ags provider geneed training health & wellness genetic profile program/pdf... · 2018-10-03 ·...

AGS Provider GeneED TrainingHealth & Wellness Genetic ProfileMicronutrients

October 2018

Proprietary & Confidential

AGS Provider GeneED Training: Micronutrients

MicronutrientsTraining Objectives:

• Define micronutrients: vitamins and minerals.

• Describe how genetics can impact micronutrient needs through potential genetic predispositions revealed in the AGS Health & Wellness Genetic Test.

• Describe what happens if a predisposition becomes a deficiency.

• Describe the genes AGS uses and what specific effects they have on the human body and overall health and wellness.


• Micronutrients are chemical elements required in small quantities for healthy living.

• Micronutrients include:- Vitamins: organic compounds essential

for life (most cannot be synthesized by the body).

- Minerals: elements that originate from the Earth’s soil; also essential for life.

• The human body can only synthesize some vitamins (i.e. vitamin D with sunlight exposure), but not all. Additional nutrients must come from the foods we consume or through vitamin supplementation.


Micronutrients = Vitamins and Minerals


• Genetics alone can reveal predispositions, not outright deficiencies. In order to determine full deficiencies, blood work or thorough physical examination by a physician is required.

• People with genetic predispositions have a greater likelihood of developing micronutrient deficiencies if they do not achieve proper nutrition through the foods they consume.

• Many predispositions can be countered through proper diet, but some individuals may require, or even prefer, supplementation:

- Very busy or active individuals.- Those who travel frequently.- Those who want to close nutritional gaps.


What Can Genetics Tell Us About Micronutrients?


• Vitamin A: Required to maintain healthy skin, a strong immune system, good vision, and achieve adequate growth.

• Vitamin B6: Required for carbohydrate and protein metabolism. Supports blood cell synthesis and neurotransmitter synthesis.

• Vitamin B9 (Folate): Required for DNA synthesis, cell division, amino acid metabolism, and the maturation of cells (including red blood cells).

• Vitamin B12: Required to assist in the metabolism of folate (also necessary to make red blood cells).


What Micronutrients Does AGS Cover?


• Vitamin D: Required to regulate blood calcium levels and achieve/maintain healthy hormonal balance.

• Vitamin E: Required to protect cell membranes from oxidation. (*Note: only reported on the AGS Premium Health & Wellness Genetic Profile)

• Iron: Required for the formation of hemoglobin (used to carry oxygen around the body), as well as to assist in the production of neurotransmitters. (*Note: only reported on the AGS Premium Health & Wellness Genetic Profile)


What Micronutrients Does AGS Cover?


• There are minimum requirements and “upper limits” (UL) for micronutrients.

• The minimum can be defined as the “Recommended Daily Amount (RDA)”:

- Vitamin A:• RDA: 0.6 - 0.7 mg/day• UL: 1.5 mg/day

- Vitamin B6:• RDA: 1.2 - 1.4 mg/day• UL: 200 mg/day


How Much of These Nutrients Do I Need?When it comes to micronutrients,

can I have too much of a good thing?

Source: Government of UK & WHO


- Vitamin B9 (Folate):• RDA: 200 micrograms/day• UL: 1 mg/day

- Vitamin D:• RDA: 10 micrograms/day• UL: 100 mg/day

- Vitamin E:• RDA: 3 – 4 mg/day• UL: 540 mg/day

- Iron:• RDA: 8.7 mg/day• UL: 17 mg/day


How Much of These Nutrients Do I Need?

Source: Government of UK & WHO



Can Supplements Interact with Medications?• Yes. Supplements can have profound physiological effects – interacting with each other, as

well as medications.

• Here are a few major interactions to be aware of:

- Vitamin A:• Be cautious with retinoid-containing medications to avoid excess vitamin A.• Can interact with Tetracycline and induce intracranial hypertension.• Can increase risk of liver damage if consumed with hepatotoxic medications.• Large amounts of Vitamin A may interfere with the medication Warfarin.

- Vitamin B6 • Taking Vitamin B6 with Cordarone may increase risk of sunburn.• May increase the breakdown of seizure medications such as Luminal and Phenytoin.• Moderate dosages of B6 are safe for most people, but very high dosages may be

problematic, especially if taken long-term.


- Folate:• Can interfere with the antibiotics Tetracycline, Trimethoprim, and Sulfamethoxazole

(if taking both orally, separate time of consumption by at least 2 hours).• Large-dose supplementation of the following could result in decreased efficacy:

Fosphenytoin, Methotrexate, Phenobarbitol, Phenytoin, Primidone, Pyrimethamine.

- Vitamin B12:• May experience decreased efficacy with long-term usage of Chloramphenicol.

- Vitamin D:• Dosages exceeding UL could cause excessive blood-calcium, especially long-term

(may impact calcium-related processes in the body).• May lower the effectiveness of antihypertensive and cholesterol medications.• May impact aluminum and calcium based medications (i.e. antacids).• May increase the effect of medications such as Calcipotriene (synthetic vitamin D).• May impact calcium-channel blockers and heart medications.


Can Supplements Interact with Medications?


- Vitamin E: (*Reported on the Premium Health & Wellness Genetic Profile only.)• Vitamin E can increase absorption and side-effects of Cyclosporine (can increase the

production of certain liver enzymes, impacting the medication’s effects).• Ask your doctor if on any medications processed by the CYP3A4 gene.• Vitamin E may slow blood clotting and increase the effects of anticoagulants.• May lower the effectiveness of statins (cholesterol lowering medications).• Taking Vitamin E along with beta-carotene, Vitamin C, and selenium may decrease

beneficial effects of niacin on cholesterol.• If taken with Warfarin, Vitamin E may increase bruising and bleeding.

- Iron: (*Reported on the Premium Health & Wellness Genetic Profile only.)• May decrease the effectiveness of antibiotics such as Quinolone and Tetracycline.• May decrease the effectiveness of the following medications: Levothyroxine,

Levodopa, Methyldopa, Mycophenolate Mofetil, Penicillamine.


Can Supplements Interact with Medications?

Important Tip to Avoid Supplement and Medication Interactions:Reduce supplement interactions with oral medications by separating time of consumption by 2+ hours.


Vitamin Potential Side Effects

Vitamin A Dry skin and eyes, night blindness, infertility, infection, skin blemishes

Vitamin B6 Rashes, dried mouth/lips, mood swings, frequent sickness, low energy

Folate Fatigue, weakness, pale skin, anxiety, depression, shortness of breath

Vitamin B12 Pale/yellowish skin, fatigue, prickling pain, oral sores, vision impairment

Vitamin D Frequent sickness, fatigue, aches, depression, loss of bone density

Vitamin E Fatigue, weakness, numbness/tingling, vision impairment, frequent infections

Iron Fatigue, pale skin, shortness of breath, headaches/dizziness, muscle spasms


Potential Side Effects from Inadequate Vitamin Levels



The Genetics of Micronutrients• Vitamin A:

- Gene BCMO1 (SNPs = rs12934922 and rs7501331)- Encodes a key enzyme for converting precursor beta-carotene to vitamin A.- *Note: Two variants which interact to affect vitamin A production.

• Vitamin B6:- Gene NBPF3 (SNP = rs4654748)- While still not fully understood, this gene is associated with decreased levels of vitamin B6.

• Vitamin B9 (Folate):- Gene MTHFR (SNP = rs1801133 [largest effect] and rs1801131)- Encodes an enzyme that methylates Folate for use in converting homocysteine (potentially

toxic) to methionine, an important amino acid and methyl donor.

• Vitamin B12:- Gene FUT2 (SNP = rs602662) - Associated with Vitamin B12 levels, possibly by affecting the microbiome.



The Genetics of Micronutrients• Vitamin D:

- Near Gene CYP2R1 (SNP = rs10741657): Controls key Vitamin D metabolism step in the liver.- Near Gene DHCR7 (SNP = rs12785878): Associated with Vit D levels in 34,000 person study.- Gene GC (SNP = rs2282679): Encodes Vitamin D binding protein that helps transport Vitamin

D to target tissues.

• Vitamin E:- Intergenic (SNP = rs12272004)- Variation is not embedded in a particular gene, but may affect a regulatory region or simply

be meaningful incidental association.

• Iron:- Gene TMPRSS6 (rs855791 and rs4820268)- Encodes key protein which regulates iron level in the body.


KCTD10 rs10850219

TA TT AA 24

Partial reduction inconversion to bio-active

Vitamin A from precursor.

Decreased conversion to bio-active Vitamin A.

No reduction in conversion to bio-active

Vitamin A fromprecursor.

BCMO1 rs12934922


Genetics of Vitamin A

TA TT AA


KCTD10 rs10850219

TC TT CC 24BCMO1 rs7501331

Partially reduced conversion to

bio-active Vitamin A from precursor.

Decreased conversion to

bio-active Vitamin A.

No reduction in conversion to

bio-active Vitamin A.


