Tag Archives: MTHFR

I Have MTHFR C677T Mutation – What Does That Actually Mean?

MTHFR mutations are just starting to be recognized as an issue and so more and more doctors are testing, but what happens if your doctor tells you that you’re homozygous for MTHFR C677T? They might as well be speaking Greek! So here’s the skinny on what that really means. Also here’s a post about MTHFR mutation basic in general.

MTHFR C677T Terminology Basics (or as basic as we’re going to get with genetics).

The simplest level of information here is just the plain genetics.  Here are some quick factoids to get us started:

  • MTHFR is the short name for the genes that code for the enzyme that changes folic acid to the active form that your body uses (the long name is methylfolate reductace).
  • 677 is the marker for one particular MTHFR gene.
  • The official genetics labeling of this gene is Rs1801133. Sigh.
  • You get one copy of this gene from your mother and one from your father, so there are two possible copies that can be either “normal” or “mutant”
  • If you inherited one good copy and one bad copy that’s called “heterozygous C677T”
  • If you inherited two bad copies (one from each parent) that’s called “homozygous C677T”
  • C…T stand for the bases that you actually have.  C = cytosine, T = thymine.  Bases are essentially the letters that spell out your genetic code.  There are four of them commonly (C, T, A and G).
  • When this gene is “normal” it looks like MTHFR C677C.
  • Heterozygous mutations are MTHFR C677T because there is one normal C and one abnormal T. Also occasionally written 677CT.
  • Homozygous C677T can also be written as T677T (because there are two abnormal copies with T instead of C). Occasionally you’ll also see it written 677TT




Phew! So the take-away there is MTHFR C677T means you have at least one bad copy of this gene, and if it’s called homozygous, or T677T then you have two bad copies.

How Much of a Problem Is This?

This can be a significant problem If you don’t have a good diet or you don’t take supplements. If you get lots of dark green leafy veggies, legumes and other food sources of natural folate – see this post – then you’re probably already getting good methylfolate. If your diet isn’t up to scratch, then supplementation can be useful and here’s a whole post about that.

Heterozygous MTHFR C677T have about 65% normal MTHFR activity (so 35% compromise) and homozygous MTHFR C677T (T677T) have about 30% normal activity (so 70% compromise). Normal activity refers to the way your body activates your folic acid so that it can be used, so compromise usually looks like a functional folate deficiency.

What Are The Health Risks of C677T Mutation?

According to SNPedia, which compiles research on genetics, C677T mutants have been shown in at least one research study to have an increased risk for:

  • Midline defects such as:
    • Cleft lip
    • Cleft palate
    • Neural tube defects
    • Facial asymmetries
  • Cancers including:
    • Breast
    • Lung
    • Brain
    • Stomach
    • Head and neck
    • Kidney
  • Cardiac-related issues including:
    • Thrombosis (increased tendency to clot inappropriately)
    • High homocysteine levels (a heart risk)
    • Pre-eclampsia (dangerous high blood pressure in pregnancy)
    • Vascular dementia
  • Fertility issues including:
    • Multiple pregnancy loss
    • Low sperm count
    • Birth defects such as down syndrome
  • Neurological issues including:
    • Migraines
    • Autism
    • Alzheimer’s dementia
  • Mood and psychological issues including:
    • Depression
    • Anxiety
    • Schizophrenia

You’ll notice that this is quite a list, and it can be a little daunting to think about when you’re just learning about this.

What Do You Do About This?

Compromise with the MTHFR C677T gene can have severe consequences so it’s important to work on getting good sources of natural folate, which is generally useable by mutants, or 5-MTHF (5-methyltetrahydrofolate) which is already methylated so the genetic compromise doesn’t matter.  As discussed in this article, I feel supplementation should be started slowly because for many mutants who haven’t had active forms of folate very much in their lives it feels really strange when those active forms start showing up and there is a whole lot of adjusting by your body.  This activated folate is used by your body to run enzyme pathways, to aid in some parts of normal metabolism, to help your body detoxify and even to methylate your DNA. If it isn’t there then your body does what it can, but what it can’t do starts to pile up. Any time you start supplementation then your body starts digging in that pile to clear up high priority items.  This is exactly what we want, but if you start with high doses of a supplement then it’s a little like drinking from the firehose.  Kind of out of control and not very pleasant.

A great way to start if you’re unsure, is with a folate-rich diet.  I love this image because it kind of covers what we’re looking for.  Hint – think dark greens and beans. 🙂

Is folate in foods safe in MTHFR mutants? In these foods YES - even for MTHFR C677T mutants. Thanks to exhibithealth.com for the great image.

Is folate in foods safe in MTHFR mutants? In these foods YES, even for MTHFR C677T mutants. Thanks to exhibithealth.com for the great image.

Can Mutants Become “Normal”?

If you’re a mutant (like me) then you’ll always be a mutant, but it doesn’t have to matter. Essentially as long as you’re getting enough of the active form of folate then the mutation doesn’t have to matter.  If you aren’t, then it matters a lot.

The bottom line is MTHFR C677T mutations don’t have to mean anything at all as long as you supplement and have a good diet (here’s an article about a folate-rich diet for MTHFR mutants) I always suggest taking a little more care with yourself too.  There are known health risks for things like clotting, fertility and cancers so it makes sense to take some precautions.  Eat your fiber, do your exercises, get your sleep and generally treat yourself with high regard – shouldn’t we all anyway?



Is Genetic Testing Necessary if You Suspect MTHFR Mutation?

The quick answer is no. You probably don’t need genetic testing for MTHFR even if you suspect there’s a problem, but you still might want it.  If that isn’t enough information, then read on!

Why Genetic Testing for  MTHFR Might Not Be Necessary

  1. For many people with the MTHFR mutation, there is a simpler, more medically recognized, cheaper test called homocysteine.  For the majority of MTHFR folk homocysteine levels become elevated because of the lack of usable folate. This test is cheap and you won’t have any trouble talking your doctor into ordering it.  Bonus!
  2. Dr. Charis Eng, a prominent geneticist at the Cleveland Clinic makes a great argument that really, if you suspect a mutation, you can just take the methyl-folate and appropriate B vitamins and you’re done.  No harm, no foul. In short you don’t need genetic testing because you can just go ahead and take the vitamins. Good point Dr. Eng!
  3. Even with a complete genetic profile run through every methylation panel out there, finding the right dose of methylfolate for you is still a lot of educated guessing and trial and error. Testing might give you guidelines, but you really still have to start slowly and work your way up.

    Kind of awesome picture of human chromosomes. Genetic Testing for MTHFR doesn't look this cool, but still.

    Kind of awesome picture of human chromosomes. Genetic Testing for MTHFR doesn’t look this cool, but still. Image by Andreas Bolzer, Gregor Kreth, Irina Solovei, Daniela Koehler, Kaan Saracoglu, Christine Fauth, Stefan Müller, Roland Eils, Christoph Cremer, Michael R. Speicher, Thomas Cremer – Bolzer et al., (2005) Three-Dimensional Maps of All Chromosomes in Human Male Fibroblast Nuclei and Prometaphase Rosettes. PLoS Biol 3(5): e157 DOI: 10.1371/journal.pbio.0030157, Figure 7a, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=1371900




Are There Reasons Why I Should Do Genetic Testing for MTHFR?

