23andMe Health Testing Reviews - DNA Testing Choice

Health + Ancestry Service review on February 1, 2019 by Rebecca Fishwick
Health + Ancestry Service review on September 1, 2018 by Craig Macpherson

Geneticist's Opinion by Sano Genetics:

23andMe is probably the most widely known consumer genetics company in the world. They’ve spent a long time under the microscope but when it comes to the companies working with your DNA, there’s always room for some healthy scrutiny.

Accurate communication
23andMe has clearly spent a lot of time working with customers to accurately communicate risk, and they frequently make clear that genetics is not the whole picture for most traits. However, for some traits, they simply state ‘increased risk’ without going into further detail, which can be worrying. For example, my report stated I was at increased risk for macular degeneration, but did not say what the baseline risk was, and just encouraged me to speak to my doctor. Only by clicking ‘scientific details’, which was in pretty small print, could I see how high this risk actually was.

23andMe has expanded its health offering and has done a great job making it clear that interpretations are not necessarily relevant for all ethnicities. The one exception to this may be their new diabetes test, which their research shows to underperform for non-Europeans, but this is not clear from the site. 23andMe also clearly states their report does not account for every possible genetic variant that could affect your likelihood of developing a particular condition, which is a very important caveat that very few genetic testing companies are so transparent about.

Scientific backing
23andMe provides the opportunity to ‘see scientific details’ on nearly all of the traits and conditions they report on, which is very helpful to understand how the prediction is made, and where to learn more. They also give very detailed information on how genotype arrays work, and that their tests are processed in a CLIA certified lab. 23andMe also publishes original research, which is frequently, though not always, peer-reviewed providing a level of integrity that is higher than many other genetic tests.

Ethics and consent
23andMe have greatly improved their communication around the fact that participant data is being sold to pharmaceutical companies for research purposes. However, it is not always clear to users exactly how their data will be used – only that it is available to pharmaceutical and academic partners in an anonymized format.

At a Glance

Editor's Rating:

Customer Service:

Clarity of Results:

References Cited:

Value for Money:

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Summary

I was impressed by the amount of detail that had gone into 23andMe’s genetic health report, and I appreciated comprehensive manner in which they explained each finding, and outlined the limitations of the analyses.

I was pleased to see that all of the reports had been based on established research, and was impressed that the carrier status and genetic risk reports were FDA-approved, which leant more credibility to their results.

All in all, the 23andMe ‘Health + Ancestry’ test seemed to me to be great value for money, and I would highly recommend it.

Full Review

Founded in 2006 by C.E.O. Anne Wojcicki, 23andMe is one of the largest DNA testing companies in the world. Their ever-growing database currently contains the genetic data of over five million people, many of whom choose to share their data for research.

23andMe reports on your genetic predisposition to various diseases, carrier status and inherited conditions. It also reports on genetic traits, genetic ancestry, and helps you find living relatives.

Please note that reviews for the ancestry-related aspects of the test can be found here.

Product Expectations

From the 23andMe website, I learned that the test would help me discover if I carry genetic variants that could affect my children, and identify genetic risk factors which could help me make better lifestyle choices. I’d receive genetic information relating to my ‘Wellness’, including traits such as response to caffeine and how deeply I sleep, as well as a list of the physical traits that I’ve inherited, such as hair color.

I could view the full list of more than 100 health conditions and traits that 23andMe would report on, and could read about the research behind their findings.

There were multiple disclaimers saying that the 23andMe reports were intended for informational purposes only, and that they did not diagnose disease or illness.

Ordering Experience

I received the kit three working days after ordering and used the spit collection tube to provide a sample (which was effortless and pain-free). Instructions inside the kit advised that I consult with a genetic counsellor if I had any questions interpreting my results, but I wasn’t sure how I’d go about this.

A list of limitations was provided for each section of the report that I'd receive, and the instructions went on to warn me that 23andMe’s test is not a substitute for a healthcare professional, and that the results should not be used to diagnose any condition. I found that the term “genetic risk factor” (which they used frequently) was clearly explained.

The box was pre-addressed and the return postage had already been paid, so all I had to do was pop my saliva sample in the post. I received confirmation by email that my sample reached the lab two weeks later.

Friendly warnings on the kit advised that I must register online before dispatching my sample back to 23andMe. While registering, I went through the privacy policy, and noticed that even if I didn’t consent to 23andMe’s research program, my genetic and self-reported information would still be shared with other companies, though as aggregated data that they were confident could not be traced back to me.