Genetics of Vitamin A

TC TT CC


KCTD10 rs10850219

CC CT TT 17

Results in additively lower Vitamin B6

levels in the blood.

Results in moderately lower Vitamin B6

levels in the blood.

Associated with normal Vitamin B6 levels

in the blood.

NBPF3 rs4654748

CC CT TT


Genetics of Vitamin B6


KCTD10 rs10850219

AC CC AA 37

Moderate ability to form bio-active folate.

Higher risk of deficiency.

Decreased ability to form bio-active folate.


No effect on the ability to form bio-active folate.


MTHFR rs1801131


Genetics of Vitamin B9 (Folate)

AC CC AA


KCTD10 rs10850219

TC TT CC 37

Moderately decreased ability to form bio-active

folate. Higher risk of deficiency.

Significantly decreased ability to form bio-active

folate. Higher risk of deficiency.

No impact on the ability to form

bio-active folate.

MTHFR rs1801133


Genetics of Vitamin B9 (Folate)

TC TT CC


KCTD10 rs10850219

GA GG AA 17

Moderate risk of Vitamin B12 deficiency

due to genetic predisposition.

Greatest risk of Vitamin B12 deficiency

due to genetic predisposition.

No known genetic predisposition to

Vitamin B12 deficiency.

FUT2 rs6022662


Genetics of Vitamin B12

GA GG AA


KCTD10 rs10850219

GA GG AA 1

Intermediate circulating Vitamin D

in the blood.

Tendency towards lower amounts of

Vitamin D than “AA”.

Higher Vitamin D in the blood relative to other genotypes.

CYP2R1 rs10741657


Genetics of Vitamin D

GA GG AA


KCTD10 rs10850219

GG GT TT 1

Most likely to be Vitamin D deficient

relative to other genotypes.

An intermediate genotype. Increased

likelihood of Vitamin D deficiency.

Normal Vitamin D

predisposition.

DHCR7 rs12785878



GG GT TT


KCTD10 rs10850219

CC AA CA 1GC rs2282679

Most likely to be Vitamin D deficient

relative to other genotypes.

Normal Vitamin D

predisposition.

An intermediate genotype. Increased

likelihood of Vitamin D deficiency.



CC AA CA


KCTD10 rs10850219

CC AA CA 4

Associated with lower levels of Vitamin E

in the blood.

Associated with higherlevels of Vitamin E

in the blood.

Intermediate genotype. Associated with moderate

amount of Vitamin E in the blood.

Intergenic rs12272004


Genetics of Vitamin E

CC AA CA


KCTD10 rs10850219

TC TT CC 58TMPRSS6 rs855791

Associated with lower hemoglobin.

Two “T” reduce iron absorption.

Intermediate reduction in iron

absorption.

No association with reduction in iron

absorption.


Genetics of Vitamin E

TC TT CC


KCTD10 rs10850219

CC CT TT 59

Associated with lower hemoglobin.

Two “C” reduce iron absorption.

Intermediate genotype. Intermediate reduction

in iron absorption.

No association with reduction in iron

absorption.

TMPRSS6 rs4820268


Genetics of Iron

CC CT TT



MicronutrientsTraining Recap:

• Ensure you are meeting your unique micronutrient needs by consuming fats that help aid in the absorption of fat-soluble micronutrients (foods rich in Vitamins A, D, and E).

• Pay attention to labels (many contain information on micronutrients).

• Natural food sources provide the best ways to absorb the vitamins and minerals needed to achieve optimal health and wellness.

• Supplementation can help counter a predisposition if food sources aren’t an option (key for those who are busy and travel).



• AGS adheres to strict confidentiality and privacy laws, including GINA

(Genetic Information Nondiscrimination Act of 2008) and HIPAA.

• Unlike other genetic testing companies, AGS does not sell, share,

transfer or disclose personal or “de-identified” data to third parties.

• In compliance with and adherence to GINA, AGS does not provide

individual genetic data to employers (but can provide requested

aggregated data for recording and tracking purposes).

• AGS is focused on the delivery of informatic vs. clinical data (no

ancestry, heredity, genealogy, or illness/ disease prediction).

GeneShield™: Your Privacy is Our Priority

AGS is committed to protecting privacy.

For more information, please contact:Advanced Genomic Solutions (AGS)p: 877-URgenes (877.874.3637)w: www.ags-health.com

Thank You!

M171 B Micronutrients 100218

ags provider geneed training health & wellness genetic profile program/pdf... · 2018-10-03 ·...

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