There are certainly some compelling reasons to get the testing done, not the least of which is your kiddos.

  1. With genetic testing, especially the complete information gathered from 23andme, you have a better idea of not only your MTHFR status but also about all of the other genes that play into the methylation and detoxification process.  It helps us understand all of the ways you might be compromised and so gives a more solid starting place. (If your doctor runs the MTHFR test then really you’ll only have info about MTHFR, not about any of the related genes).
  2.  You know right away how compromised you are (check out these handy graphics if you can’t remember) and generally the more bad copies of the genes you have the slower you want to go with supplements and detox.
  3. If you have kids or are thinking about having kids it really helps to know what their chances are of picking up bad copies of these genes from you.   If you know there might be an issue then you can start helping them find balance while they’re young (or even before they’re born).

What are the Options for Genetic Testing for MTHFR from my MD?

MDs have started ordering testing – especially if you have some strange blood coagulation issues, if you’ve had repeat miscarriages, or if you pester the hell out of them. Insurance will only cover testing if it’s “medically necessary” – and typically that is only if there are weird blood clotting issues. Just keep that in mind. There are only a few MTHFR tests that are FDA approved, and none of them are intended for people with anxiety, depression, inflammatory disorders, etc… They still work, but it can be hard to talk your doctor into ordering them. These are all spendy if insurance isn’t paying for them, so ask your doctor before you have them run.

Is there Genetic Testing for MTHFR that You Can Run Yourself?

This is by far my favorite option, simply because you get so much for so little money (relatively speaking).  It’s 23andme. They provide you with a saliva test kit that you mail in and in about a month you get a whole heap of information online including info about your ancestry, about your genetic response to certain pharmaceutical drugs, and about different health risk factors. At the time of this article it’s $199 US or $249 Canadian. Typically this is cheaper than the FDA approved testing and there’s far more information. Embedded in all of this information is your MTHFR status, although it’s hard to find unless you run your results through some kind of interpretation engine.

In terms of interpretation for MTHFR there are a couple that I like.  The one I suggest most often is called “genetic genie” and they have a methylation panel (that uses the raw data from 23andme) and a detox panel (again with the 23andme). The reports are very complete and they ask for a modest donation.  Freaking awesome.

Another good option are the reports from MTHFR support.  This report shows more gene snips than the genetic genie report, but gives less information about each one.  It also costs a little more (but still totally reasonable).  Like genetic genie, MTHFR support doesn’t actually test the genetics – you need 23andme for that – they just interpret the information.

At the end of the day you can get genetic testing for MTHFR if you choose, but you don’t really have to – you can also just go ahead and start to supplement if you suspect an issue. I’m a total geek for information, so of course I got mine done by 23andme (I’m 3% neanderthal, in case you were wondering, because obviously that is information everybody needs).  I’m glad I know, but honestly it really didn’t change too much about the way I approach my dosage of methylfolate.  It’s just better information for me (and for my kiddos).



Is Folate in Food Safe for MTHFR Mutants?

The question of  folate in food safe for MTHFR mutants has, like everything else about MTHFR, a complex answer: yes and no.  Sigh. But actually there’s a pretty easy split, and that’s between foods naturally high in folate, and foods fortified with folic acid.

Foods Naturally High in Folate

This list is all awesomeness. These are great healthy foods that most people want to incorporate into their diet but many of us mutants (MTHFR mutants that is) hesitate because of the folate content. Great news folks – naturally occuring folate is actually not a problem with the MTHFR mutation. Here’s the thing – what we call “folate” isn’t actually just one thing. In nature it’s a collection of related molecules in the family of pteroylglutamates (say that three times fast).  Folate can be used directly by the human body, it doesn’t have to be converted into anything and so with or without a MTHFR mutation we can use folate well.

We use folate to synthesize, repair and methylate DNA, and as a cofactor in a number of reactions in the human body.  It’s especially important in periods of rapid growth and cell division  – so infancy, growth spurts and pregnancy. We also use it to make our red blood cells and deficiency is one of the causes of anemia.

Is folate in food safe for MTHFR mutants? In these foods YES. Thanks to exhibithealth.com for the great image.

Is folate in food safe for MTHFR mutants? In these foods YES. Thanks to exhibithealth.com for the great image.

Foods Highest in Folate (Safe for MTHFR)

Beans and Pulses:

  • Black eyed Peas – 356 mcg/cup serving (89% daily value)
  • Mung beans – 80% DV per cup serving
  • Pinto beans – 74% DV per cup serving
  • Chickpeas – 71% DV per cup serving
  • Lentils – 90% DV per cup serving

Dark Green Leafy Veggies:

  • Spinach – 66% DV per cup serving (cooked)
  • Turnip greens – 42% DV per cup serving (cooked)
  • Romaine Lettuce – 16% DV per cup serving (raw)

Brassica Family Veggies:

  • Broccoli – 42% DV per cup serving (cooked)
  • Cauliflower – 14% DV per cup serving (cooked)
  • Brussels sprouts – 25% DV per cup serving (cooked)

Odd Ducks:

  • Avocado – 30% DV per cup serving (raw)
  • Mango – 18% DV per cup serving (raw)
  • Oranges – 18% DV per cup serving (raw)
  • Asparagus – 68% DV per cup serving (cooked)
  • Okra – 37% DV per cup serving (cooked)
  • Liver – 50-60% DV per 3 oz serving (because nobody eats a cup of liver.) Percentage range depending on the type of animal the liver comes from.




The answer to the question ‘Is NATURALLY OCCURING folate in foods safe for MTHFR mutants?’ Is a resounding YES.

Foods Fortified with Folic Acid

Here’s where the MTHFR group get tripped up. Often ‘folate’ and ‘folic acid’ are used interchangeably to refer to the same thing, because they theoretically do the same things in the body.  Except for MTHFR mutants they really don’t do the same thing because we have varying degrees of impairment with the enzyme that converts folic acid to folate. This means that MTHFR mutants really can’t count folic acid, which is the synthetic, lab-created, oxidized form of folate which is really not found so much in nature.  This requires functioning MTHFR genes to be converted into a usable form of folate.  If you don’t have good function of your MTHFR genes (and just a note – we all have some function, we’re just impaired) then you don’t get to use this form very well.

Folic Acid ≠ Folate

The issue with eating a lot of foods fortified with folic acid for an MTHFR mutant is that the folic acid competes at receptor sites with natural folate that is coming from your diet. This means the synthetic folic acid makes the natural folate less effective because much of the time the synthetic (unusable) form is clogging up the folate receptors.

Foods Most Likely to Be Fortified with Folic Acid (Unsafe for MTHFR Mutants):

Grains:

  • Breads
  • Cereals
  • Pasta
  • Flour
  • Baking mixes

So – is Fortified “Folic Acid” folate in food safe for MTHFR mutants? Absolutely Not.

The best strategy to make your foods MTHFR friendly is to eat whole foods, natural unfortified whole grains, and skip the fortified garbage.  There are many dangers of folic acid (and not just to MTHFR mutants – we’ll talk about that later) so avoid it wherever possible and add naturally-occurring folate-rich foods into your diet wherever you can. One more time: Is folate in food safe for MTHFR mutants? You betcha, but folic acid isn’t.



How Long Does Health Recovery Really Take?

I don’t know about you, but I have this kind of indestructible myth going on about my body and I always expect to bounce back from major health stuff immediately, but then I have to remember what I always say to my clients – health recovery is WAY more work for your body than you think it is and it takes SO MUCH LONGER than you think it will.  This applies pretty much across the board and the bottom line is to be gentle with your body, be gentle with yourself.  There are so many ways that your body can be asking for help and support and at the end of the day, it’s the most intelligent tool you will ever have so here’s some more reasons to treat your body right.

It’s hard to accept the idea that something you had a month ago might actually still be affecting the way your body is doing things, but the fact is that for some common conditions, recovery can literally take years.  This does not gel with our instant gratification society at all.




So – why is this important?  Well, your body is more vulnerable when it’s trying to recover from something so part of your resources are devoted to that task – meaning there is less to go around for everything else. Still, the human tendency is to push to what you can normally do, or even worse: what you feel you *should* be able to do rather than listening to your body’s signals that it needs rest, nourishment, sleep.




What Happens When You Ignore the Recovery Period:

  • Recovery Takes Longer: The recovery HAS to happen. Your body has an imperative for that to continue.  If it doesn’t happen then it just keeps dragging you down in the background or weakening your fundamental energy and strength.  It’s like an open drain at the bottom of your bucket – your energy is constantly siphoned off, bit by bit.
  • Energy Drain: The more you push through, the stronger the signals your body will send to not push through.  Energy gets lower and lower because your body has to make you stop and rest somehow.  Really, how many ways can your body tell you it’s still hurting?
  • Resources Dwindle: Your body is actively using nutrients, energy reserves and even hormonal reserves to try to deal with this lingering issue and if you’re not giving it extra time, rest and nutrients to do that or if you’re expecting to do all he things you normally do in a day as well then reserves get used up quickly.
  • Long-term Consequences: Pushing through just compounds the problem and can lead to long-term consequences.  Conditions like chronic fatigue, fibromyalgia, adrenal fatigue and “burn out” are all natural consequences of your body bearing more burdens than it can handle for longer than it had the resources to deal with. These burdens can include stunted or ignored recovery times, emotional stressors, nutritional deficiencies, unhealed viruses, high inflammation and sleep deprivation.

So How Much Time Does Your Body Need?

Wouldn’t it be great if there was a magical one-size-fits all answer to that question?  Sadly, there isn’t but there are ball-park figures that can give you an estimation.  The healthier you are going into something the generally shorter the recovery period is, but the biggest gift you can give your body is actually listening to your body’s signals.  Here are some typical situations that take far longer to recover from than you would ever think possible:

  • Dehydration/heat exhaustion – Typically initial recovery to the point that your body feels normal takes 4-6 weeks depending on how severe the dehydration was.  After that count on at least a year of having to be vigilant about hydration, trace minerals and electrolytes because your body is far more susceptible to relapse in this time – even though you may feel “normal” your reserves are still far lower than they should be. If you don’t put the effort into rebuilding those reserves you can perpetuate a situation where relapse remains an issue, even for a decade or more.
  • Food sensitivities – Food sensitivities are a bigger issue than you may realize.  So many people discover a food sensitivity such as wheat or corn, but because they’ve been eating that thing their entire lives they don’t especially take it seriously, or eliminate the food 95% but cheat a few times per week. This can actually raise the total level of body inflammation and perpetuate it.  We are human, and sure – cheating happens, but it’s actually better to save it and do it big than to cheat in little ways frequently.  Like the Christmas cookies cheat and the birthday cake cheat and the rest of the time be 100% sensitivity free. Eliminating a food sensitivity completely will yield long-term results but your body will be changing, regaining health and recovering from that food for a long time – even years.  Of course this is hard to quantify, but I can say that I noticed subtle, positive changes continue to happen for me for approximately the first four years of being wheat-free before things leveled off.  There is digestive repair, better nutrient absorption, replenishing nutrient reserves, reducing inflammation and healing damage. Of course the little constant cheats undermine that process and essentially stop progress.
  • Pregnancy, pregnancy loss, delivery – Pregnancy takes a huge toll on a woman’s nutrient and energy reserves, as do pregnancy loss (especially late losses) and labor and delivery. Your body is programmed to give the best of everything you have to the baby. The best nutrients, the best fats, the best minerals, the bulk of your reserves. It takes a lot of time to build those up again.  Outside of that, actually building a baby is a tremendous effort – think of it like continuously running a marathon.  There is a reason the first and third trimesters are such sleepy times and although part of it is changing hormone levels, those hormones make you sleepy for a reason.  That reason, of course, being that you actually need far more sleep, far more rest, far more down time because your body is building a human.  The hardest scenario to recover from is back-to-back babies. Although there hasn’t been research done on the length of the recovery period ancient cultures tend to say that six weeks of rest, relaxation, pampering and the most nourishing foods will prevent six years of fatigue, frustration and sadness.  This truly means six weeks of being cared for after delivery. Here’s a great article on postnatal depletion.
  • Virus – Of course every virus is different and your body will recover from the common cold (usually rhinovirus) far before it will recover from mono or parvovirus or herpes.  The thing about viruses is that they linger in your system and can become dormant, only to reemerge in times of stress (the classic is herpes – cold sores or outbreaks will happen any time your body reaches a certain level of stress or depletion).  Recently medicine is realizing that high viral loads also accompany conditions like chronic fatigue and fibromyalgia – especially the slow-burn viruses like epstein-barr (mono) and cytomegalovirus (which typically only causes symptoms in newborns and the elderly, but can eat away at reserves in the background). As a general rule I like to give the body two times the active period of the virus for recovery if you really rest and let your body do it.  So however long you feel symptoms give your body twice as long as that again to actually focus on great nourishment, good sleep, low stress and moderate activity.  Remember for mono the symptoms can last easily 6-12 weeks so 12-24 weeks after that for recovery.
  • Over-training – Over-training can be a big issue in athletes and weekend warriors alike.  Essentially it’s a situation where you ignore your body’s actual capacity to reach a goal. The common factor is ignoring capacity – athletes have a tremendous capacity and typically take great care of themselves physically, but also generally push the limits of what their body can do, how it performs and how much it can do.  Weekend warriors are typically not the best at taking care of their bodies, but over-push when they get a chance to because they don’t get as many chances to as they’d like.  Either way, the consequences are similar – little bits of damage with every work out that don’t always get a chance to fully heal before the next workout and so build up in the background.  A good trainer or coach should encourage rest days and even rest weeks to their athletes, but that doesn’t always happen.  Again – it comes down to actually listening to your body and responding appropriately. Typically though when you stop listening injuries start to escalate.  It starts with small things and then bigger things as you re-injure vulnerable areas that haven’t fully healed. For a cycle like this I suggest 3-6 months off of training with great nutrition, hydration, rest, and gentle therapeutic exercise to the injured area (often range of motion exercise, stretching, foam roller and massage to the area). Truly letting your body heal is hard when you’ve got a goal, but so worth it in the end.
  • MTHFR recovery – For anyone struggling with MTHFR you know it has often been a lifelong symptom picture that just isn’t addressed until the gene mutation is discovered. Once the mutation is discovered then starts the long road of nutrient repletion, damage repair and detoxification.  Essentially your body has always been malnourished in a fundamental way and starting to re-nourish with the active forms of folate and B12 also allows your body to get the wheels turning on all of the work it couldn’t do while you were malnourished. This process can take years to fully evolve and can be incredibly rocky as you’re first trying to find the best protocol for you.  Once you do find a good protocol, plan on allowing the process to unfold for several years before you really see the true end-result.  Stick to your supplements and listen to your body because you will need more rest, better hydration and better nutrition through this process as your body catches up with the backlog of work it didn’t have the resources to do before. The more severe your mutation, the longer the process will take. Count on at least a year and typically longer to see the full results.
  • Anaphylaxis – A serious allergic reaction triggers so many processes within your body and it uses a tremendous amount of resources in an extremely short time.  With appropriate treatment your body can get feeling back to normal even within the first 24 hours, but for most people the allergic response is actually heightened for weeks, sometimes months after the event.  This means that smaller insults and things that don’t normally trigger full-blown allergic responses can do so because your body is already more keyed up.  Recovery takes rest, lots of water, trace minerals and electrolytes but also a “clean” environment where you work to eliminate even the minor allergies from your sphere so that your body has a chance to truly calm down.  Steroid treatment is the fall-back if you can’t interrupt this process naturally, but steroids take a toll on your body too. The best way is to avoid as much as possible your food sensitivities, environmental allergies and triggers and give your body good hydration, nutrition and electrolytes. Let your body calm down naturally and plan on at least 3 months.
  • Surgery/Trauma – Naturally it depends on the type of surgery or trauma, but recovery truly does take far longer than most people consider.  Repair and remodeling is typically happening well beyond the length of time you feel the pain of the wounds.  Use the viral model – however long you were hurting, take that length of time again after the pain stops to recover fully. That means during that time you’re focusing on good sleep, good nutrition, good hydration and minimizing stress.
  • Mental and Emotional Stress – This is a biggie – I can’t tell you how many times I’ve had a client in my office who had a divorce two years ago and their health just hasn’t been the same since. Likewise with family dying, extended stress or grief situations and lawsuits. Mental and emotional stress is as much of a stressor for your body, your system and your reserves as any physical ailment you can think of, and maybe more. This drains energy, keeps up an unhealthy hormone cascade and uses far more nutrients than you might realize.  Recovery after a stressful period is often years in the making and requires not only physical rest and nurturing but mental and emotional rest as well.  Counseling, homeopathy, meditation, spiritual or religious work and hypnosis can all be helpful at this point.  Use the tools that work for you and allow yourself the time and space to fully heal. Get help when you need it, ask friends and family for support, do things that bring you joy. Allow yourself to grieve fully, release emotions, sleep, cry, scream, get angry and do whatever it is you need to do.  Just try not to “push through” and ignore your needs or tell yourself you “should” be over it by now – if you’re not, you’re not. Just listen to your body’s needs.

    Health recovery needs sleep. More sleep. Great picture quote from dazzduz.com

    Health recovery needs sleep. More sleep. Great picture quote from dazzduz.com

Health Recovery: How to Truly Recover Fully:

Your body has an inherent wisdom and a knowing about what needs to happen. The problem is that your brain often overrides that wisdom with all of the social rules you learned as a kid – you “should” be tough enough to handle this. Laying around or sleeping too much is “lazy.”  Taking all that time is “self-indulgent.” “Other people have it way worse.” Sure – they might, but life isn’t a competition to see who suffers the most and only that person gets to feel bad. Western society has a kind of work-martyr complex where we all need to be pushing as hard as we can all the time to be better, faster, richer, slimmer, nicer and younger. Because that’s possible. Actually recovering requires letting some of that go – stepping a little to the side and acknowledging that you are important to you. I am important to me.  Important enough to rest, to relax, to let go of the extra stuff.  Important enough to do this:

  • Stop when you’re tired in any way – mentally, physically or both.  This requires noticing when you’re tired so if you’re one of those people who notices they’re exhausted only when they sit down, then it’s time to start sitting down every 10 minutes just to check in. Don’t tell yourself all about the things that need doing, just sit your but down and pay attention.
  • Stop making excuses – we all do it.  When people ask how you’re doing and you say “Busy!” with that note of eager pride it means that your life is unnecessarily cluttered up by ridiculous things.  If your answer to that question is or has recently been “busy,” “hectic” or anything similar then it’s time to sit down with your schedule and get brutal about slashing things away.  You don’t need to volunteer for the PTA, the neighborhood association, business networking meetings or anything else that isn’t directly your job or your family.  The kids don’t need 8 extra-curricular activities to which you need to drive them.  You won’t die if your house is less than perfect, if the car doesn’t get washed or the lawn doesn’t get mowed.  I’m willing to bet you make time on your schedule for all kinds of people who you don’t actually want to spend your time with. Slash it all.  Everything that isn’t absolutely necessary, needs to go so that you can have space to do whatever nourishes you. Here’s a great article about it called “The Busy Trap.”
  • Do what nourishes you – If really what your body wants is a long soak in the bathtub, make it happen. If you’re craving that extra two hours of sleep in the morning, find a way.  If you want to sit and stare at the wall for 20 minutes doing nothing, go for it. If walks in nature or journeling have always been your solace then take the time. If you loved drawing or coloring or whatever as a kid, then try that again to see if it still sparks your mind. If you want to lay on your bed and stare at the ceiling then by all means.  Schedule it in if you have to, but do it – not just once.  Carve out an hour a week for just you.  Once you’ve got the hang of an hour a week, carve out a second hour.
  • Eat nourishing food – I”ve heard the argument that “what nourishes me is a dozen krispy kremes.” Actually no, no it’s not.  Granted, it’s a great drug but ultimately using a drug (alcohol, sex, pain, food, drama) to take your attention away from your own life, health, situation or healing boils down to avoidance.  That doesn’t mean a good pizza and donut night is entirely out on the recovery plan, it just means that it isn’t every night or even the majority of nights. Focus on fruits and veggies and simple grains like rice.  Slow cooked meals, soups and stews are great because the long-cooking essentially partially digests them so your body has less work to do.  Eat foods your mom or grandmother would have made for you – chicken soup, chili, beef stew, roasted veggies, baked apples.
  • Hydrate – drink lots of water, every day.  Add lemon juice, a pinch of sea salt, trace minerals or electrolytes if it seems like the water goes straight through you. So many of us are chronically dehydrated all the time – get used to drinking more.
  • Sleep – I don’t care what everyone else says you should get.  Sleep as long as your body wants as often as your body wants.  If you have to get up to go to work then do it, but sleep as much as you can. Go to bed earlier, get up later. Nap. Invest in a hammock. Just sleep.
  • Emote – I’m often surprised by how much emotion comes up in every type of recovery. Even something emotionally neutral like foot surgery or a common cold. That is totally okay,, and whatever is coming up just go with it. If you need to cry, or scream, or throw things, or put on the Cure and mope a bit then get right to it.  You don’t need to understand it, you don’t need to judge it, you don’t even need to attach any importance to it. At the end of the day it doesn’t matter why you feel like that, if you’re supposed to feel like that or how long you’re going to feel like that.  Just let yourself feel like that.  Emotions don’t make logical sense and they aren’t really supposed to.  Sometimes you have to just let them happen and accept them.
  • Don’t Judge – You are human.  Stuff takes longer than you think it’s going to.  Life isn’t what they show in movies, and it isn’t going to be.  Hollywood is in no way representative of reality. Recovery takes a long time and you need more love, gentleness and care than any character John Wayne ever played.  Our society loves to martyr itself – we have the work martyr, the family martyr, the achievement martyr. There are so many ways to hang yourself on that cross, but here’s the thing.  Killing yourself to do more, be better, ignore your own needs or downplay your own suffering doesn’t actually help anyone at all.  Nobody benefits when you burn yourself down to a nub, or when you make a bunch of judgements about actually taking care of yourself.  Just let it all go and allow yourself to be human. The more you are able to take care of your own needs, the more you actually have to offer the world. There is a reason they tell you to put your own oxygen mask on before helping those around you.

Health recovery is slow, stepwise, and can’t be skipped.  Don’t fall into the trap of opening the drain at the bottom of your bucket and forgetting to close it again. You can contribute so much more to the world when you are operating at full capacity.



The Best Plan for Natural Heart Health

Heart health is one of those things that we all know we should be taking care of, but don’t necessarily think about day to day until that horrible moment in the doctor’s office when you find out something is already wrong. That is not the best moment to be unprepared for. Maintaining natural heart health should be a priority for everyone, but deserves extra attention if there is heart disease in your family or if you have any contributing risk factors such as metabolic syndrome, MTHFR mutation, overweight, pre-diabetes or diabetes, or have an inflammatory disease. The great news is that a good plan for natural heart health is also a good plan for human health and will help you to become and stay healthy and vital in general and keep you feeling great into your later years. If you’re not sure about your heart disease risk, your Framingham Risk Score is the best way to find out how you stack up.

Key Elements for Heart Health:

Get Active

  • At least 20 active minutes every day this doesn’t have to be exercise, but you have to be moving! We’re all desk jockeys, so it’s important to remember that your body isn’t built for that. Lately I’m into doing these fabulous retro-90s 8 minute workout series – partly for the greatness of the workout and partly for the ridiculousness of the spandex. I’ll put the “8 minute Abs” right here, but have no fear. There are also 8 minute buns, legs, arms, and even 8 minute stretch.  Each one is just as awesome as the last. You’ll totally thank me for this:

  • Something that gets your heart rate up three times a week for 45+ minutes. If you’re a gym person, that’s awesome but I prefer to get outside and walk, jog, swim, dance, bike, kayak, toss a frisbee around, or generally do something fun. Besides taking care of my heart health gives me an excuse to do something fun three times a week! I get to legitimately put “dance” or “hike” or “kayak” on my calendar without guilt.




Natural Heart Health Diet

  • Balanced meals and snacks with higher protein, moderate carbohydrates and moderate fat. I like the zone diet which is 40/30/30, meaning 40% protein, 30% carbs and 30% good fats. The Mediterranean diet is also proven for heart health – this one focuses on lots of healthy veggies and fruits, good fats and proteins from nuts and olives and moderate lean meats and fish. Make sure fats are balanced between saturated (solid at room temp like meat and butter fat) and unsaturated (liquid at room temp).  Also minimize your sugar intake as much as possible.
  • Paleo and primal diet is great for so many reasons and it’s very popular right now, but it actually isn’t the best choice for your heart simply because the emphasis on protein, which usually ends up being meat protein, is higher than the average person needs.  If you’re an athlete, paleo is awesome but if you’re just kind of a normal person then this amount of animal protein can be more risky for your heart. It’s a great diet, just not perfect for this.
  • High fiber! This independently reduces the risk of death from heart causes as well as from cancer. At least 30 grams per day from your fruits, veggies and whole grains.
  • Ditch the processed foods – whole foods are the only way to go.
  • Reduce your total calorie intake. In developed countries, we tend to chronically overeat – for most people 2500 calories is enough, and for many it’s too much. Reduced calorie diets reduce the risk of death from all causes and are considered an “anti-aging” therapy.

Get Your Omega-3s (And Reduce Your Inflammation)

  • Inflammation is proving to be one of the biggest factors in heart health – along with every other type of health you have.
  • Fish oil improves heart health, reduces inflammation, stabilizes mood and reduces your risk of death from all causes. No worries if you’re not into fish, there are plenty of vegetarian options to supplement the essential omega-3 oils that we’re looking for.  Flax, hemp or mixed seed oils are great.  The emphasis should be on a mixed spectrum of beneficial fats but especially EPA and DHA.
  • There is a prescription fish oil but studies haven’t shown any difference between it and the over the counter fish oils.
  • 1500 to 2500 mg omega-3 per day, 5 days per week (I’m a huge fan of weekends off vitamins).

Magnesium

  • Magnesium relaxes smooth, skeletal and cardiac muscle and helps improve blood flow to heart muscle and can help those who suffer from chest pains and anxiety.
  • For natural heart health Magnesium Taurate is best if the heart muscle is weak and Magnesium Glycinate is best if there is a high-stress component. Here’s more detail about magnesium.

Support Your Nitric Oxide

  • Nitric oxide is the main molecule that your body uses to help open your blood vessels to allow smooth, easy blood flow when you need it.  It is one of the most important things your body does to keep circulation going to the areas that need it.  This makes it hugely important for your heart health.
  • The amino acid arginine is one of the main building block for nitric oxide, so 1000 mg of arginine on an empty stomach twice a day will help to open up those blood vessels – it’s great to take before a workout. For even greater results use sustained release arginine (Perfusia) which opens blood vessels and increases blood flow dramatically. The biggest issue with arginine supplements is that arginine is also the preferred food of the herpes virus and can cause outbreaks if you’ve already got the virus.
  • If arginine isn’t an option for you then boosting your nitric oxide can happen through lots and lots of dark green leafy veggies – especially beet greens, and also beets, beet juice or concentrated beet crystals in general. In fact because of this effect beets are the new performance enhancers for elite athletes because they help them legally boost circulation in key moments.

Stress Reduction

  • Because it’s just that easy to reduce stress.  Ha! I wish.  Still, reducing stress is very important – the most common time for heart attacks is Monday morning at 8 a.m. – no joke.
  • Meditation, yoga, laughter, whatever makes you happy
  • Working over 45 hours a week is not reducing your stress (just a hint and a reminder to myself too.)

    Reducing your stress will boost your natural heart health. Just take it from this frog. Also - the frog is from visboo and the quote was added by Amanda Hurt.

    Reducing your stress will boost your natural heart health. Just take it from this frog. Also – the frog is from visboo and the quote was added by Amanda Hurt. At least I think that’s how it all went down – so near as I can follow the interwebs.

Lose Weight if You Need To

  • Extra pounds mean extra stress on your heart, circulatory system, metabolism, hormones and antioxidants. In fact, for every pound of fat you lose your body can eliminate a MILE of blood vessels. Obviously losing a mile of unnecessary blood vessels is probably going to help with natural heart health.
  • Losing even 10 pounds can help lower your cholesterol between 7 and 10%.
  • Maintaining healthy body weight also reduces risk of death from other conditions such as diabetes, stroke, heart failure and some cancers.

An Aspirin A Day?

  • 81 mg baby aspirin has been suggested for primary prevention of heart attack and stroke and more recently some cancers.  It is still suggested by many doctors as an early therapy for heart disease and even many of the major health organizations.
  • Research about the effectiveness of aspirin is unclear – a recent meta-analysis published in PLoS One shows that there is an overall reduced risk of heart attack and reduced cancer mortality but an increased risk of gastrointestinal bleeds, and hemorrhagic stroke. Talk with your doctor about this one, and maybe bring a copy of the full text of this research.

Reduce Your Blood Pressure

  • By any means necessary.  Having high blood pressure is one of the biggest risk factors and everything we’ve talked about so far will help. If it isn’t enough, then try supplements or talk with your doctor about pharmaceuticals.
  • Even if you don’t like the idea of taking a prescription (it’s not natural after all), it’s still better to use a prescription short-term while you work on other things that might raise your blood pressure (like MTHFR, weight, stress levels, poor sleep, chronic dehydration) than it is to leave it elevated.  Once things are under control you can quit the medication.

Check your MTHFR Status

  • MTHFR is a genetic pathway that helps you to activate folic acid, which then helps you to keep levels of inflammation down and make nitric oxide effectively so it’s all tangled up in heart health.  If you’re not sure what the heck I’m talking about, you can read more about MTHFR in general here, and if you kind of think you  might be a mutant (like me) then check here.
  • If your doctor gives you a blank look when you ask them about MTHFR testing, which happens sadly often, then a great way to do it is to order a 23andme test kit to test your own genes (you also get to find out what percentage neanderthal you are, which is pretty awesome).  The awesome folks over at 23andMe got slapped by the FDA for coming too close to giving health advice, so now you have to run your results from the full test through the methylation analysis at Genetic Genie. Then the real fun begins!  MTHFR is ridiculously complicated, so it can help to work with someone but start here to find out the right dose of methylated folic acid for you (this is the active form that you can’t make if you don’t methylate properly).

Hang Out With Some Trees

Natural heart health is essentially the same as natural human health so start today.  You don’t have to do everything all at once and suddenly be the amazing vice-free human, just make small steps forward and keep at them.  If it takes you a year to change your diet, then it takes you a year.  Just as long as you keep it changed that was a year well spent. None of this has to happen overnight unless you’ve just been lucky enough to survive a heart attack, in which case you do have to do everything at once to make sure number 2 doesn’t get you.  For most people though, change can be gradual and easy.  Make sure you are working with a physician if you have high blood pressure, abnormal blood clotting, a strong family history of heart disease, or are having chest pains (and it’s kind of a good idea in general).



What is the Best B12 for MTHFR Mutants?

The best B12 for MTHFR mutants is… not easy. Just like everything else about being an MTHFR mutant – but the good news is that there is a logical process of discovery that you can go through to find the best B12 for your own brand of mutant-hood.  Also, if you’re a little fuzzy on the MTHFR particulars this is a great place to start for the basics and this article will help you figure out if you’re an MTHFR mutant.

Obviously the Best B12 for MTHFR Mutations is Methyl-B12 (methylcobalamin) Right?

Nope. At least not for everyone.  It makes sense on the surface that if you can’t methylate well then you probably don’t methylate B12 any better than you methylate folate. The problem is that nothing about methylation issues is “on the surface.” Let’s look at a diagram from Dr. Amy Yasko’s awesome website, which focuses on MTHFR mutations and autism,  to help to understand this further:

Awesome (and kind of intense) view of that methylation cycle that helps to show the best B12 for MTHFR mutants from Dramyyasko.com

Awesome (and kind of intense) view of that methylation cycle that helps to show what B12 is best for MTHFR mutants from Dramyyasko.com

Just to clarify, what you’re looking at is a huge, complex, multi-step chemical reaction. Each of the green arrows signifies a vitamin or co-factor that is important for that step of the reaction.  The boxes are particular genes that also influence that step of the reaction. You’ll notice the MTHFR gene that we all know and love at the bottom left of the diagram. You’ll also probably notice that the whole picture is so much bigger than just those two genes (eek!).




The big green arrow for B12 comes straight down between the two big wheels of the methylation cycle.  There are two genes that can change that step of the process, which are called MTR and MTRR. Both MTR and MTRR genes code for enzymes that convert homocysteine to methionine. Both of these enzymes need methyl-B12 to work and your body especially needs B12 support if you have the MTR or MTRR mutations. So, in theory, the best B12 for MTHFR mutants should be methyl, and this is a great place to start but sometimes clinically this doesn’t pan out. Often clinically hydroxycobalamin, which is a slower-release, longer-acting form does much better.

Methylcobalamin, or methyl-B12, is still the best first choice. It makes the most logical sense, it’s the most rapidly active form and it’s already methylated so your body doesn’t have to convert it to anything for it to work.  It’s also the most rapidly acting (and therefore rapidly broken down form) and because of this some people with MTHFR mutations have problems with it. Especially the MTHFR mutants who have severe side-effects from taking 5-MTHF. If you’re not sure if that’s you then read more here.

Signs Hydroxycobalamin (hydroxy-B12) Could Be Better For You:

  • You take methyl-B12 and don’t notice any difference in energy level, mood or really anything else.
  • You have the MTR or MTRR mutations but don’t respond to methyl B12.
  • You have started slowly taking methylfolate but quickly started having side effects.
  • Your blood levels of B12 show up too high, but you still have symptoms of B12 deficiency.
  • Even taking a good dose of methylfolate and methylcobalamin your homocysteine levels don’t come down.
  • You take methyl-B12 and kind of start to freak out.
  • You’re taking good methyl-folate, other good B-vitamin support, and you don’t feel better at all, or feel worse.
  • You take methyl-B12 and on blood tests you still show up B12 deficient.
  • You also have the COMT or MAO mutations,  that change the way some of your neurotransmitters are broken down.

The bottom line is that if you start a good protocol with methylfolate and methyl B12 and don’t feel any better, or feel worse then either you started with too high a dose, or hydroxycobalamin (hydroxy B12) would be a better choice than methyl B12.

The Benefits of Hydroxycobalamin or Hydroxy B12

  • Hydroxycobalamin is used more slowly by your body and so can help to maintain steadier levels of B12
  • It helps prevent methylfolate from forming too much nitric oxide in your body, which helps to reduce side effects of 5-MTHF.
  • It easily converts to methyl B12
  • It helps reduce cyanide in the body (totally unrelated, but it’s a bonus!)

So does this mean hydroxycobalamin is the best B12 for MTHFR mutants? Well – no. The best B12 for MTHFR mutants is always unique to that particular person. It means that your total picture determines what’s best for you.  The logical place to start is with a methyl B12, but if that isn’t giving you the results you want or if you’re having a lot of side effects from the mthylfolate you’re taking then try switching to a hydroxycobalamin form. For many of you it will help to get you feeling energetic and happy and all the things we should feel every day.



The best dose of methylfolate for MTHFR mutants

MTHFR mutation is a huge factor in physical and mental health but we’re still learning the basics because it’s all very new research so the best dose of methylfolate for MTHFR mutants isn’t really a straight answer.  The good news is there are lots of ways to read your body and to learn the best dose of methylfolate for YOU. If you’re a little fuzzy on this whole MTHFR thing, then check out this post on the MTHFR basics.  This will give you a good framework for the whole conversation – also if you suspect you have the mutation, read more about how to know you’re a mutant here. If you, like me, already know that you’re a mutant then let’s tackle the hard problem of finding the best way to compensate for your body.  Finding the right dose of methylfolate can help to reduce anxiety and depression, stabilize mood, boost fertility, protect your heart and cardiovascular system and generally keep your body at peak performance so it’s important to take some time and do this the right way.

Finding the Best Dose of Methylfolate is a Process of Trial and Error

I wish there was just one answer – this is the right dose, but sadly it all comes down to what is the right dose for your body.  First off, I never suggest taking methylfolate by itself without any other B vitamins.  The B vitamins all have overlapping functions and so it’s important to have decent doses of all of them.  Typically though I start clients with a B complex that has a reasonably low dose of methylfolate – like maybe 400 mcg.  I really like the one from Pure Encapsulations called B Complex Plus. It’s basic, simple, and most people – even hard core mutants – tolerate it pretty well, but I’m not married to it. Any good multi-B with a low-dose methylfolate will do or you can look for a multivitamin that has methylfolate in it like Thorne Research Basic Nutrients.  Occasionally even this low dose creates a bad reaction – if that happens then we’ll have to start with a low dose MTHF by itself and split the capsule apart but this is the option of last resort. First, let’s try the low dose B complex or multivitamin and see what happens.




Keep in mind the first three days of any MTHF might be difficult and there may be some adjustments. You may  notice that you’re a little agitated, or anxious, or depressed or just feel a little spacy or off. With any luck that should pass pretty quickly and we’ll wait for things to stabilize before increasing the dose.

If the Low- MTHF  B Complex or Multi Works for You

Great! We’re on the right track.  Even if this is the right dose for you there might be a few odd adjustment days in the beginning – that is totally normal.  Just wait until everything settles down and see how you’re feeling.  Typically with this low dose people may notice a small spike in energy or a little boost to mood, but often it isn’t enough methylfolate to start to touch the issues – that’s okay because it’s enough to get the ball rolling.  The next step would be to add a 1 mg (1000 mcg) MTHF by itself to the B complex you’re already taking. We’re looking to make forward progress without rocking the boat too much.  Each time you increase the dose there may be another adjustment reaction as your body gets used to things, so try to stick it out for 3 days before you make a final judgement about it.

If the Low-MTHF B Complex or Multi DOESN’T Work for You

Then we switch to plan B.  Plan B is a little messier and more tedious, but it could make all the difference for how you’re feeling on a day-to-day basis.  Start with a 1mg MTHF – I prefer a capsule so that you can just open it and portion out the powder (instead of trying to cut or crush a tablet). In this situation start with 1/4 of the capsule – easiest is mixing it with some peanut butter, applesauce or yogurt and taking it that way.  It tastes pretty gross, but hopefully you can hide it in something. Again count on about 3 days of adjustment, but we’re starting with very low doses here so hopefully that will be fine and if it’s still too much then you can cut it down even further. Once you get to the dose you can tolerate, keep it there for a couple of weeks and try to slowly increase.  By now your body has started to process some of the back-log of work so it might be easier to tolerate a bigger dose. Now would be a great time to try going to the B complex with MTHF or multi with MTHF because you do still need all those other B vitamins.

What to Do If You Can’t Tolerate ANY MTHF?

Yup – I’ve seen clients like this. They take the tiniest amount and spiral into depression or anxiety attacks or start to feel itchy. Not fun at all!  In this situation it’s tiny-dose niacin to the rescue.  For whatever reason taking about 10-50 mg of niacin  – this is usually 1/10th or even less of a 500 mg niacin tablet.  It’s a tiny dose, but for many people it really helps to ease the transition into MTHF.  Start again with a small dose from the opened MTHF capsule (maybe 1/4) and add a tiny shaving off the niacin capsule and see how you do.  The niacin seems to buffer things a big so that the MTHF is a little bit easier to tolerate – again it’s about helping your body to do some of the work that has piled up in the absence of activated B vitamins. If niacin doesn’t help then sometimes hydroxycobalamin will.  This is a little bit mysterious because you’d think it would be methylcobalamin (the methylated form of B12 which MTHFR mutants also have a hard time making).  Oddly, the hydroxycobalamin form seems to be the most helpful when you’re starting MTHF dosing and when niacin doesn’t take the edge off, a lot of times hydroxycobalamin will.  Do you see what I mean about trial and error?




Methylation, it's complicated. The best dose of methylfolate is out there for you - you just have to find it. Thanks to flickr user Franklin Park Library for the image.

Methylation, it’s complicated. The best dose of methylfolate is out there for you – you just have to find it. Thanks to flickr user Franklin Park Library for the image.

How Do I Know I Found The BEST Dose of Methylfolate?

We are doing all of this to help you feel better as a whole human.  Methylating your B vitamins or taking methylfolate is supposed to help boost your energy, stabilize and elevate your mood, help your body with detox reactions and reduce a wide variety of symptoms over time.  So how do you know you’re’ at the perfect dose for you?  Well – you should feel better.  Keep in mind the prescription methylfolate comes in 7 mg and 15 mg doses (deplan).  Those are a whole lot bigger than the doses we’re starting with above so when you find a good starting dose for yourself then stay there for a couple of weeks.  If you’re feeling fine and stable but not a lot of improvement then try a higher dose and see how you feel with that. For everyone there is a sweet spot where they feel better and more energetic, but not anxious or wound up.  Keep in mind every time you increase dose those first 2-3 days may be a little bit odd.  Don’t judge by those days.

