For <a href="https://www.un.org/en/observances/international-day-of-families">International Day of Families</a>, 23andMe wanted to share with you what amounts to an international family story.
Life has been good for Paul Knoll.
<img loading="lazy" decoding="async" class="alignright wp-image-28257 size-medium" src="http://35.88.189.111/wp-content/uploads/2020/05/image6-1-224x300.jpeg" alt="" width="224" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/05/image6-1-224x300.jpeg 224w, https://blogcms.23andme.com/wp-content/uploads/2020/05/image6-1.jpeg 452w" sizes="auto, (max-width: 224px) 100vw, 224px" />
He and his wife raised two sons and a daughter. For years, he operated a successful professional staffing agency in New York City. Then not too long ago he moved back to his hometown in Nebraska, to retire. And he took more time to visit his kids and spend a little more time with his five grandchildren.
Life is good.

<h6>A French Canadian Connection</h6>
Adopted at nine months, Paul grew up in Nebraska with five siblings, four others were also adopted. But since he can remember, Paul, 67, had a nagging question he was never able to answer. Who were my birth parents, and why did my mom leave me in a Catholic home in Quebec, Canada, for unwanted children?
&#8220;Over the years, I tried to find out more,&#8221; he said. &#8220;But I never was able to find much information about them.&#8221;
<img loading="lazy" decoding="async" class="alignright wp-image-28256 size-medium" src="http://35.88.189.111/wp-content/uploads/2020/05/image3-1-e1588962325465-203x300.jpeg" alt="" width="203" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/05/image3-1-e1588962325465-203x300.jpeg 203w, https://blogcms.23andme.com/wp-content/uploads/2020/05/image3-1-e1588962325465-694x1024.jpeg 694w, https://blogcms.23andme.com/wp-content/uploads/2020/05/image3-1-e1588962325465-768x1134.jpeg 768w, https://blogcms.23andme.com/wp-content/uploads/2020/05/image3-1-e1588962325465-596x880.jpeg 596w, https://blogcms.23andme.com/wp-content/uploads/2020/05/image3-1-e1588962325465-799x1180.jpeg 799w, https://blogcms.23andme.com/wp-content/uploads/2020/05/image3-1-e1588962325465.jpeg 1064w" sizes="auto, (max-width: 203px) 100vw, 203px" />
Paul traveled to Quebec a few times to see if he could find records of his adoption, but the records were sealed, and the nuns gave up little information on his origins. All he learned was that his birth mother was a teenager when she became pregnant. Eventually, he gave up trying to find out more.
That all changed after his daughter, Katie, gave him a <a href="https://www.23andme.com/gifts" target="_blank" rel="noopener">DNA testing kit</a> as a gift two years ago. She too wanted to know more about her father&#8217;s origins, his ties to Quebec, and his <a href="https://en.wikipedia.org/wiki/History_of_the_Acadians">Acadian</a> roots. But neither expected what came next.
<h6>Someone in Omaha Love You</h6>
Soon after they both tested, opted into 23andMe&#8217;s DNA Relative tool, Katie told her dad that Paul&#8217;s half-sister had contacted her. And his half-sister said to them that Paul&#8217;s birth father, Pierre, is still alive and thriving at 92.
&#8220;I was floored,&#8221; Paul said.
For years all his focus was on his birth mom. He never expected to find his father. He&#8217;d been wondering about his mother. But instead, he&#8217;d suddenly connected with a sister and learned the identity of his father. And the surprises didn&#8217;t end there. Paul had six other half-siblings, five sisters and a brother. With email and phone calls, he soon had connected with all of them.
&#8220;All of a sudden, I got a whole family here,&#8221; he said. &#8220;We were just ecstatic over this news.&#8221;
<img loading="lazy" decoding="async" class="alignright wp-image-28258 size-medium" src="http://35.88.189.111/wp-content/uploads/2020/05/Paul-Knoll-and-siblings-300x225.jpeg" alt="" width="300" height="225" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/05/Paul-Knoll-and-siblings-300x225.jpeg 300w, https://blogcms.23andme.com/wp-content/uploads/2020/05/Paul-Knoll-and-siblings-768x576.jpeg 768w, https://blogcms.23andme.com/wp-content/uploads/2020/05/Paul-Knoll-and-siblings-880x660.jpeg 880w, https://blogcms.23andme.com/wp-content/uploads/2020/05/Paul-Knoll-and-siblings.jpeg 960w" sizes="auto, (max-width: 300px) 100vw, 300px" />
In June of last year, Paul traveled to Montreal to meet his brother and sisters. They spent a few days together learning about their lives and adding to their family story. He brought his siblings t-shirts that read, &#8220;Someone in Omaha Loves You.&#8221;
Paul was struck by how much in common they had with each other, from their looks to their mannerisms. Paul, it turned out, was the oldest. He was born before Pierre married his half-siblings&#8217; mother, who is also still alive. And a little after their gathering in Montreal, Paul, and his siblings learned that there was one other half-sister out there. There was another child born to unmarried parents and put up for adoption. Paul is the oldest, then the other half-sister who&#8217;d also been adopted, and then their six other siblings.
Paul has yet to meet his father.
&#8220;Pierre is in excellent health,&#8221; Paul said. &#8220;He knows about me but hasn&#8217;t hasn&#8217;t had the opportunity to meet yet as he lives in New Brunswick (Canada.)”
He&#8217;d like to meet him. He&#8217;d like to find out more about his birth mother and what happened to her.
But for now, he feels blessed by meeting his sisters and brother. A true friendship has grown between them. Their accomplishments humble him; one is the dean of a university, the husband of one of his sisters is a Parkinson&#8217;s disease researcher, another is a wilderness guide.
His family now sprawl across Canada and the United States. They&#8217;ve all agreed to meet again when it becomes possible. Maybe he will get to meet his birth father. Perhaps he&#8217;ll find out more about his birth mother. But, for now, Paul has what he needs.
&#8220;Meeting them all is good enough for me,&#8221; Paul said.

23andMe Blog

23andMe Blog Team

Connecting with Family Across Borders

(Editor&#8217;s note 5/: Although 23andMe researchers continue to work on the COVID-19 study we are no longer recruiting new customers as study participants. Existing 23andMe customers can still complete the survey and can contribute to the study <a href="https://you.23andme.com/research/surveys/covid_19_baseline/">here.)</a> 

Encouraged by strong interest, 23andMe is expanding its COVID-19 genetics study and opening enrollment to people who have been hospitalized with severe cases of the virus but are not currently 23andMe customers.<img loading="lazy" decoding="async" class="aligncenter wp-image-28267 size-larger" src="http://35.88.189.111/wp-content/uploads/2020/05/FB-Twitter-1200x628-1-880x461.png" alt="" width="880" height="461" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/05/FB-Twitter-1200x628-1-880x461.png 880w, https://blogcms.23andme.com/wp-content/uploads/2020/05/FB-Twitter-1200x628-1-300x157.png 300w, https://blogcms.23andme.com/wp-content/uploads/2020/05/FB-Twitter-1200x628-1-1024x536.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2020/05/FB-Twitter-1200x628-1-768x402.png 768w, https://blogcms.23andme.com/wp-content/uploads/2020/05/FB-Twitter-1200x628-1-1180x618.png 1180w, https://blogcms.23andme.com/wp-content/uploads/2020/05/FB-Twitter-1200x628-1.png 1200w" sizes="auto, (max-width: 880px) 100vw, 880px" />
Launched on April 6th to existing 23andMe customers who have consented for research,<a href="https://blog.23andme.com/articles/covid-19-genetic-study/"> the study</a> aims to enlist hundreds of thousands of individuals to determine if there are genetic factors associated with why the virus hits some people so much harder than others. Beginning today, anyone who is eligible will be able to <a href="http://you.23andme.com/covid19-study">enroll in the study</a>, which is no longer limited to just 23andMe customers.

