nutrients and extrapolate out to these very nebulous things such as your “immunology” or “energy” or “inflammation.”
“Mom! It’s Jimmy! His vitality score is 54! Send the mortician with his tape measure, STAT!”
One more time for everyone in the back: vitamin levels are not a measurement of your health. They can’t tell you your “inflammation” or “immune health.” You can be healthy and have a low B12. You can have excellent Vitamin D levels and be a hot mess.
DNA Companies Shouldn’t Be Trusted
If we look honestly at the personas of consumers who engage with home DNA companies, you’ll see a general distrust of big corporations, especially medical industry businesses.
Without a hint of hesitation, though, some hand over the literal single identifier of who they are to businesses smaller and probably less compliant than the ones who can’t even keep our credit card information safe.
I’m sick of changing my passwords every ten minutes and getting month after month of free credit monitoring from one breach after another. Now my DNA is vulnerable? Heck, even my fingerprints were stolen in a breach of the VA’s HR records!
There’s that “they’re up to something” twitch coming back in me. If we think these companies’ sole purpose is to make a profit on the testing service in the era of data mining, we’re quite naive.
They’re compiling your data. They’re selling your data. Except the data they have on you is WAY deeper than what Google or Facebook is pilfering as we speak.
We give away so much, and for what? Not any information that’s clinically relevant.
And, to scare you straight, “hackers” can access genetic data and pose a huge threat, as reported on by the International Business Times.
DNA Testing Can Be Very Valuable
Of course, all of the excitement about genetics should continue. The sky is literally the limit on what we can uncover that can help us make better decisions and be healthier.
Most of the most useful genomic information doesn’t involve consumer-level testing, though. Instead, a real doctor works with an approved lab to gather relatively important information.
For example, some physicians are testing patients to determine the activity of various enzymes used to metabolize and clear drugs. This is most helpful when switching patients from one therapy that works to an alternative therapy, for whatever reason.
Dr. Jeff Fudin discussed how this can be helpful during opioid therapy transition on his opioid epidemic podcast episode, but more recently he and I talk about genetic testing and how it helps him make better decisions on what drug to use.
Dr. Fudin got excited because genetic testing led him directly to a solution for a very tough patient case AND it resulted in less medication with a higher quality of life. I was equally excited for him and the patient, but I had to make sure we clarified our discussion.
Genetic testing for medications (or even MTHFR) will give us a better starting point, but it is no guarantee of success. If you rapidly metabolize one class of drugs, then we know to not give you that as you’d need mega-doses to make it work, if it would work at all.
Even with genetic testing, we still need the normal trial-and-error. You just will have a smarter starting point and hopefully more trial and less error.
Bespoke Supplements Aren’t Real
Here’s what really happens with “customized” recommendations from these brands:
- Take some sort of an assessment or quiz
- Take some sort of bloodwork or real analysis (That doesn’t say much of anything)
- Take a DNA “test” to determine the activity levels of enzymes we know about.
- They give you a slightly tweaked variation of the general recommendations that all humans would get.
- They sell you a poorly absorbed, usually synthetic, isolated chemical compound that has no evidence to actually improve your health. In fact, there is evidence that it WON’T improve your health.
This is a more entertaining version of an example that happened to a real patient of ours who did this testing:
Her: “Oh, my zinc is a little low!”
Them: “Well, you should strive to get 12mg of zinc and we have this supplement.”
Her: “Wait, doesn’t everybody need about 12mg of zinc and don’t we get most of it from our diet and couldn’t I just eat a more balanced meal plan that ensures I get exposed to zinc (and other nutrient) rich foods?”
We want individualized recommendations to not only supplement with what we need, but also eliminate anything we don’t or could be harmful to us.
The dirty, ugly truth that the industry doesn’t want you to know is that you can do great with healthy lifestyle choices alone. I tell people all day to Throw Away Your Multivitamin.
That aside, individualized recommendations start with the practices generally recognized as effective for us as humans. A healthy diet, stress management, exercise, environmental exposure control, and sleep. You know, the bottom of the Wellness Pyramid.
We can use supplements, but they should be used strategically. This is individualized. You start with the things most of us are missing, the Vital Five, then tailor that list to your actual nutritional needs. Then, based on your situation, you can add more options to help you manage your health concerns.
When it comes down to it, customization based on a test is a way for us to take the guess-work out.
When we do so, however, we remove our agency (once again). We really are going on near-blind faith that the company will actually act on good faith, recommending truly what you need and not what makes them profit.
And maybe that’s why we want a test; we want something more objective than the wandering snake-oil salesperson. Or even our doctor. Who wants to wait months to have some guy spend 2 minutes with us and push drugs our way? “I want access to my information and want to make decisions for myself.”
The only way we can accomplish this goal is to be engaged with the process and direct our care ourselves. We still need professionals, we just have to find those that we trust and can help us build the wellness plan we seek.
BS Detection is in My DNA
“When it comes to wellness, everyone has different aspirations that no single nutrition plan, exercise routine or vitamin and supplement regimen can help achieve…”
It should be stated that DNA testing marketing statements like that ARE true. You should not be following generic advice, especially the gimmicky or trendy. You should work with someone who builds you a lifelong wellness plan, and supports it by adapting to your ever-changing needs.
Customization is an OK compulsion, we just can’t take it to the extreme.
The things we’ve discussed here today are more about the story than the substance. We tell ourselves a story we hope to be true: I’m unique. I’m special. I can (as the ad for DNA testing said) “unlock” my secrets to live a healthier, longer life. This is all aspirational.
And while there may be scientific accuracy to some of this genomic “stuff”, I’m arguing that there’s little clinical relevance. Especially with vitamins, minerals, and supplement testing.
In fact, the stories they tell us about the data they uncover are normally not true. Meaning, you’re not really 10% Koala, it doesn’t matter that you process saturated fat slowly, nor do you need more Vitamin C.
You are unique. You are special. You are so because of your emotions, experiences, relationships, and actions. Our physical bodies, though, kinda aren’t that special or unique. It’s not like you have to plug yourself into an outlet to go to the bathroom or chew Lego for nutrition.
We’re all pretty much the same, which makes doing things like hip replacements and heart surgery quite easy.
I tell you this not to crush your spirits, but to help you better engage with the BS. The trap these companies set for us is to keep telling that story. The more that pop up, the more the store reinforces itself and solidifies as fact in our mind.
Right now, it is not anything more than entertainment. They unlock nothing.
Don’t fall for it. They’re exploiting your vulnerabilities. Don’t give them the key.
Wellness DOES happen through individualized care. This involves true holistic care based on science, one where lifestyle, natural products, and conventional medicines are used to prevent and manage diseases. It involves setting a new standard for supplement quality and only using best-in-class products.
Most importantly, it involves only using what you really need. This could mean fewer unnecessary supplements.
The solution isn’t getting some fake test done. The solution is being more engaged with the process, retaining your agency, and having a trusted professional in your corner.
Just trying to keep it real…
Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth