kris ulland

Your Nutrition Partner

It is becoming commonplace to learn about your health from the comfort of your home without ever seeing a doctor. Just send in a urine, saliva, or blood sample, and you’re on the path to knowing more about you.

Do you have Lyme disease or HIV? How’s your vitamin D? Your cholesterol? Your estrogen levels? Do your genes make you more likely to get late-onset Alzheimer’s?

“In theory, I like the idea of direct-to-consumer testing,” says Rashmi Mullur, an endocrinologist and assistant professor of medicine at UCLA. “The thought of not having to go into a lab to get a blood test is so appealing.”

“But I worry that some patients are taking these tests out of frustration because they haven’t found an answer through traditional systems, and they feel compelled to take matters into their own hands.”

What’s more, adds Mullur, “some of these tests are not ready for prime time.”

In vitro diagnostics (IVDs) that are marketed directly to consumers without the involvement of a health care provider are called direct-to-consumer tests (also referred to as DTC).

Direct-to-consumer testing is expanding the number of people who are able to get genetic testing of their DNA (or genome). Your genome is made up of thousands of genes that carry the hereditary information about your traits, such as eye color or height. This information is based on the arrangement of distinct molecules (also known as “bases”) that make up genes. Some of these arrangements, or variants, can be used to diagnose a rare disease, provide information about a person’s risk of developing disease, or other types of information. Some variants have clinical significance and may give consumers insight into monitoring their own health, or about potential disease or conditions.

Not all direct-to-consumer tests are genetic tests, though the majority on the market today are. Some measure other things, such as levels of proteins in your body, levels of toxins in urine, or levels and types of bacterial flora (referred to as a “microbiome”).

Direct-to-consumer tests have varying levels of evidence that support their claims. Some direct-to-consumer tests have a lot of scientific and clinical data to support the information they are providing, while other tests do not have as much supporting data. There can also be disagreements in the clinical community about the role that different genetic variants have in contributing to disease, and new information is being learned every day.

There are tens of thousands of variants and varying information available to determine whether those variants are relevant to whether a person may get a disease or condition. Not all variants that contribute to a person’s risk of getting a disease or condition may be known, so it is important that consumers understand that a negative result means they still may be at risk for a particular disease or condition.

Not all direct-to-consumer genetic test companies test for the same set of variants, and therefore may provide different results for the same disease or condition. Therefore, consumers must use their judgment when ordering and interpreting their results from these tests. Consumers should consider discussing their results with a genetic counselor or a qualified health care provider to better understand the clinical relevance of the result to their own health.

The stakes for some tests are far too high to risk a wrong answer.

For example, more than 1,000 variants in the BRCA1 and BRCA2 genes are linked to a higher risk of breast and ovarian cancers. 23andMe tests for just three of them.

And knowing if you have a disease-causing BRCA variant matters. Women with some of those variants have a 45 to 70 percent lifetime risk of breast cancer and a 10 to 45 percent risk of ovarian cancer. Many experts advise those women to consider surgery to remove their ovaries and breasts as soon as they’re done having children.

With direct-to-consumer tests for BRCA variants, “people may experience unneeded anxiety or false reassurance,” cautions the National Cancer Institute. “If you have a family history of breast cancer, do not rely on a direct-to-consumer genetic test to assess your risk,” says the CDC. Instead, see a geneticist or genetic counselor.

It’s the Food and Drug Administration’s job to keep tabs on direct-to-consumer test companies and to ensure that customers are getting clear, accurate information. For most tests, though, the FDA does little or nothing.

“If the test claims to make a diagnosis, the FDA is supposed to regulate that,” says Alberto Gutierrez, former director of in vitro diagnostics at the FDA. “But there are claims that fall into the category of wellness that the agency is not interested in seeing because they are considered low-risk,” he adds.

Tests that predict athletic ability, caffeine metabolism, or lactose intolerance are considered “wellness tests”. “But it’s very much a gray area,” Gutierrez admits. “There are a lot of internal discussions at FDA about what is considered wellness.”

Everlywell claims that most of its tests are for “wellness monitoring, informational and educational use.” That includes its test for hemoglobin A1c, a long-term measure of blood sugar. “It’s hard to see how that fits under wellness,” says Gutierrez, because doctors use hemoglobin A1c to diagnose diabetes.

The company does offer some tests for Lyme disease and a handful of sexually transmitted infections that it calls “diagnostic.” But other than a test for Covid-19, the FDA hasn’t authorized any of Everlywell’s diagnostic tests.