<h6>Hundreds of Thousands of Participants</h6>
23andMe has already enrolled more than half a million participants in its COVID-19 study, including more than 7,000 who&#8217;ve been diagnosed with the virus. We hope to continue to add more as we gradually reach out to our millions of customers. We are now expanding the study to up to 10,000 individuals who have been hospitalized with severe cases of COVID-19 but are not currently 23andMe customers. Individuals who qualify for the study and are willing to participate in online surveys will receive the <a href="https://www.23andme.com/dna-health-ancestry/" target="_blank" rel="noopener">23andMe Health + Ancestry Service</a> at no cost. (Learn more about the study and eligibility <a href="http://you.23andme.com/covid19-study">here</a>.)
“Opening up the research to individuals with more severe symptoms will increase our power to learn how genes play a role in the severity of this disease,” said Joyce Tung, Ph.D., 23andMe’s Vice President of Research.
In addition, 23andMe is encouraging hospitals and healthcare systems that are interested in collaborating on this research to reach out to us at <a href="mailto:apply.research@23andme.com">apply.research@23andme.com</a>.
<h6>23andMe&#8217;s Unique Research Model</h6>
Our research platform allows 23andMe to not only reach out to current customers, but also quickly recruit and genotype new research participants. We can then survey those participants, and conduct genetic studies at a massive scale.
There is still much scientists do not know about this virus. It is also possible that 23andMe will not find strong genetic associations for the differences in the severity of symptoms. But we know from research that<a href="https://blog.23andme.com/articles/genetics-and-covid-19-severity/"> genetics plays a role</a> in both susceptibility to and severity of other infectious diseases. For example, variants in the HBB gene influence an individual’s susceptibility to malaria.  Variants in the FUT2 gene confer some resistance to the norovirus. And variants in the HLA genes may explain the differences in the immune response to several different infections. In the case of COVID-19, there are several questions about whether genetics may explain the differences in immune response among patients. Our study could aid in assessing differences in risk among individuals. It could also guide efforts now underway to treat the disease caused by the virus.
<h6>Studying at Differences in Severity</h6>
Enrolling more individuals who have experienced severe COVID-19 symptoms in the study will enable 23andMe to investigate a spectrum of how people experience this disease. By studying those with severe symptoms versus patients with moderate or mild symptoms, 23andMe researchers will be in a better position to uncover potential genetic factors associated with the severity of the disease.
If we are successful in gathering enough data for this genome-wide association study, we plan to share the results of our research with the broader scientific community. We will also continue to consider the expansion of enrollment and eligibility requirements for the study.
If you or someone you know has been hospitalized for COVID-19 and is interested in participating in this research you can find out more <a href="http://you.23andme.com/covid19-study">here</a>.
<hr />
<h6>References:</h6>
1)<a href="https://www.ncbi.nlm.nih.gov/pubmed/22310894"> Chapman SJ et al. (2012). “Human genetic susceptibility to infectious disease.” Nat Rev Genet. 13(3):175-88.</a>
2) <a href="https://www.ncbi.nlm.nih.gov/pubmed/28928442">Tian C et al. (2017). “Genome-wide association and HLA region fine-mapping studies identify susceptibility loci for multiple common infections.” Nat Commun. 8(1):599.</a>

23andMe Expands its Genetic Study of COVID-19

Many people who carry a BRCA genetic variant associated with an increased risk for breast, ovarian, prostate, and certain other cancers do not have a strong family history of cancer, according to a new study from 23andMe. This means that these individuals would likely not qualify for clinical genetic testing unless they developed cancer themselves, representing a missed opportunity for cancer prevention.<img loading="lazy" decoding="async" src="https://blog-api.23andme.com/wp-content/uploads/2018/04/BRCA-wide-image-1-300x192.png" alt="" class="alignright wp-image-26127 size-medium" width="300" height="192" srcset="https://blogcms.23andme.com/wp-content/uploads/2018/04/BRCA-wide-image-1-300x192.png 300w, https://blogcms.23andme.com/wp-content/uploads/2018/04/BRCA-wide-image-1.png 318w" sizes="auto, (max-width: 300px) 100vw, 300px" />
The study, published in the journal <a href="https://www.nature.com/articles/s41598-020-63466-x">Scientific Reports</a>, could help inform the on-going discussion around broader access to BRCA genetic testing.  
&#8220;Our study suggests that many individuals with a BRCA variant are likely being missed under current testing criteria,&#8221; said Ruth Tennen Ph.D., a 23andMe Product Scientist and a co-author of the study. 
<h6>Cancer History and Ashkenazi Ancestry </h6>
The study is consistent with findings from other researchers suggesting many individuals who carry BRCA risk variants slip through the cracks in current testing. A recent study by <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2703131">researchers at Geisinger</a> reported that more than 80 percent of people with a BRCA variant did not know they have one.
Current clinical criteria for BRCA genetic testing include having a personal or <a href="https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing">family history of cancer</a>. Having Ashkenazi Jewish ancestry is also taken into consideration. 
But the 23andMe study found that a significant number of individuals with one of three BRCA risk variants common among Ashkenazi Jews have no known first-degree family history of a BRCA-related cancer or no known Jewish ancestry. 
About 44 percent of individuals who provided both ancestry and family health history information had no first-degree relative with a BRCA-related cancer, the study found. The researchers also found that 21 percent of individuals who had one of the three Ashkenazi Jewish BRCA1 or BRCA2 founder variants did not report having Jewish ancestry. But of those individuals, more than half did have detectable Ashkenazi Jewish genetic ancestry. In the absence of a personal history of cancer, these individuals would have been unlikely to qualify for clinical genetic testing, and would have been left unaware of their risk. 
<h6>23andMe Study Details</h6>
The study included data from more than 2,800 23andMe customers who consented to participate in research. All of those individuals carry one or more of the three genetic variants in the BRCA1 and BRCA2 genes included in 23andMe&#8217;s BRCA1/BRCA2 (Selected Variants) Genetic Health Risk report* that are associated with an increased risk for breast, ovarian, prostate, and certain other cancers. 
While these three variants are most commonly found in people of Ashkenazi ancestry, they confer significant risk no matter a person&#8217;s ancestry. The prevalence of these three variants is about 1 in 40 in people of Ashkenazi Jewish descent. In the general population, about 1 in 300 to 1 in 800 individuals has a BRCA variant, although typically not one of the three variants included in 23andMe&#8217;s report. Women with a BRCA variant have a 45-85 percent chance of developing breast cancer and up to a 46 percent chance of developing ovarian cancer by age 70. Men with a BRCA variant have an increased risk for male breast cancer and may have an increased risk for prostate cancer. Having one of these variants may also increase the risk for pancreatic cancer and melanoma.
<h6>23andMe&#8217;s Genetic Health Risk Report</h6>
<div id="attachment_26897" style="width: 272px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-26897" src="https://blog-api.23andme.com/wp-content/uploads/2019/02/Speak-BRCA-262x300.jpg" alt="" class="wp-image-26897 size-medium" width="262" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2019/02/Speak-BRCA-262x300.jpg 262w, https://blogcms.23andme.com/wp-content/uploads/2019/02/Speak-BRCA.jpg 376w" sizes="auto, (max-width: 262px) 100vw, 262px" />You can learn more about BRCA <a href="https://www.23andme.com/brca/">here</a>.</div>
It&#8217;s important to understand that 23andMe&#8217;s BRCA1/BRCA2 (Selected Variants) Genetic Health Risk <a href="https://www.23andme.com/test-info/genetic-health/">report</a>* looks at just three genetic variants associated with increased risk for breast, ovarian, prostate, and certain other cancers. 23andMe is still the only company <a href="https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm599560.htm">with FDA authorization</a> to offer direct-to-consumer genetic health risk reports for cancer predisposition. The report is by no means a comprehensive screen, nor is it meant to be diagnostic. There are more than 1,000 other BRCA variants associated with increased cancer risk.
This study focused on just the three variants 23andMe tests for because they have been analytically validated on the most recent versions of 23andMe&#8217;s genotyping chip. For these three risk variants, 23andMe has demonstrated a greater than 99 percent accuracy and reproducibility in testing. 
Several years ago, 23andMe conducted a smaller study looking at the response to <a href="https://peerj.com/articles/8/">unexpected BRCA</a> findings. That study found that those who learned they carried a risk variant generally took appropriate actions, talking to their doctors and sharing their results with family members, creating what the study called a &#8220;cascade effect&#8221; that benefited relatives who might not know of the family risk for these hereditary cancers.
The 23andMe study published this week may help inform discussions about broader access to BRCA<a href="https://www.23andme.com/" target="_blank" rel="noopener"> genetic testing</a>. 
&nbsp;
*The 23andMe PGS test uses qualitative genotyping to detect select clinically relevant variants in the genomic DNA of adults from saliva for the purpose of reporting and interpreting genetic health risks, including the 23andMe PGS Genetic Health Risk Report for BRCA1/BRCA2 (Selected Variants). Your ethnicity may affect the relevance of each report and how your genetic health risk results are interpreted. The test is not intended to diagnose any disease and does not describe a person&#8217;s overall risk of developing any type of cancer. It is not intended to tell you anything about your current state of health, or to be used to make medical decisions, including whether or not you should take a medication, how much of a medication you should take, or determine any treatments. Warnings &amp; Limitations: The 23andMe PGS Genetic Health RIsk Report for BRCA1/BRCA2 (Selected Variants) is indicated for reporting of the 185delAG and 5382insC variants in the BRCA1 gene and the 6174delT variant in the BRCA2 gene. The report describes if a woman is at increased risk of developing breast and ovarian cancer, and if a man is at increased risk of developing breast cancer or may be at increased risk of developing prostate cancer. The three variants included in this report are most common in people of Ashkenazi Jewish descent and do not represent the majority of BRCA1/BRCA2 variants in the general population. This report does not include variants in other genes linked to hereditary cancers and the absence of variants included in this report does not rule out the presence of other genetic variants that may impact cancer risk. The PGS test is not a substitute for visits to a healthcare professional for recommended screenings or appropriate follow-up. Results should be confirmed in a clinical setting before taking any medical action. 
&nbsp;

New 23andMe BRCA Study Published

<img loading="lazy" decoding="async" class="alignright wp-image-28186 size-medium" src="http://35.88.189.111/wp-content/uploads/2020/03/Maida--225x300.jpeg" alt="" width="225" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/03/Maida--225x300.jpeg 225w, https://blogcms.23andme.com/wp-content/uploads/2020/03/Maida--768x1024.jpeg 768w, https://blogcms.23andme.com/wp-content/uploads/2020/03/Maida--660x880.jpeg 660w, https://blogcms.23andme.com/wp-content/uploads/2020/03/Maida--885x1180.jpeg 885w, https://blogcms.23andme.com/wp-content/uploads/2020/03/Maida-.jpeg 1512w" sizes="auto, (max-width: 225px) 100vw, 225px" />Maida approached 23andMe as a skeptic, but seeing her reports completely changed her mind.
Maida, who has celiac and type 2 diabetes, used 23andMe because she was curious about her genetic predispositions.
<h2>Changing her Mind</h2>
Maida was shocked that the 23andMe reports did indeed indicate that she had a higher genetic likelihood of developing both conditions. Maida was first diagnosed with celiac disease in the 1970s. The autoimmune condition can damage the small intestine, triggered by the consumption of gluten (found in wheat, barley, and rye).
A lot has changed in medicine since Maida was diagnosed with celiac disease. The diagnosis of type 2 diabetes came much later.
“Both of those things showed up on my report, boom boom,” Maida said. “Ok, I believe this test has got something right.”
Maida also noticed that her report indicated she is at increased risk for developing harmful blood clots due to the factor V Leiden variant.
“I told my doctor about it. She wrote it down in my chart, saying that she will watch out for deep vein clotting,” said Maida.
<h2>A Little Neanderthal</h2>
As for her 23andMe ancestry reports, those confirmed what she already knew about her family. Maida comes from a long line of Englishmen, supported by some Northern European, French, German and Scandinavian stock.
The one surprise for Maida was discovering she has a significant number of Neanderthal traits. According to her report, the highest number of Neanderthal traits found was 367, but Maida has a whopping 328.
“I thought, what am I, A caveman?” Maida mused.
What began as a slightly skeptical experiment has completely turned Maida’s opinions around.
“I’ve recommended 23andMe to other people,” Maida said. “I’ve told my doctors about it too.”

A 23andMe Skeptic Changes Her Mind

<div id="attachment_28228" style="width: 268px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-28228" src="https://blog-api.23andme.com/wp-content/uploads/2020/04/Mimi.png" alt="" class="wp-image-28228 size-medium" width="258" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/04/Mimi.png 441w, https://blogcms.23andme.com/wp-content/uploads/2020/04/Mimi-258x300.png 258w" sizes="auto, (max-width: 258px) 100vw, 258px" />Mimi in her 20s.</div>
 by Samantha Ancona Esselmann, Ph.D., product scientist at 23andMe
From an early age, I knew my great-grandmother had superpowers. “Mimi,” we called her. 
She was born in the late 1800s, earned a graduate degree from Berkeley in 1919, sipped a glass (or two) of sherry every evening, and charmed us with her wit until the very end. And, like her mother “Nanan” before her, Mimi lived to be over 100.  
During the course of her remarkable life that straddled three different centuries and two millennia, she survived tuberculosis (which killed her father), the 1906 San Francisco earthquake, the 1918 Flu, retro-peristalsis (the reversal of intestinal smooth muscle movement), and two C-sections before the discovery of penicillin.
In her late 90s — coincidentally, during the late 1990s — she recovered from a broken hip, sepsis, and flu that would have felled a woman half her age. Well into her hundreds, she still walked every day, required no prescription medications, and ate ice cream every night. 
<h6>I thought she was invincible</h6>
When she died at 103 shortly after a bad fall, it wasn’t an infection that killed her. It was organ failure. Her own body simply turned off the switch. 
I think about Mimi — and her immune system — a lot. Apart from the obvious privilege that comes with being a white, middle-class woman in California, she lived a charmed life. 
And while Mimi’s immune system never faced this coronavirus, I wonder if some people are just born better equipped to fight infection than others? After all, each of us has that family member who “gets sick a lot” and that one relative who is “never sick” (lookin’ at you, Mom). 
We don’t know much yet about what factors can influence our immune systems’ responses to COVID-19. <a href="https://www.nature.com/articles/s41467-017-00257-5">Research shows</a> there are clear genetic differences in susceptibility to other infectious diseases — with much of that variation found in genes involved in the immune system.<a id="f1" href="#a1">[1]</a> 
 But our environment <a href="https://www.cell.com/cell/fulltext/S0092-8674(14)01590-6">likely plays</a> a big role in how well our immune systems function, too.<a id="f2" href="#a2">[2]</a> 
 Good news for me because I probably only inherited around 12.5% of Mimi’s DNA. 
The more I learn about the complexity of the human immune system, the more I realize it may not have been a particularly “strong” immune response that saved Mimi. It might’ve just been the “right” response. After all, an overzealous immune reaction — like anaphylactic shock — can kill a person. 
And an overzealous immune reaction seems to be contributing to COVID-19 <a href="https://www.ncbi.nlm.nih.gov/pubmed/32192578">deaths</a>. 
<h6>COVID-19 vs. the Immune System </h6>
When a person is infected with SARS-CoV-2 (aka novel coronavirus), the virus invades cells lining the patient’s respiratory tract and hijacks their cellular machinery to make more coronavirus, which goes on to infect more and more cells. 
Next, the body’s immune system starts to take notice. But in some patients, the immune system gets carried away and they become sicker from their body’s own inflammatory response than from the virus itself. 
Widespread inflammation of the lungs — triggered by a wave of inflammatory molecules in your body called cytokines — can lead to a condition called Acute Respiratory Distress Syndrome, or ARDS. In ARDS, the barrier between the blood and the lungs’ delicate air sacs breaks down and the lungs fill with fluid. This breakdown impairs the lungs’ ability to oxygenate the blood and clear carbon dioxide, which can lead to organ failure. 
The drugs being deployed in hospitals to fight COVID-19 are not just experimental antiviral drugs like <a href="https://www.ncbi.nlm.nih.gov/pubmed/32152082">remdesivir</a>. <a id="f3" href="#a3">[3]</a> 
 Some of them are drugs that dampen the body’s immune response, in the hopes that they will give the patients a chance to take a deep breath (literally and figuratively) and get back to the business of fighting the virus. 
During recent infectious diseases division <a href="https://youtu.be/bt-BzEve46Y?t=2139">grand rounds</a> at UCSF, Dr. Michael Matthay, an ARDS expert and professor at UCSF’s Pulmonary Medicine department, speculated that once a patient has arrived in the ICU and developed ARDS, antiviral therapy may “not be effective.”<a id="f4" href="#a4">[4]</a> 
 Some experts think it may be more effective to intervene with antiviral drugs <a href="https://youtu.be/bt-BzEve46Y">during earlier stages</a> of the disease when symptoms are not yet severe.<a id="f5" href="#a5">[5]</a> 
 Or, perhaps an immune overreaction only affects certain patients, while others with severe symptoms could still benefit from antiviral treatment. 

So what can make some peoples’ immune response to COVID-19 different from others?
<h6>Sex and the Immune System</h6>
We’re beginning to see clear sex differences in the rate of COVID-19 infection and mortality: not only are men more susceptible to infection by SARS-CoV2, but they are also more likely to die from the disease. In a recent European surveillance report from the World Health Organization, about two-thirds of COVID-19 deaths that week were men.<a id="f6" href="#a6">[6]</a> 
 
Some of these differences could be environmental. In many parts of the world, for example, men smoke more than women (which reduces lung health) and men are more likely to have preexisting chronic health conditions, such as heart disease, or high blood pressure. 
But biological sex is known to play a differential role in the immune system. Women are much more susceptible to autoimmune diseases in which their own immune systems turn against them and attack healthy tissue such as rheumatoid arthritis, multiple sclerosis, and lupus. 
At the same time, women often have a more robust immune response to pathogens like viruses and bacteria — a pattern that may be repeated with SARS-CoV-2. 
Some researchers are <a href="https://www.latimes.com/science/story/2020-03-21/why-is-the-coronavirus-more-deadly-for-men-than-for-women">speculating</a> that women may have a stronger immune response to SARS-CoV-2 in the early stages of a viral infection than men. <a id="f7" href="#a7">[7]</a> 
 Compared to SARS (the classic kind), COVID-19 viral replication <a href="https://youtu.be/bt-BzEve46Y?t=442">seems to peak earlier and at higher levels</a> during the course of the disease, meaning an early and robust immune response could be the difference between life and death. <a id="f8" href="#a8">[8]</a> 
 
A delayed immune response can be doubly dangerous. After the virus has a chance to wreak havoc in the lungs, an overzealous immune reaction can set off a widespread inflammatory response that causes further damage, accelerating progression to ARDS.
But sex is not the only variable that influences our body’s ability to fight infection.
<h6>Age and the Immune System</h6>
You’ve probably heard by now that mortality from COVID-19 is much higher among older people. <a id="f9" href="#a9">[9]</a> (Though it’s important to note that all age groups are <a href="https://www.statnews.com/2020/03/18/u-s-official-says-data-show-severe-coronavirus-infections-among-millennials-not-just-older-americans/">susceptible to severe infection</a> and young people can die from it too.) 
Apart from being more likely to have chronic “comorbid” conditions such as heart disease, type II diabetes, or high blood pressure, older people are more likely to have <a href="https://www.ncbi.nlm.nih.gov/pubmed/29111233">dysregulated immune systems</a>. <a id="f10" href="#a10">[10]</a>
Like a trailer slowly fish-tailing out of control, our immune system’s ability to cope with pathogens decreases as we age, and our inflammatory response <a href="https://www.ncbi.nlm.nih.gov/pubmed/18240544">increases</a>.<a id="f11" href="#a11">[11]</a>
Fewer precision-guided missiles. More carpet bombs.
While we may never be able to stop or reverse the aging of our immune systems — and genetics likely play a role that’s outside of our control — there are certain <a href="https://www.nytimes.com/2020/03/10/well/live/can-i-boost-my-immune-system.html">things we can do</a> to slow it down and keep it in a “goldilocks zone” for as long as possible. <a id="f12" href="#a12">[12]</a>
Exercise. Get enough sleep. Avoid stress (where possible). And eat a healthy diet. 
Not too hot. Not too cold. Just right. 
Like Mimi. 
<hr />
<h6 class="footnotes">References:</h6>
<footer class="footnotes">
<code style="display: none;"> 
</code><code style="display: none;"> 
</code><a id="f1" href="#a1">[1]</a> Tian, C., Hromatka, B.S., Kiefer, A.K. et al. Genome-wide association and HLA region fine-mapping studies identify susceptibility loci for multiple common infections. Nat Commun 8, 599 (2017). https://doi.org/10.1038/s41467-017-00257-5. <a href=" https://www.nature.com/articles/s41467-017-00257-5#citeas"> https://www.nature.com/articles/s41467-017-00257-5#citeas</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f2" href="#a2">[2]</a>Broden P et al. (2015). &#8220;Variation in the Human Immune System Is Largely Driven by Non-Heritable Influences.&#8221; Cell. 2015 Jan 15;160(1-2):37-47. doi: 10.1016/j.cell.2014.12.020.<a href="https://www.cell.com/cell/fulltext/S0092-8674(14)01590-6">https://www.cell.com/cell/fulltext/S0092-8674(14)01590-6</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f3" href="#a3">[3]</a>Martinez MA (2020). &#8220;Compounds with therapeutic potential against novel respiratory 2019 coronavirus&#8221; Antimicrob Agents Chemother. 2020 Mar 9. pii: AAC.00399-20. doi: 10.1128/AAC.00399-20. [Epub ahead of print]<a href="https://www.ncbi.nlm.nih.gov/pubmed/32152082">https://www.ncbi.nlm.nih.gov/pubmed/32152082</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f4" href="#a4">[4]</a>Martinez MA (2020). &#8220;Compounds with therapeutic potential against novel respiratory 2019 coronavirus&#8221; Antimicrob Agents Chemother. 2020 Mar 9. pii: AAC.00399-20. doi: 10.1128/AAC.00399-20. [Epub ahead of print]<a href="https://www.ncbi.nlm.nih.gov/pubmed/32152082">https://www.ncbi.nlm.nih.gov/pubmed/32152082</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f5" href="#a5">[5]</a> &#8220;UCSF Experts on the Epidemiology, Science, &amp; Clinical Manifestations of COVID-19, and UCSF Response&#8221; YouTube <a href="https://youtu.be/bt-BzEve46Y?t=2139">https://youtu.be/bt-BzEve46Y?t=2139 </a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f6" href="#a6">[6]</a> &#8220;UCSF Experts on the Epidemiology, Science, &amp; Clinical Manifestations of COVID-19, and UCSF Response&#8221; YouTube <a href="https://youtu.be/bt-BzEve46Y?t=2139">https://youtu.be/bt-BzEve46Y?t=2139 </a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f7" href="#a7">[7]</a> &#8220;Weekly surveillance report &#8211; COVID-19 
&#8221; WHO http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/weekly-surveillance-report</footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f8" href="#a8">[8]</a> &gt; &#8220;UCSF Experts on the Epidemiology, Science, &amp; Clinical Manifestations of COVID-19, and UCSF Response&#8221; YouTube <a href="https://youtu.be/bt-BzEve46Y?t=2139">https://youtu.be/bt-BzEve46Y?t=2139 </a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f9" href="#a9">[9]</a> &#8220;U.S. official says data show severe coronavirus infections among millennials, not just older Americans&#8221; STAT News 2020 Mar 18<a href="https://www.statnews.com/2020/03/18/u-s-official-says-data-show-severe-coronavirus-infections-among-millennials-not-just-older-americans/">https://www.statnews.com/2020/03/18/u-s-official-says-data-show-severe-coronavirus-infections-among-millennials-not-just-older-americans/</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f10" href="#a10">[10]</a>Pawelec G (2018). &#8220;Age and immunity: What is &#8220;immunosenescence&#8221; Exp Gerontol. 2018 May;105:4-9. doi: 10.1016/j.exger.2017.10.024. Epub 2017 Oct 27. <a href="https://www.ncbi.nlm.nih.gov/pubmed/32152082">https://www.ncbi.nlm.nih.gov/pubmed/32152082</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f11" href="#a11">[11]</a> Franceschi C (2007). &#8220;Inflammaging as a major characteristic of old people: can it be prevented or cured?&#8221; Nutr Rev. 2007 Dec;65(12 Pt 2):S173-6. <a href="https://www.ncbi.nlm.nih.gov/pubmed/18240544">https://www.ncbi.nlm.nih.gov/pubmed/18240544</a></footer>
<footer class="footnotes">
<code style="display: none;"> 
</code><a id="f12" href="#a12">[12]</a> &#8220;Can I Boost My Immune System?&#8221; New York Times 2020 Mar 10]<a href="https://www.nytimes.com/2020/03/10/well/live/can-i-boost-my-immune-system.html">https://www.nytimes.com/2020/03/10/well/live/can-i-boost-my-immune-system.html</a></footer>
<footer class="footnotes">
</footer>

COVID-19 and the immune system’s double-edged sword

Since 23andMe’s Neanderthal Ancestry report was first released eight years ago, new scientific discoveries have enabled 23andMe to identify previously unknown associations between Neanderthal DNA variants and certain traits. 
While most people have a relatively tiny percentage of Neanderthal DNA, our ancient cousins are a big part of the human story. Now we’re celebrating that ancient DNA in a big way with the release of an even more detailed Neanderthal Ancestry report.
<img loading="lazy" decoding="async" src="https://blog-api.23andme.com/wp-content/uploads/2020/03/macbook-pro-stock-mockup@2x-1024x649.png" alt="" class="aligncenter size-large wp-image-28102" width="1024" height="649" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/03/macbook-pro-stock-mockup@2x-1024x649.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2020/03/macbook-pro-stock-mockup@2x-300x190.png 300w, https://blogcms.23andme.com/wp-content/uploads/2020/03/macbook-pro-stock-mockup@2x-768x486.png 768w, https://blogcms.23andme.com/wp-content/uploads/2020/03/macbook-pro-stock-mockup@2x-880x557.png 880w, https://blogcms.23andme.com/wp-content/uploads/2020/03/macbook-pro-stock-mockup@2x-1180x747.png 1180w" sizes="auto, (max-width: 1024px) 100vw, 1024px" />
<h6>A Brief History of the Neanderthal Ancestry Report</h6>
Since the Neanderthal genome was sequenced for the first time in 2010, scientists have learned a lot more about how these ancient hominins lived, and how their DNA may affect us today. These studies have even given us insight into human migration out of Africa. Most recently <a href="https://www.cell.com/cell/fulltext/S0092-8674(20)30059-3">we learned</a> that modern humans may have left the continent 200,000 years ago, much earlier than we thought. Since 23andMe first started offering Neanderthal ancestry insights in 2011, many new discoveries have been made that we’d like to highlight. 
But this series of recent scientific discoveries aren’t the only driving force behind this update — we also listened to all the customer feedback and questions we’ve received over the years. We appreciate all of the Neanderthal nerds who asked for more features, suggested new stories, and shared their own experiences.

<img loading="lazy" decoding="async" src="https://blog-api.23andme.com/wp-content/uploads/2020/03/blog_image-1024x315.png" alt="" class="aligncenter size-large wp-image-28100" width="1024" height="315" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/03/blog_image-1024x315.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2020/03/blog_image-300x92.png 300w, https://blogcms.23andme.com/wp-content/uploads/2020/03/blog_image-768x237.png 768w, https://blogcms.23andme.com/wp-content/uploads/2020/03/blog_image-880x271.png 880w, https://blogcms.23andme.com/wp-content/uploads/2020/03/blog_image-1180x363.png 1180w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /> 
<h6>What’s New in this Update </h6>
All the Neanderthal report features our customers know and love — their Neanderthal Ancestry percentile, Connections leaderboard, and ancient history stories —  are still included in the report. Now, customers will also see more than double the number of Neanderthal trait associations, including brand new trait associations, some of which are exclusive to customers on a v5 chip.  We’ve also added three new social share cards for your Neanderthal results as part of the ultimate ancient DNA conversation starter pack. 
In addition to giving the Neanderthal report a whole new look and feel, we’ve simplified customers’ results for clarity and added new stories to help bring humans’ ancient Neanderthal ancestors to life. 
 