The process also required me to agree to the terms and conditions, and after going through them, I read that if my genetic or self-reported information helped 23andMe (or its partners) develop any research or commercial products, I’d have no right to these developments, and would not receive any compensation. This made me wonder what my genetic information was really worth to 23andMe…

The Results

Four weeks after the lab acknowledged they’d received my sample, I received an email saying my results were ready, which was earlier than I’d expected. I was directed to log in to the online account that I’d set up when I’d registered.

Once I’d logged in, I was able to view and access both my Ancestry and Health reports, as well as other included features, like the DNA Relatives family finder.

In my Health results section, I was greeted with highlights from my results (i.e. the most interesting things that had discovered about me). I could browse my reports by each category: Health Predisposition, Wellness, Carrier Status, and Traits.

Part of my Health reports dashboard.

Results Section: Carrier Status

I looked first at the carrier status report, and was presented with a list of 43 conditions that can be passed on genetically from parents to children. A part of this list is shown below.

A section of my Carrier Status results.

I was relieved to see that I hadn’t tested positive for the any of the genetic variants associated with the conditions tested for, which meant that I would not be at risk of passing any of these genetic diseases on to my children.

Results Section: Health Predisposition

The next section revealed my risk of developing nine different health conditions. Including how likely I was to suffer from Late-Onset Alzheimer’s Disease, Parkinson’s Disease, and whether I had the genetic variants associated with elevated risk of breast cancer. Before viewing these results, I was warned that they could contain unexpected and potentially upsetting information.

The result I was most interested in was the one that assessed my risk of developing Late-Onset Alzheimer’s Disease. I have a family history of the disease, and I was pleased to see that I didn’t carry the variant associated with a higher risk.

I was understandably relieved, but it was also made clear that this didn’t mean I wouldn’t get the disease. As well as stating this fact, the limitations of the test were outlined and the other factors, such as ethnicity and lifestyle were explained in detail. I was surprised but impressed that this was included. This honesty and openness further increased my trust in the results and the service as a whole.

A snippet from my Health Predisposition results.

I found that I had one variant associated with age-related macular degeneration. However, 23andMe considered that I was not likely to be at increase risk of developing this condition. But I did have a slight risk for developing celiac disease (associated with sensitivity to gluten). As far as I know, I don’t have celiac disease. I do, however, have some family history of age-related macular degeneration, and I was relieved to find that though I had inherited an associated variant, my genetic risk was not significant.

All of these results included similar information to the Carrier Status section of the report, including the location and details about the variant(s) and gene(s) analyzed, hyperlinked references and even a table of the different risks for different groups of people.

Results Section: Traits

My Traits results outlined some of the genetic factors affecting 30 of my characteristics. It was fun to compare my actual experiences with the conclusions drawn from my DNA analysis. For instance, they predicted that I had detached lobes, no hair-loss, and was unlikely to be afraid of heights – which are all true.

A snippet from my Traits results.

I could click my results for an explanation of each, as well as a percentage of other 23andMe customers that share that trait. The explanations were interesting yet concise and, similarly to the Carrier Status reports, each result was accompanied by more detailed scientific information about how the conclusion had been reached. It appeared that a lot of the information was, at least in part, based on the self-reported conclusions made in customer surveys, which didn’t seem like a particularly scientific method, and may explain why – though many results rang true – others seemed a bit off.

Results section: Wellness

The Wellness section contained eight reports in total, which ranged from results about lactose intolerance to sleep movement. I was surprised to read that rather than testing for my reaction to caffeine, the result relating to this actually indicated that I was more likely to consume caffeine: a behavioral choice that I had previously assumed had little or no genetic influence.

A snippet from my Wellness results.

I was somewhat skeptical, but found in the scientific information that there were several published research studies specifically backing the idea that certain genetic variants can affect the amount of caffeine someone is likely to consume, not just their reaction to it.

Although I didn’t display any particularly unusual wellness characteristics, this section was interesting. It was made very clear that the information was not intended for medical use, but it would have been good to have slightly more information on how the characteristics might affect me, and maybe how to respond practically, especially as these were largely non-medical traits. For example, the results suggested that I am likely to move more than the average person whilst sleeping, and although I was told that this could be disruptive to my sleep, there was no further explanation or tips on how to reduce these potentially disruptive effects.

However, there were other results in this section which did provide helpful advice and information, such as the saturated fat result. I was interested to learn that I’m likely to be the same weight regardless of whether I eat a diet high or low in saturated fat. But this doesn’t mean that I am any less likely to suffer the internally harmful effects, such as heart disease.

It was really useful to have the different types of fat explained, and eye-opening to learn the foods that contained high levels of saturated fat in them (steak and ice cream for example), as well as those high in the healthier, unsaturated fat (nuts, fish, avocados etc.).