“The agency has been inconsistent about what they regulate,” says Gutierrez.

Sometimes, the feds seem to be on the job. For example, in 2013, the FDA ordered 23andMe to stop marketing genetic tests that told customers about their risk of disease. (The letter was signed by Gutierrez.)

In 2017, after the company submitted enough data to satisfy the agency, it got the FDA’s stamp of approval to tell users about their genetic risk for 10 diseases. And in 2018, 23andMe received the green light to test for three of the BRCA1 and BRCA2 mutations that occur more frequently in people of Eastern European Jewish descent.

“It’s difficult to know exactly why the agency hasn’t thrown the book at Everlywell, Lets Get Checked, and others,” says Gutierrez.

Lets Get Checked allows users to discuss results with a nurse, while Everlywell offers a physician-led live webinar where you can ask questions. (If you test positive for, say, a sexually-transmitted infection, they offer a consult.) The nurses and physicians can only provide so much insight without knowing you or your medical history.

Gutierrez believes the FDA needs to step up.

“Consumers need a referee. Companies have a lot of incentive to make claims. And if somebody isn’t looking at the data behind those claims and making a judgment, you’re in a ‘buyer beware’ marketplace.”

Rutabaga

Rutabagas are in the mustard family and are a cross between turnips and cabbage. Since they grow well in cool weather and can be harvested into winter, they tend to be popular in northern countries.

The rutabaga is very similar to the turnip except that it generally has yellowish flesh, a denser root and smooth, waxy leaves similar to cabbage. While a purple and white turnip is usually two or three inches in diameter, rutabaga is twice that size. Rutabaga tends to be sweeter in flavor when left in the ground until after a frost

The leaves of rutabaga plants are edible and similar to turnip leaves but are thicker, like cabbage or kale leaves. Rutabagas often do not flower, but when they do, it is a small, yellow Brassica flower, with four petals that form a cross and give them their designation as cruciferous vegetables. They are typically planted in spring, but they can be planted in fall in warm climates.

Rutabagas are an excellent source of nutrients.  One medium rutabaga provides:

  • Calories: 143
  • Carbs: 33 grams
  • Protein: 4 grams
  • Fat: 0.5 grams
  • Fiber: 9 grams
  • Vitamin C: 107% of the Daily Value (DV)
  • Potassium: 35% of the DV
  • Magnesium: 18% of the DV
  • Calcium: 17% of the DV
  • Vitamin E: 7% of the DV

Rutabagas provide a good amount of potassium, calcium, magnesium, and vitamins E and C. They also contain a moderate amount of folate, a B vitamin that’s important for metabolism, protein synthesis, and DNA replication.

Rutabagas also provide small amounts of phosphorus and selenium. Phosphorus is an important mineral for energy production and bone health, while selenium is essential for reproductive health.

Rutabagas are an excellent source of antioxidants, including vitamins C and E.

Vitamin C is an antioxidant that neutralizes free radicals, which are harmful compounds that damage cells and lead to oxidative stress when levels become too high in your body. Vitamin C also plays key roles in immune health, iron absorption, and collagen synthesis. Vitamin E is a fat-soluble antioxidant that also fights cell damage and helps maintain a healthy cell membrane. Vitamins C and E work closely together. After vitamin E is depleted, vitamin C helps regenerate it.

Rutabagas also contain high amounts of glucosinolates, which are compounds with antioxidant properties. They have been shown to reduce inflammation and potentially even your risk of heart disease and colorectal, prostate, and breast cancer.

A recent study on 3D human skin models found that glucosinolates helped protect against UV damage.

Rutabagas are an excellent source of fiber. One medium rutabaga provides 9 grams of fiber, which is 24% and 36% of the recommended daily fiber intake for men and women, respectively.

Rutabagas are high in insoluble fiber, which does not dissolve in water. This type of fiber helps promote regularity and adds bulk to stool. Fiber also feeds gut bacteria, promoting a healthy microbiome. A diet high in fiber is linked to many health benefits, such as a decreased risk of colorectal cancer, heart disease, and type 2 diabetes. A high-fiber diet is associated with a greater diversity of gut bacteria. Recent research has shown this connection is important for preventing long-term weight gain.

Rutabagas are a good source of potassium, which plays many important roles in your body and is especially important for heart health. One medium rutabaga provides 1,180 mg of potassium, which covers 35% of your daily needs for this nutrient. Potassium is important for nerve signaling and muscle contraction. It also works closely with sodium to regulate fluid balance, which is important for maintaining healthy blood pressure.

How to Buy

Rutabagas are in season October to March.

Look for rutabagas that feel heavy for their size with smooth, heavy and firm roots. The skin should be free of major damage although smaller cuts around the top are natural.  Smaller rutabagas (4 inches in diameter or less) tend to have a sweeter flavor than larger varieties.

How to Store

Store rutabagas are room temperature for up to 1 week.  Rutabagas will keep for months in a cool storage place. They store well in silicone bags in a refrigerator or cold cellar. Be sure to remove the leaves before storing the bulbs

 

How to Cook

Although rutabagas are related to turnips, they have a different flavor altogether. Rutabagas are sweeter and almost buttery when cooked. They are also excellent as a side dish when mashed or baked like fries. They are delicious roasted and are great in soup.

You can eat rutabagas raw or cook them similarly to how you cook potatoes, but be sure to peel the skin, as these vegetables usually have a protective wax coating. Leaves of the rutabaga can be added to salads or soups.

Raw rutabagas are crunchy and juicy. You can slice, cube, or grate ​them into all kinds of dishes and snacks.

Rutabagas have a sweet and slightly bitter flavor. Try them:

  • boiled and mashed
  • cut into fries and fried
  • roasted in the oven
  • added to a soup
  • thinly sliced and added to a casserole
  • grated raw into a salad

Rutabagas can replace potatoes, carrots, turnips, and other root vegetables in most recipes.

 

Crisp Rutabaga Rösti

Purple Carrot

2 servings

Ingredients

  • 3/4 cup quinoa
  • pinch of salt
  • 12 ounces rutabaga
  • 1 red onion
  • 3 tablespoons olive or avocado oil
  • garlic –  2 teaspoons
  • 1 pound baby spinach
  • 1 teaspoon fresh rosemary
  • dash of pepper
  • 2 tablespoons vegan mayonnaise
  • 1 tablespoon Dijon mustard
  • 1 tablespoon white balsamic vinegar

Instructions

  • Soak, rinse and drain the quinoa, then put it in a small saucepan with 2 cups water and a pinch of salt; bring to a boil. Lower the heat so it bubbles gently, cover, and cook, adding water a 1/4 cup at a time if the quinoa starts to stick, until the grains are overcooked, very tender, and bursting, 25 to 30 minutes. Put in a large bowl.
  • Rinse, trim, and peel the rutabaga; grate it by hand or with a food processor.
  • Trim, peel, and chop the onion.
  • Put 1 tablespoon oil in a medium skillet over medium-high heat. When it’s hot, add the rutabaga, onions, and a sprinkle of salt. Cook, stirring occasionally until the vegetables are tender and starting to brown and stick to the pan, 10 to 15 minutes.
  • Peel and slice enough garlic to measure 2 teaspoons.
  • Rinse and dry the spinach.
  • Strip the leaves of the rosemary from the stems, and chop enough to measure 1 teaspoon add it to the rutabaga mixture during the last few minutes of cooking.
  • Heat the broiler and put the top rack 4 to 6 inches from the heat. Grease a baking sheet with 1/2 tablespoon oil.
  • Stir the rutabaga mixture into the quinoa. Taste and adjust the seasoning.
  • Using your hands, and handling the mixture as little as possible, gently form 6 small cakes by cupping a little of the mixture in your hands, then flattening it into a patty. Put the cakes on a baking sheet and brush the tops with 1/2 tablespoon oil.
  • Broil the cakes until the tops are crispy, 5 to 10 minutes, then carefully flip the cakes and broil until crispy on the other side, 3 to 5 minutes.
  • Mix the mayonnaise and 1/2 tablespoon of the mustard in a small bowl. Taste and adjust the seasoning, adding more mustard if you’d like.
  • Wipe out the skillet, add 1 tablespoon oil and 1 teaspoon garlic and cook until fragrant, 1 or 2 minutes. Add the spinach and a sprinkle of salt and cook, until wilted, 3 to 5 minutes. Add the vinegar, toss, and taste and adjust the seasoning.
  • Serve the cakes with the spinach and pass the mustard sauce at the table.

Resources

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Michigan State University Extension. (2006). Get fresh too! (CYFC065)(Rev. ed.). East Lansing, MI: Author.
Schroepfer, M., & Lueders, J. (2005, September). Parsnips, rutabagas, turnips – Oh my! Columbia, MO: University of Missouri Extension.
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University of the District of Columbia, Center for Nutrition, Diet and Health. (n.d.). Rutabaga, 1, 12. Washington, DC: Author.
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