An introduction to DNA health testing to improve your health and well-being

DNA testing has gone from prohibitively expensive to widely available for ancestry and health testing, but what will a DNA health test tell us and how is that data used?

This article describes the role of DNA in health, well-being, medicine and healthcare. It includes topics from diagnosis and screening to our own DNA health test and how we use it to help members build healthier lifestyles.

Author: Brian O’Gilvie, Senior Manager, Customer Proposition, Aetna International.

Introduction

Since the sequencing of the first genome, innovations have fuelled reduced sequencing times, which have in turn reduced costs. Today we are able to use that cutting-edge technology to understand how to use your DNA to live with the best possible health — to get the most out of your DNA and yourself.

The road to DNA health testing

With anything that relates to clinical care, we always need sufficient evidence before we can ‘know’ something and make recommendations. In some cases, the research can take 10 years before there are proven outcomes, before it’s appropriate to bring to the general population or implement a large-scale deployment.

As such it means a lot to us to have the right kind of science and governance behind it. For example, we have a robust scientific advisory board that conducts the evidence inclusion protocol. This includes consensus of multiple peer-reviewed research studies so we know that an outcome is reliable. It’s really important to understand that.

Within DNA testing, it is also important to know: is a given gene one that is modifiable? Do we know that with easily actioned lifestyle or environmental changes, someone can make a difference to a given factor?

Only once we know it’s been peer reviewed and once we know that an individual can impact their health with easily modifiable environmental changes are we able to say ‘yes, we can bring this to people and help them make use of their DNA to improve their health’.

Diagnosis and screening

There are different types of test available. For example, some can diagnose predispositions to certain diseases and/or conditions, for example looking for the BRCA gene — the breast cancer gene. This type of screening can be useful to doctors who might be having a hard time identifying a given disease – especially rare ones. Tests include:

• Cell-free fetal DNA
• Newborn screening
• Pre-implantation genetic diagnosis
• Carrier testing
• Predictive and pre-symptomatic testing

These tests can often allow doctors to see what’s going on that they may not be observing in a physical examination — things that don’t manifest in the body. But such hereditary and congenital diseases are rare.

DNA is not destiny

People are complex, and there are many things that affect someone’s health and ability to be healthy — from environmental to genetic.

Your DNA is saying who you are—– not what you can and can’t be. And that’s an important message. For example, Andrew Steel, a 400-metre runner and former Olympian, discovered that he didn’t have what is called ‘the sprint gene’, one of a pair of genes that almost all other Olympic sprinters have. Had he been told at an early age ‘you don’t have this gene, so you’ll never amount to anything in sport’, he may not have gone on to become an Olympic medal-winning runner. The example also demonstrates the importance of reputable advice on how to interpret the results of DNA health tests.

As such, Aetna International doesn’t use DNA health tests for disease and diagnostics, only to help people build healthier lifestyles.

Genetics only tells you your predisposition for a given condition, but we can combine that insight with how we’re doing in the here and now.

What can a DNA health test tell us?

There are literally hundreds of DNA tests available, offering a range of insights. It’s almost like building a report out of various specific tests where it’s up to you which genes you test. And this doesn’t mean that two tests will actually be the same, because companies will test different genes within the DNA.

Pharmacogenomics

DNA can tell you everything from your ancestry to pharmacogenomics (‘smart medicine’). For example, we can use DNA testing to help you understand how you metabolise medication: are you a slow or fast metaboliser? Are there certain drugs that might cause an adverse reaction? Pharmacogenetic information could be critically important for someone with a recent diagnosis of a condition such as coronary vascular disease. If you suffer from it, you might have to endure the merry-go-round of trying different drugs to identify the right ones for you. This means delays in receiving the right kind of medication, which can impact costs as well as your recovery.

Aetna DNA health tests include:

Fitness

• Power/endurance response
• Aerobic (VO2 Max) training response
• Injury risk
• Recovery speed

Stress

• Stress tolerance
• Warrior to strategist

Nutrition

• Optimal diet type
• Carbohydrate and saturated fat sensitivity
• Salt, alcohol and caffeine sensitivity
• Lactose intolerance and coeliac predisposition
• Individual vitamin and mineral needs
• Detox ability and antioxidant need

Sleep

• Genetic chronotype
• Sleep quality
• Caffeine and sleep

Aetna DNA includes all of these tests amongst others.

How will hospitals and doctors be able to use our DNA data?

Imagine if our doctor and the hospitals treating us had additional insights into our individual response to medication. The opportunity to enhance our treatment plan could be really beneficial. In practice, right now, that could happen with a doctor or patient sharing their pharmacogenomics report. In order to be effective at scale we would need to see pharmacogenomics results and reports stored in a patient’s electronic health record. Some pioneering hospitals have started to store pharmacogenomics reports and have integrated them within their clinical systems. This allows them, for example, to send an alert to the treating doctor and your pharmacist that says: ‘while we’re treating this person for X, please be aware, don’t use Y or Z because their pharmacogenetics test indicates alternatives with a potentially better outcome’.

What does Aetna DNA test for and how is it used?

We test about 80 specific gene variants. These variants are only linked to exercise, nutrition and mental well-being (stress and sleep). No disease or diagnostic testing is involved — therefore people can really look at this as a way to help them improve their health and well-being.

With Aetna DNA, we supply a series of reports that covers and sets out in a transparent manner: What genes we’re testing, why they’re important and what individuals can do about them. This last point is particularly important; we recommend real-world advice and guidance on how to make relevant lifestyle changes.

All of this data might seem overwhelming, but we work with individuals to explain it and help them implement meaningful changes.

For example, vitamin B-related DNA tests. We help people understand its role in maintaining a healthy nervous system and being able to fight infection, and, if you are prone to having a lower deficiency in this area, here are the things you can do to improve it — in this case, food and nutrition.

Read more about Aetna International’s DNA health testing

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