<h6><img loading="lazy" decoding="async" src="https://blog-api.23andme.com/wp-content/uploads/2020/03/neanderthal_desktop_v2_1.2-copy-1024x464.png" alt="" class="aligncenter size-large wp-image-28103" width="1024" height="464" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/03/neanderthal_desktop_v2_1.2-copy-1024x464.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2020/03/neanderthal_desktop_v2_1.2-copy-300x136.png 300w, https://blogcms.23andme.com/wp-content/uploads/2020/03/neanderthal_desktop_v2_1.2-copy-768x348.png 768w, https://blogcms.23andme.com/wp-content/uploads/2020/03/neanderthal_desktop_v2_1.2-copy-880x399.png 880w, https://blogcms.23andme.com/wp-content/uploads/2020/03/neanderthal_desktop_v2_1.2-copy-1180x535.png 1180w" sizes="auto, (max-width: 1024px) 100vw, 1024px" />
The Science Behind the Report</h6>
Research suggests that 1-2 percent of the genomes of all modern humans with European, Asian, or Native American ancestry are of Neanderthal origin. (A <a href="https://www.cell.com/cell/fulltext/S0092-8674(20)30059-3">recent study </a>suggests that people of African ancestry also have a very small amount of Neanderthal DNA, a surprising finding that suggests modern humans migrated out of Africa much earlier than we thought, intermixed with Neanderthals, and then some migrated back to the continent.)  Scientists at 23andMe further noticed that several Neanderthal DNA variants are associated with traits in 23andMe customers. To do this, scientists combined and analyzed data from 23andMe’s database of genotyped customers who have consented to participate in research through web-based surveys. The team was then able to identify associations between Neanderthal DNA variants and human traits like the likelihood of sneezing after eating dark chocolate, sense of direction, mosquito bite frequency, body type, dandruff, or being naturally strong, among others.
&nbsp;
Many of these new Neanderthal trait associations were identified from DNA variants that are only found on 23andMe’s v5 chip. A customer will need to upgrade their chip if they’re on a previous version in order to see all of the new possible Neanderthal trait associations. 
&nbsp;
“So much about Neanderthals have been discovered over the last decade, and we’re really starting to understand that they were probably a lot like us,” said Samantha Ancona Esselmann, Ph.D., the 23andMe product scientist behind the new report. “23andMe has a unique opportunity to highlight some of those exciting new discoveries to help bring our Neanderthal ancestors to life.”
<h6>What’s changing for existing customers?</h6>
If you are on the most recent version of the 23andMe genotyping chip (called “v5”), you can expect your Neanderthal DNA variant count and percentile to change with the most recent update. That’s because we improved the way we count your Neanderthal variants. Now, our analysis does a better job identifying Neanderthal ancestry in non-European populations and provides you with a more representative estimate of your Neanderthal ancestry compared to people from around the world. 
Customers on earlier versions of the genotyping chip should see no change in their number of Neanderthal DNA variants, but they may see a small percentile change reflecting the most up-to-date analysis.
Not a 23andMe customer yet? <a href="https://www.23andme.com/compare-dna-tests/">Buy a kit </a>to start learning all about your own Neanderthal DNA and more. If you’re already a customer, you can share your updated Neanderthal results and fun facts with share cards to post on your favorite social media channels. 
&nbsp;
<img loading="lazy" decoding="async" src="https://blog-api.23andme.com/wp-content/uploads/2020/03/iphone-x-mockup-scene@2x-2-1024x768.png" alt="" class="aligncenter size-large wp-image-28105" width="1024" height="768" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/03/iphone-x-mockup-scene@2x-2-1024x768.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2020/03/iphone-x-mockup-scene@2x-2-300x225.png 300w, https://blogcms.23andme.com/wp-content/uploads/2020/03/iphone-x-mockup-scene@2x-2-768x576.png 768w, https://blogcms.23andme.com/wp-content/uploads/2020/03/iphone-x-mockup-scene@2x-2-880x660.png 880w, https://blogcms.23andme.com/wp-content/uploads/2020/03/iphone-x-mockup-scene@2x-2-1180x885.png 1180w" sizes="auto, (max-width: 1024px) 100vw, 1024px" />

Celebrate your Ancient DNA with a New Neanderthal Report

By Stella Aslibekyan, Briana Cameron and Teresa Filshtein



A <a href="https://blog.23andme.com/23andme-research/23andme-explores-dietary-habit-and-health-outcomes/">recent 23andMe blog post</a> explored the old adage “you are what you eat,” examining the relationship between eating habits and their health outcomes.



However, we wanted to explore another dimension of the data. We wanted to see if where you live is associated with what you eat. So rather than looking at “you are what you eat,” we want to see whether “You eat where you are.”



<h2 class="wp-block-heading" id="h-dietary-geography">Dietary Geography</h2>



Years of scientific research have brought us to the almost undeniable conclusion that the food you eat affects health outcomes, especially later in life. However, dietary habits can be influenced by many different factors. Some of those factors include personal food preferences, local policy, availability of options, and cultural ones, like the habits of those around us. (See our new paper on <a href="https://www.medrxiv.org/content/10.1101/2020.04.14.20058263v1">dietary habits research</a> and the sidebar to this post, &#8220;A New Recipe for Nutritional Studies.&#8221;)



<figure class="wp-block-image alignright size-full"><img loading="lazy" decoding="async" width="283" height="424" src="http://35.88.189.111/wp-content/uploads/2013/03/mediterranean-diet.jpg" alt="" class="wp-image-17819" srcset="https://blogcms.23andme.com/wp-content/uploads/2013/03/mediterranean-diet.jpg 283w, https://blogcms.23andme.com/wp-content/uploads/2013/03/mediterranean-diet-200x300.jpg 200w" sizes="auto, (max-width: 283px) 100vw, 283px" /></figure>



Being aware of external factors influencing your dietary habits could be a first step to making changes that might reduce your risk of adverse health outcomes such as type 2 diabetes, obesity, cardiovascular events, accelerated aging, and more.[1] One external factor is location, as public health research has shown how “food deserts”&nbsp; — urban and rural neighborhoods without grocery stores — have contributed to poor health outcomes. At 23andMe, we have a unique opportunity to explore the connections between diet and geography.



Our scientists analyzed data from more than 750,000 23andMe customers who consented to participate in the research and shared details about their eating habits. Our results focused on four major food categories: vegetable and fruit intake, sugar intake (added sugar intake and sugar-sweetened beverages), red meat intake, and dairy intake. Vegetables, fruit, and dairy were measured in cups per day; sugar was measured in teaspoons per day, and red meat was measured in times eaten per day.



We found distinct differences in eating habits among broad regions in the United States and between urban and rural environments.



<h2 class="wp-block-heading" id="h-dietary-habits-in-the-us">Dietary Habits in the US</h2>



The map clearly shows that people in the West and Northeast eat more fruit and vegetables, while those in the Central and Southern U.S. eat more sugar. Below are some nutrition maps across the U.S. Each map represents a visualization of self-reported consumption by county. In each map, red indicates consumption levels associated with BMI increases.



<figure class="wp-block-gallery has-nested-images columns-2 is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex">
<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="512" height="376" data-id="30711" src="http://35.88.189.111/wp-content/uploads/2022/11/Mean-Fruit-Map.png" alt="" class="wp-image-30711" srcset="https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Fruit-Map.png 512w, https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Fruit-Map-300x220.png 300w" sizes="auto, (max-width: 512px) 100vw, 512px" /><figcaption class="wp-element-caption">People in the West and Northeast consume more fruit.</figcaption></figure>



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="512" height="376" data-id="30707" src="http://35.88.189.111/wp-content/uploads/2022/11/Mean-Dairy-Map.png" alt="" class="wp-image-30707" srcset="https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Dairy-Map.png 512w, https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Dairy-Map-300x220.png 300w" sizes="auto, (max-width: 512px) 100vw, 512px" /><figcaption class="wp-element-caption">The Northern US consumes greater amounts of dairy than the Southern half, with the highest consumption in the northern Central region. </figcaption></figure>
</figure>



The maps represent the average self-reported consumption of each dietary factor at the county level; counties with less than 5 participants were not evaluated and show up in white on the map to protect our participants&#8217; privacy. 



