Sunday, August 4, 2019

Emphasis on "Hypothesis-Generation" for Supplement Recommendations

This is a subset of my notes on 4 "Nutrigenomics" companies on GitHub:

To be fair, I am starting with a negative bias.  However, I will be very happy if I can convince people that the companies / organizations need to i) share your raw data with you, ii) share all the details for coming to their conclusions, and iii) have some way of publicly sharing trends in their own data, with fair representations in limitations in confidence.

In other words, that is a little different than the results being inaccurate, which is harder to show (and I have to be mindful of my prior expectations, since that can cause me to be overly harsh).

That said, my primary concern with most of the Nutrigenomics results is that they weren't the best way to get your genomic data (and/or they provided risk assessments that I thought were less useful than direct measurements, such as routine blood tests covered by insurance).  However, the situation was a little different for Vitagene (who does provide genotype information at 632,150 positions).

While my opinion is that I would probably still prefer 23andMe / Genes for Good / All of US over Vitagene, I think that can largely be considered a personal preference.  However, I think there is one point worth emphasizing more (which I feel more strongly about).

Namely, Vitagene provides supplement recommendations based upon your genotypes (and non-genetic information).

While I did experiment a little with 1 supplement because of these results (and may eventually test 1 or 2 more), I think it was important that I viewed the overall results as something that needed to be critically assessed.

In other words, Vitagene recommended that I take 7 supplements:

  • Bromelain Quercetin Complex (500 mg): Lifestyle (Joint health and Digestive health)
  • Probiotics (40 billion CFU): Genetics (31%, risk of Overweight, Hormonal support, Eczema, Allergies and Blood pressure health, based upon 103 variants, all reported to have "Fair" research quality), Lifesytle (Everyday stress and Digestive health), and Goals (Everyday stress and Overweight)
  • Vitamin D (2000 IU): Genetics (59% Vitamin D Levels, Eczema and Joint health, based upon 36 variants, all reported to have "Fair" research quality), Lifesytle (Everyday stress), and Goals (Everyday stress)
  • Theanine (200 mg): Lifesytle (Everyday stress), and Goals (Everyday stress)
  • Iron Free Multivitamin (10 Multi): Lifestyle (Energy and Nutrient intake levels)
  • Zinc (15 mg): Genetics (50% Overweight, based upon 52 variants, all reported to have "Fair" research quality) and Goals (Overweight)
  • Chromium (200 mcg): Genetics (83% Hormonal support, Overweight and Blood Sugar Health, based upon 203 variants, all reported to have "Fair" research quality) and Goals (Overweight)

To be clear, I believe I currently have a normal BMI (23.7), but I would like to trim down my gut a little bit.  However, I think doing some 8 minute abs and exercise (and avoiding over-eating) is probably going to be more helpful to me than a supplement to lose weight.  I only bring this up because "Overweight" appears more than once above.

More importantly, if I over-estimated the ability to accurately make supplement / drug recommendations, I think this could potentially cause harm.

For example, I would be cautious about taking 7 new drugs all of a sudden.  While they attempt to give some indication of drug interactions (such as listing a potential drug interaction between Bromelain and Indomethican), I didn't see a warning about an interaction between L-Theanine (specifically, Nature's Trove L-Theanine) and SSRIs except on the container after ordering the supplement.

Accordingly, I encountered some minor side effects both times that I took it (as I recorded in my PatientsLikeMe profile).  To re-iterate, there was a warning on the container (but not from Vitagene) said "If you are currently taking prescription antidepressants such as MAOIs or SSRIs, consult your physician before taking this product".

I also tested 50 mg of Zinc from target (which I evaluated on PatientsLikeMe).  However, I don't think it really helped with weight loss (after testing taking it for a little less than 2 weeks).

So, this was not a huge problem for me.  However, I would be a little concerned if the typical patient/customer didn't question the full set of recommendations (and/or didn't consult a doctor prior to adding a large number of supplements into their daily routine).  It may also be worth mention that the supplement I ended up testing (as something novel that I thought could help) did not use any of my genetic information to make that recommendation.

Update (3/8/2020): I submitted an FDA MedWatch report for this collection of blog posts, emphasizing the Vitagene result because of the mild adverse reaction (while providing the FDA with the general link).  Identifying information was removed, but you can see what the public version of report MW5092056 looks like in the MAUDE Adverse Event Report database.

Update (4/27/2020 + 5/24/2020): I don't mention it in the above post (since I made the purchase noticeably later), but I think my GitHub notes on Dante Labs may also be relevant (1 of the 3 reports was a "Nutrigenomics" report).  I have also submitted an FDA MedWatch report, and I will provide the identifier for that as soon as I know it.

I am not sure why the information about Dante Labs is missing (since that seems important), but you can see that report in MAUDE as MW5094322.  You can also see the original draft (without the removed information or reformatted text) here.

Update (5/18/2010): When I thought I heard that Everywell was going to provide COVID-19 tests, I thought that I should report my experiences for what appears to be different metabolite levels for the regular blood draw versus the at-home blood test (MW5094002).  I also mentioned that DNA results were provided, but I didn't think they were the best way to get those results and I thought the blood test results should be getting more emphasis.  As mentioned toward the beginning, this was one of the results that I described in greater detail on the GitHub Nutrigenomics subfolder.

Update Log:

8/4/2019 - public post date
8/16/2019 - minor changes
8/20/2019 - mention zinc testing
8/26/2019 - fix GitHub link
8/30/2019 - add link for PatientsLikeMe zinc evaluation
11/20/2019 - add Chromium (all 7 supplements were on the GitHub page, but I previously only listed 6 in the blog post)
3/8/2020 - add link to FDA MedWatch report
4/27/2020 - add information about Dante Labs
5/18/2020 - add reference to Everywell FDA MedWatch report
5/24/2020 - add reference to Dante Labs FDA MedWatch report


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