There are tons of what we call "direct to consumer" genetic testing kits now available on the market. A simple search of "23andme" returns dozens of tests on Amazon. There are ancestry tests, health risk tests, cancer risk tests, exercise and nutrition tests, likely physical traits and many more. So how do you choose which test to buy? Well, that is what this website and blog are all about! If you have any questions about which tests would help you accomplish your health goals, feel free to reach out. A few weeks ago I purchased my first two consumer DNA test panels 23andMe - Health + Ancestry ($199) and the Vitagene - Health + Ancestry ($79). I will be comparing them here to give you an idea if the 23andMe brand was worth the extra $120. Similarities between the two tests Both tested an astounding number of genes for the price (around 700!). They both caught my MTHFR 677 mutation. They both showed my ancestors primarily lived in Western Europe. They both had similar (and extremely limited and not useful) information on their website about the "Health and Wellness" part of the test. They are both very limited by what the FDA allows the "direct-to-consumer" DNA tests to disclose. For this reason, I recommend speaking to a healthcare provider trained in genetic testing who can help you get the most out of your test results and use them as a guide to create your life long "HEALTH ROADMAP". Differences Price - Vitagene $79 and 23andMe $199 Information on their site - both had similar (extremely limited) information about Health and Wellness, however I did think Vitagene explained the results a bit better. Business model - Vitagene's business model seems to be more geared towards selling their supplements. The community of ancestry mapping and genetic reporting seemed to be the focus of the 23andMe site. Usefulness I downloaded my raw genetic data from both Vitagene and 23andMe so I could run it through a more advanced gene testing software (see reports below). The results were similar, but there was some notable differences in the genes being tested. Both tested COMT, MTHF, MTRR AND NAT genes which all play a role in management of mental health conditions. Both tested some of the Cytochrome P450 liver enzymes that tell us how well your body can tolerate a drug, but they were limited to just a few genes. For patients on ADHD or other psychiatric medications, it may be a good idea to ask your doctor or pharmacy for a pharmacogenomic test since neither of the tests focus much on the liver enzymes responsible for breaking down these medications. You can see the comparison of my results below. The "red" indicates a potentially harmful mutation to which I am homozygous (received the gene from both parents and is indicated by a +/+). When it comes down to it, I believe Vitagene provides the best value of any test I've completed so far. So what is the difference between a direct to consumer test and a pharmacogenomic test? Pharmacogenomic tests are able to test the specific genes responsible for breaking down ADHD and depression (psychotropic) medications. A simple psychiatric panel can start at $500 per test, but will save countless hours of trying and failing multiple medicines before finding the right fit for you or your child. A pharmacogenomic test is considered a "class II medical device". This means you'll need a doctor to sign off on the test and the results will be shared with you by a healthcare professional. If you or you child has already had a genetic test done, we can take the results of that test, put it into a software system and tell you which medications may be more safe and effective based on your genetic profile. A trained pharmacist or healthcare provider would be able to help you interpret the test and use it to create a "health roadmap" for identifying potentially harmful or beneficial medications throughout your child's life. If you'd like to discuss setting up a Genetic Consult and getting your Health Roadmap, send an email to blairthielemier@btpharmacyconsulting.com for more information and recommendations on how genetic testing can help your healthcare provider choose safer, more effective medications. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an medication therapy management consultant pharmacist living in Arkansas with her husband and two children. She is also the founder of Genetic Consults, a program that helps patients understand their genetics and use that information to guide future medical care.
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We all know we're probably supposed to me taking a daily multivitamin. But has anyone ever actually explained WHY? Simply put, our bodies need certain nutrients to function properly. If we don't supplement these nutrients with proper nutrition or supplements like multivitamins, then our bodies don't work as efficiently and medications aren't as effective. There are many reasons for being nutrient deficient ranging from poor diet to medications to genetic mutations affecting our body's ability to make or collect those nutrients. Since I'm a pharmacist and I like to talk about drugs, lets start there. Drugs in the "stimulant" class of medications (such as Ritalin and Adderall for ADD/ADHD) can cause a reduction in appetite as a side effect. Decreased intake equals nutrient deficiency. Other drugs in the "psychoactive" class of medications may have the opposite effect and increase the desire for unhealthy sugars, fats or carbohydrates. Some medications in the anti-psychotic and anti-depressants classes can cause insulin resistance and may lead to metabolic syndrome. Consumption of high-calorie, low nutrient density foods can also have an impact on the resources our bodies use to rebuild our cells. Antibiotics and anti-cholesterol drugs also affect the absorption of nutrients in the stomach and GI tract leading to additional deficiencies. Though the reasoning for the problem varies, the outcome is the same. Deficiencies cause drugs that require certain nutrients Vitamin B, Co-enzyme Q-10, folic acid and others as "building blocks" in order to work to be much less effective. For example, antidepressants work by increasing the neurotransmitters serotonin and dopamine. But serotonin and dopamine aren't made from nothing, they are built by tiny "building blocks" like B vitamins. Another reason for nutrient deficiencies can be attributed to genetic mutations. Mutations can affect the way enzymes break apart building blocks like folate into a usable form. One of the most infamous enzyme mutations is in the MTHFR gene which affects the way the body changes folate into methylfolate. In this situation adding a folic acid (folate) supplement, could cause ADDITIONAL harm because the body is already having trouble clearing the folate. For MTHFR positive patients, I'd recommend a methylated version of folate instead. Methylfolate is another one of the "building blocks" for making the neurotransmitters serotonin and dopamine as well. Which again affects the way ADHD, anti-depressant and anti-psychotic medications work. The MTHFR gene mutation is just one example of the many ways genetics can affect the way your body reacts to medications and supplements. Having a full picture of your genetic profile, medication therapy, and nutrient deficiencies can help your doctor or pharmacist choose the most effective treatment for you. If you are interested in learning more about genetic testing or have already had a genetic test performed and would like to get more information about it, send an email to blairthielemier@btpharmacyconsulting.com for more information and recommendations on how genetic testing can help your healthcare provider choose safer, more effective medications. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an medication therapy management consultant pharmacist living in Arkansas with her husband and two children. She is also the founder of Genetic Consults, a program that helps patients understand their genetics and use that information to guide future medical care. 