<figure class="wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex">
<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="512" height="376" data-id="30706" src="http://35.88.189.111/wp-content/uploads/2022/11/Mean-Vegetables-1.png" alt="" class="wp-image-30706" srcset="https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Vegetables-1.png 512w, https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Vegetables-1-300x220.png 300w" sizes="auto, (max-width: 512px) 100vw, 512px" /><figcaption class="wp-element-caption">People in the West and Northeast also eat more vegetables.</figcaption></figure>



<figure class="wp-block-image size-full"><img loading="lazy" decoding="async" width="512" height="376" data-id="30709" src="http://35.88.189.111/wp-content/uploads/2022/11/Mean-Sugar.png" alt="" class="wp-image-30709" srcset="https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Sugar.png 512w, https://blogcms.23andme.com/wp-content/uploads/2022/11/Mean-Sugar-300x220.png 300w" sizes="auto, (max-width: 512px) 100vw, 512px" /><figcaption class="wp-element-caption">Sugar consumption in the US followed a pattern opposite to that of vegetables and fruits, with the highest consumption occurring in the Central and Southern parts of the country. </figcaption></figure>
</figure>



Each map is scaled such that the color shift occurs at the median. Gradients within color are based on quantiles, so extremes (bottom and top 5 percent of the population) are darkest.



<h2 class="wp-block-heading" id="h-the-rural-effect-nbsp">The Rural Effect&nbsp;</h2>



<div style="float: right; text-align: justified; width: 300px; background-color: #eee; padding: 10px; margin-left: 15px;">
A New Recipe for Nutritional Studies
Something so elemental as food shouldn’t be so complicated. Still, it is often confusing to scan through the conflicting coverage about what is and what isn’t healthy to eat.
<code style="display: none;"></code>Is sugar toxic? Is coffee good or bad for you? And what about red meat and eggs?
<code style="display: none;"></code><a href=" https://newsinhealth.nih.gov/2017/05/how-your-eating-habits-affect-your-health">Diet and nutrition are </a><a href="https://www.nytimes.com/2019/11/13/opinion/diet-research-nutrition.html">difficult to study.</a> But studying what we consume is critical for understanding because of how and what we eat impacts our health. This understanding is especially true as the implications of diet-related conditions like obesity, Type 2 diabetes, and heart disease rise to epidemic proportions. That’s what makes nutritional studies — as well as better ways of powering those studies — so critical.
<code style="display: none;"></code>This week, 23andMe <a href="https://www.medrxiv.org/content/10.1101/2020.04.14.20058263v1">published a paper</a> describing our unique approach to these kinds of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/observational-study">observational studies</a>, which make up a cornerstone of nutrition research. With millions of individuals who have consented to participate in research and answer questions about their daily eating habits, 23andMe’s can quickly collect nutritional information in real-time.
<code style="display: none;"></code>Using this data with other health-related information can help inform studies that look at the impact of different diets on different populations, identify trends, and spot correlations. For example, we’ve spotted seasonal dietary changes, differences in diet between men and women, and people of different age groups. We’ve also looked at correlations between different kinds of diets and exercise frequency.
<code style="display: none;"></code>Most recently our researchers looked at geographic differences in the United States and diet. This helped illuminate not just the differences in diet between urban and rural populations but also the differences in lifestyles between these communities. Looking at these different types of data in different ways allows scientists to explore the complicated relationship between diet, lifestyle, and health.
<code style="display: none;"></code>In our<a href="https://www.medrxiv.org/content/10.1101/2020.04.14.20058263v1"> new paper</a>, we demonstrate 23andMe&#8217;s ability to quickly and contemporaneously collect nutritional data for fast assessment of trends. We can do this much faster and at a much larger scale than traditional approaches like those of the CDC’s National Health and Nutrition Examination Survey (<a href="https://www.cdc.gov/nchs/nhanes/index.htm">NHANES</a>).
<code style="display: none;"></code>“23andMe created an opportunity for very large, rapid-scale, and real-time data collection, which may inform national nutritional trends and future epidemiologic studies in a much shorter time frame than ever before,” said Stella Aslibekyan, Ph.D., a co-author of the paper and Senior Scientist at 23andMe.
<code style="display: none;"></code>Although 23andMe customers are not exactly representative of the population as a whole, as 23andMe grows and diversifies, findings drawn from this data will be more applicable to the population as a whole. The next step will be adding genetic data and this, in turn, will help in learning more about how genetics and changes in dietary habits and lifestyle can improve health and prevent chronic disease.
</div>



In addition to exploring nutritional habits by county, we also looked at the effect of living in a rural vs. urban setting on dietary habits. After adjusting for age, sex, and BMI, we saw whether you lived in a rural vs urban setting[2], which was highly associated with dietary habits across all four food types we considered. Participants living in rural environments were likelier to consume added sugar, dairy, and red meat, whereas urban participants ate more fruits and vegetables.



This difference in dietary behavior (i.e., the &#8216;&#8221;rural effect&#8217;”) is equivalent in magnitude to the increase in sugar-sweetened beverages associated with a 14-point increase in BMI in males and a 10-point BMI increase in females. Even more striking is the association with added sugar; the rural effect is equivalent to a 19-point increase in BMI in males and an 11-point increase in females. The BMI equivalence of the rural effect on red meat is 6 and 9 BMI points in males and females, respectively,&nbsp; and dairy consumption is 13 and 7 points for males and females. The rural effect was more pronounced in men than in women for the dairy and sugar domains and was more robust in women for red meat. (See Figure 2 for a graphical display of these results.)



<figure class="wp-block-image alignright"><img loading="lazy" decoding="async" width="300" height="239" src="http://35.88.189.111/wp-content/uploads/2020/04/BMI-Table-300x239-1.png" alt="" class="wp-image-30768"/><figcaption class="wp-element-caption"> Figure 2: BMI equivalence of the rural effect. Figure 2 represents the average effect of moving from an urban setting to a rural setting associated with each nutritional domain, in terms of BMI points, for a 50-year-old individual. Specifically, for an urban-dwelling male (female) age 50, each line segment represents the equivalent BMI points associated with moving to a rural setting (SSB = sugar-sweetened beverages).&nbsp;</figcaption></figure>



While these results may seem counterintuitive, as rural settings are often where food that feeds the country is grown, studies have shown that people in these settings usually have limited access to healthy food choices. In fact, many rural communities rely on convenience stores for their food, which often offer little to no healthy options.<a id="a3" href="#f3">[3]</a> In addition, education on nutrition and funding for nutrition programs in rural schools also appears to be limited.



<h2 class="wp-block-heading" id="h-discussion-nbsp">Discussion&nbsp;</h2>



23andMe’s extensive database of self-reported dietary habits allows one to study the individual and geographic factors that influence what we eat. While factors such as sex, age, and BMI can impact our nutritional habits, where you live can also be an essential contributor to your diet. Visualizations of self-reported consumption by county show striking spatial patterns across the US. Our data also suggest that living in an urban vs. rural environment can impact diet. Participants living in rural environments were likelier to consume added sugar, dairy, and red meat, whereas urban participants ate more fruits and vegetables. Good nutrition is a critical component of leading a healthy lifestyle and understanding dietary differences between urban and rural environments may potentially help address the noted health gap between urban and rural America (<a href="https://www.cdc.gov/ruralhealth/cause-of-death.html">CDC source</a>).



<h2 class="wp-block-heading" id="h-footnotes">Footnotes:</h2>



 <a id="f1" href="#a1">[1]</a> &#8220;<a href="https://newsinhealth.nih.gov/2017/05/how-your-eating-habits-affect-your-health">How Your Eating Habits Affect Your Health | NIH News in Health</a>.&#8221; Accessed 26 Aug. 2019.



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</code><a id="f2" href="#a2">[2]</a> USDA Rural-Urban continuum codes were used to classify participants as living in an urban or rural setting based on reported zip code (<a href="https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/">source</a>)</footer>



<footer class="footnotes"><code style="display: none;"> 
</code><code style="display: none;"></code> <a id="f3" href="#a3">[3]</a> Nutrition, Physical Activity, and Obesity in Rural America</footer>



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Stella Aslibekyan

23andMe Maps the Way We Eat 

Everybody hurts, but we all hurt a little differently because pain and how we perceive it is both complex and personal.<img loading="lazy" decoding="async" class="alignright wp-image-25253 size-medium" src="https://blog-api.23andme.com/wp-content/uploads/2017/05/Pain-300x200.jpg" alt="" width="300" height="200" srcset="https://blogcms.23andme.com/wp-content/uploads/2017/05/Pain-300x200.jpg 300w, https://blogcms.23andme.com/wp-content/uploads/2017/05/Pain.jpg 724w" sizes="auto, (max-width: 300px) 100vw, 300px" />
That makes studying and treating the intricacies of pain and chronic pain difficult.
In collaboration with scientists from the German-based pharmaceutical company Grünenthal, 23andMe has been conducting a pain study and researching chronic pain, as well as the role genetics plays in it all. 
<h6>Cold Pressor Test</h6>
For that work, we developed an online version of a known experimental pain test and used a clinically validated pain sensitivity questionnaire to gauge pain thresholds and tolerance.
During the online procedure, we ask some 23andMe customers who consented to participate in the study to place a hand in icy water for up to three minutes. This &#8220;cold pressor test&#8221; helps to gauge pain sensitivity, as does the questionnaire where participants need to imagine painful situations.
<h6>Online Pain Study<img loading="lazy" decoding="async" class="alignright wp-image-28224 size-medium" src="http://35.88.189.111/wp-content/uploads/2020/04/Cold-Pressor-240x300.png" alt="" width="240" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/04/Cold-Pressor-240x300.png 240w, https://blogcms.23andme.com/wp-content/uploads/2020/04/Cold-Pressor-818x1024.png 818w, https://blogcms.23andme.com/wp-content/uploads/2020/04/Cold-Pressor-768x961.png 768w, https://blogcms.23andme.com/wp-content/uploads/2020/04/Cold-Pressor-703x880.png 703w, https://blogcms.23andme.com/wp-content/uploads/2020/04/Cold-Pressor-943x1180.png 943w, https://blogcms.23andme.com/wp-content/uploads/2020/04/Cold-Pressor.png 1256w" sizes="auto, (max-width: 240px) 100vw, 240px" /></h6>
Using these two online methods allows for more accurate comparisons of pain perception between individuals. The researchers succeeded in this crucial step for studying the genetic differences in how individuals experience pain. A paper on this online “pain testing@home” was published this week in the journal <a href="https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0231697">Plos One</a>.
&#8220;The success of using these online measures is really encouraging because it makes genetic research on pain much more feasible and scalable,&#8221; said Matthew H. McIntyre, Ph.D., a 23andMe senior scientist and the lead author of the study.
While we each understand our own levels of pain, it&#8217;s much harder to understand it in others. Those individual differences in both perception and tolerance of pain, also make it difficult to find treatments that work. Identifying the genetic associations for pain may help in identifying ways to treat it better.
&#8220;Our new paradigm testing@home will help advance genetic research into personalized treatments for pain,&#8221; said Achim Kless, Ph.D., a co-author, and Scientific Director and Principal Translational Scientist at Grünenthal.
<h6>Complexity of Pain</h6>
Beyond developing better ways to treat pain, the study could also shed more light on the complexity of chronic pain, a persistent menace experienced by an estimated 50 million people in the United States alone.
For this study, scientists included data from more than 30,000 23andMe customers who consented to participate in research. More than 8,000 of those participants administered the cold pressor test on themselves. The participants reported the results through a web-based interface custom-designed by 23andMe. The questionnaire was an online version of a clinically validated pain sensitivity questionnaire usually given on paper. It asked participants to rate imagined pain situations such as burning their tongue, or stubbing a toe, or getting a sunburn.
The study found differences between men and women.  Men have a higher threshold for pain. This finding was also something observed in clinical pain studies carried out under health care professional supervision. The researchers now hope to identify individuals who are either much more or much less sensitive to pain. The hope is to identify the genes that cause those differences. This, in turn, will help in identifying potential drug targets for treating pain.

A New Study on Pain

<div id="attachment_28185" style="width: 177px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-28185" src="https://blog-api.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522.jpg" alt="" class="wp-image-28185 size-medium" width="167" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522.jpg 773w, https://blogcms.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522-167x300.jpg 167w, https://blogcms.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522-569x1024.jpg 569w, https://blogcms.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522-768x1383.jpg 768w, https://blogcms.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522-489x880.jpg 489w, https://blogcms.23andme.com/wp-content/uploads/2020/03/mary-kay-2-e1585606326522-655x1180.jpg 655w" sizes="auto, (max-width: 167px) 100vw, 167px" />Mary taking her &#8220;after&#8221; photo.</div>
Like a lot of people, Mary struggled to lose weight. Over the years, she tried but failed to take off the pounds, and it made her wonder whether genetics was playing a role. After all, she had a family history of obesity. 
That’s, in part, what propelled her to purchase a 23andMe DNA test. She wanted to explore how her genetics may be impacting her health. 
What she learned surprised her, and it inspired her to take action, not just for her health but to connect with her newfound family.
“I found out it wasn’t genetics,” Mary said, laughing.
At least, her 23andMe Genetic Weight report indicated that she wasn’t genetically predisposed to weigh above average. Ironically it was seeing that information that prodded her to act. 
“I knew it was up to me,” she said.
Mary began prioritizing her health. She started a new, low-carbohydrate diet. Ultimately the new diet and focus helped Mary finally lose 80 pounds. 
“Three of my sisters and I all went on the same low-carb diet,” she said. 
They all lost weight. 
Then her story took another exciting turn. 
Mary had opted-into DNA Relatives, a feature that matches you with other customers with whom you share DNA. Long after she first tested, Mary noticed in her DNA Relative matches a predicted niece and a predicted nephew, who she didn’t know. Mary remembered that both of her sisters had given up children decades ago. As soon as she saw the profile photo of her niece, Ann, she knew Ann was her younger sister’s child. 
“Ann looked exactly like my sister,” Mary said.
Mary also matched with a nephew, James, a few weeks later. James was another sister’s child, adopted years earlier. Mary connected with both Ann and James, happy to share family information with them.
Ann revealed that she too had joined 23andMe not necessarily for ancestry but for the health reports. Adopted at a young age and now in her 40s, Ann didn’t have a family health history to rely on. Mary shared important information about the family’s health, including the fact that several family members had died at a young age from heart disease. Ann was relieved to have a fuller picture of her family’s health history.
Ann also mentioned that she would like the opportunity to get to know her birth mother, Mary’s sister. 
“I’m not looking to disrupt her life, but I want her to know I appreciate what she did for me because I had an awesome family,” Ann told Mary.
Mary put Ann in touch with her sister. Last year on Mother’s Day, mother and daughter spoke on the phone together for the first time. They were thrilled to connect.
Mary said she has her grandmother to thank for that because it was her grandmother who helped trigger her interest in genetics. Born in the 1890s, her grandmother was ahead of her time, interested in education, learning, and her family’s history, especially their family health history. 
“Her handwritten family tree included notes about illnesses, and included a note that said ‘lots of obesity in this branch,’” Mary said. “That’s what prompted me to do the DNA test.”
Her grandmother thought that at some time in the future science would advance to the point that this information would be helpful to future generations. It has been for Mary and the new family she’s connected with. 
Spurred by her personal fascination with genetics, Mary sees her 23andMe report — and the new updates that have continued to come out of it — as valuable information that has helped her and her family to lead healthier, more fulfilling lives.

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