As a pharmacist and a mother of two, it hurts me to see children and young adults struggle to manage mental illnesses, ADHD and even ASD with medications that aren't working.
For example, a mother brings in her child who has recently been diagnosed with ADHD. The pediatrician or psychiatrist may start out with methylphenidate (Ritalin). After three months of being on it and not seeing any results, the mother and doctor decide to discontinue the methylphenidate therapy. Next, they move to dextroamphetamine and amphetamine (Adderall). The medication seems to be helping the child focus, but its REALLY affecting their appetite. Over the next 6 months the child continues to lose weight, the mother and doctor decide to try another new medication. After 9 months of trial and error, they finally try the child on lisdexamfetamine (Vyvanse) and find a winner. Every person is different and therefore the next person who walks into my pharmacy and hands me a script for Adderall may respond wonderfully to the therapy and do great the first time. But, what if there was a better way to know BEFORE the medicine was ever taken? These months of struggling to find the right drug could have potentially been avoided if a simple genetic test was performed before starting the medications. A genetic test would tell the doctor or pharmacist which drugs would work best ("green" drugs) and which could be potentially ineffective or even harmful ("red" drugs). If your child is being put on a new ADHD or other types of psychoactive medications, consider getting them a genetic test. A trained pharmacist or healthcare provider would be able to help you interpret the test and use it to create a "health roadmap" for identifying potentially harmful or beneficial medications that will be useful throughout your child's life. If you'd like to discuss setting up a Genetic Consult and getting your Health Roadmap, send an email to blairthielemier@btpharmacyconsulting.com for more information and recommendations on how genetic testing can help your healthcare provider choose safer, more effective medications. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an medication therapy management consultant pharmacist living in Arkansas with her husband and two children. She is also the founder of Genetic Consults, a program that helps patients understand their genetics and use that information to guide future medical care. 
Patients are becoming increasingly aware that they may have to try several different medications before they find the "right" one.
But, what if you could avoid the expensive copays, back and forth to the doctor and pharmacy changing the medications and months of time wasted still feeling not so great? New technology called pharmacogenetic testing allows your healthcare provider to test your DNA and know immediately which medications to avoid and which medications to try first. And the good news is your results will NEVER change. These are once-in-a-lifetime tests if you do them correctly and use the results to guide future care. In fact, I would even go so far to say that genetic testing would be more beneficial the earlier you get it. That why I highly recommend if your child is being put on a new ADHD or other types of psychoactive medications that you consider getting them a genetic test. A trained pharmacist or healthcare provider would be able to help you interpret the test and use it to create a "health roadmap" for identifying potentially harmful or beneficial medications throughout your child's life. If you'd like to discuss setting up a Genetic Consult and getting your Health Roadmap, send an email to blairthielemier@btpharmacyconsulting.com for more information and recommendations on how genetic testing can help your healthcare provider choose safer, more effective medications. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an medication therapy management consultant pharmacist living in Arkansas with her husband and two children. She is also the founder of Genetic Consults, a program that helps patients understand their genetics and use that information to guide future medical care. 
trial and error:
phrase of trial
For decades, your doctors have been limited to 'educated guesses' about which medications would be best for you based on your genetics. We have what we call Standards of Care which tells us which medications to start with a certain diagnosis. But, that is where the "standardization" of medicine pretty much ends. If the standard medication fails, then you move of to the next drug that you have the most experience with. This can vary hugely from doctor to doctor, because each doctor relies on their own unique experiences, training and biases to choose the drug they expect will work for you. Beyond a handful of studies that show us certain medications worked better in certain racial populations, its a process of trying a medicine, giving it a few weeks or months, then evaluating the results and trying something else. TRIAL AND ERROR Currently, we rely YOU to tell us which drugs have the least side side effects and best results for you. Especially when its a result we can't easily measure, like depression, ADD and ADHD. We know how medications SHOULD work in most people, but now we can determine how medication will work for YOU. The idea of using a persons DNA to identify the safest and most effective drugs was completely out of reach... Now doctors and pharmacists have access to convenient, affordable DNA testing that can give us a better idea of which drugs work best for you! You can avoid the trips back and forth to the doctor and pharmacy. You can avoid the money and time spent on appointments and new medications. You can avoid spending additional time "testing out" new medications that aren't helping. Ask your doctor or pharmacist about getting a genetic test to help you find the drugs that will work best for YOU. If you don't know where to start, email me at blairthielemier@btpharmacyconsulting.com and I'd be happy to point you in the right direction. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an medication therapy management consultant pharmacist living in Arkansas with her husband and two children. She is also the founder of Genetic Consults, a program that helps patients understand their genetics and use that information to guide future medical care. |
AuthorBlair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. She is also the founder of Genetic Consults, a program that helps patients understand their genetics and use their information to guide future medical care. Archives |
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Photos used under Creative Commons from Damian Gadal, Oregon State University