Things to Remember:

  • You need all the B vitamins, not just methylfolate so don’t leave those out of the mix. A good methylated multi or methylated B complex is a great foundation to start with.
  • Methylation affects neurotransmitter formation, inflammation and detoxification so lots of random symptoms can pop up when you increase the dose. Give it a few days before you make judgements.
  • Increasing doses slowly is easier for your body to tolerate than just dumping a high dose in all at once.
  • Tiny doses of niacin can help smooth out the transition.
  • Hydroxycobalamine, a form of B12, can also help to make taking MTHF a little easier.
  • Every body is different so the best dose of methylfolate for you could be completely different from the perfect dose for someone else.
  • Every MTHFR mutant has mutations in different spots and combinations plus a whole host of other genetics to deal with. Don’t get discouraged – there is always a perfect solution, you just have to find it. Generally though the more mutations you have the longer it might take to find the right balance.
  • Methyl donors like Trimethylglycine (TMG)  which is also called betaine anhydrous can also support this process by donating methyl groups for your newly-functioning methylation pathways to use.
  • Riboflavin-5-phosphate also supports methylation and homocysteine metabolism (which tends to build up if you’re not a great methylator) so sometimes a small dose of this will help things out as well. It should be in a good B complex.
  • It’s important to avoid sources of folic acid (which there are many – think all of the “enriched” grain products like cereals, breads, pasta) including multivitamins with folic acid or vitamin-enhanced foods. Plain old folic acid will compete with the methylfolate you’re taking and make it harder for those pathways to work.

Specialty Methylation Products

There are a few great methylation products out there that have a combo of supportive ingredients.  One of my favorite is Methyl-Guard Plus by Thorne Research, which combines a reasonably high dose methylfolate with methyl-B12, TMG and riboflavin-5-phosphate.  It can be a high dose to start with though, so especially if you have a few mutant genes it’s a good idea to start with the lower dose products and work your way up. There is no sense shocking your body. Too high a dose can cause as many problems as too low a dose so it’s important to find your sweet spot.

The bottom line is that this is no different from any other aspect of health. You need to find the right thing for YOUR body and there is no one size fits all.  The best dose of methylfolate for you is out there – you can find it.  I feel like the biggest thing is to ease your way into it and not over-flood your body. Start slow and work your way up – better to get there slowly than to give up because you felt so bad when you tried the high dose.



All possible variations of MTHFR gene combinations.

Understanding the MTHFR Mutation Basics

I’m amazed at how many people are coming into my office with MTHFR mutations, and also at how difficult it can be to actually understand the MTHFR mutation basics. So let’s start from the beginning and go from there.

What is MTHFR? Why Do I Keep Hearing About It?

MTHFR, just to be confusing, is the name of both a gene and the enzyme which that gene helps your body to make. We call it MTHFR because the actual name, methylenetetrahydrofolate reductase, is just ridiculously long and cumbersome. This enzyme helps your body to methylate. If your genes have a mutation it means that the enzyme they’re supposed to make turns out just a little bit wrong.  You still make the enzyme it just isn’t exactly the right shape and so it works differently from normal. It’s become kind of a buzzword these days simply because we’re discovering that it is more common than we thought and if you happen to be a mutant (like I am) then you may be at greater risk for a number of health problems. We’ll get to those in a second.




What Does the MTHFR Enzyme Do?

The short answer is that this enzyme methylates. Since the short answer sounds like something nobody cares about, let’s also talk about a long answer.  Methylation means that you add a “methyl group” which is essentially a carbon bonded to three hydrogen that looks, appropriately, like mutant mickey mouse ears. This sounds highly anticlimactic, but actually helps your body to do almost everything, like replicating and using your DNA, activating your B vitamins, detoxifying toxic substances and a whole host of other things.

What Are The Possible MTHFR Mutations?

There are TWO MTHFR genes, the MTHFR-C gene and the MTHFR-A gene and you have two copies of each of these (one from your mother and one from your father). This means there is a whole variety of ways that things could go wrong… Let’s look at those here:

ossible good and bad copies of the MTHFR gene

Possible good and bad copies of the MTHFR gene

This means that there are two genes, each with two copies and you could have good or bad copies of one or both… So:

All possible variations of MTHFR gene combinations.

All possible variations of MTHFR gene combinations.

The basic rule is that the more bad copies of the gene you have, the more likely you are to have negative health effects from those genes. The good news is the more bad copies of the gene you have, the more benefit you can get out of working to improve your body’s methylation ability.




Can I Fix a MTHFR Gene Mutation?

Yes and no. You are born with a set of genes and you’ll die with the same set – nothing can change your genes.  That sounds like bad news, but the good news is that we can get around a slow enzyme pathway – usually by supplementing the methylated form of B vitamins (so that it doesn’t matter if your genes can’t convert them) and also methyl donors. MTHFR mutation can make your life miserable, but if you learn to deal with it correctly it can also be overcome.

Poor methylation is becoming a common topic in medicine simply because we’re realizing how common these mutations really are and how great an impact on health they have.  Learn more about some of the conditions caused by this mutation here, and about some of the problems you can run into taking methylated B vitamins here.  There is so much more to this story, but at least we’ve covered the MTHFR mutation basics here. If you suspect a problem, get tested and talk with a doctor who knows about it because that will be the quickest path forward.



Methylfolate Side Effects: MTHFR problems

We’ve talked about the MTHFR mutant problem before (right here) but haven’t really addressed the actual taking of methylfolate.  Folate sounds so benign, so harmless but sadly there can be methylfolate side effects. 5-MTHF fallout, if you will. We mutants are out there, walking among you unable to convert regular old folic acid into methylfolate, or 5-MTHF for short.  I will stand with pride among you my brothers and sisters because yes, I too am a mutant.  Deep shuddering sigh.  As it turns out, using gene markers alone to plan a healthy nutritional protocol is not as straightforward as it would seem.  The reason being that every system in the human body has a glorious level of redundancy – we are literally designed to fail in eight thousand ways and still function normally.




Simply having the MTHFR mutation doesn’t actually mean that high-dose methylfolate like Deplin® which is prescribed in either 7.5 mg or 15 mg doses is a good idea.  The reason for this is that your body has literally hundreds of overlapping systems that are involved in every function that is even remotely related to the ways you use folate in the body. These overlapping systems and layers of function help our body to function normally even with multiple mutations that may result in genuinely low levels of 5-MTHF. Obviously that’s awesome when you don’t have methylfolate, but it can be a little overwhelming when all of a sudden you have a ton of it.

methylfolate side effects can happen even with a great product like this 5-MTHF

5-MTHF – One of my favorite methylfolate supplements, but there can still be methylfolate side effects.

Picture flooding your system with methylfolate when there has been relatively little (and when your body has been functioning reasonably normally with relatively little). Your cup literally runneth over. In some cases, your body has been starving and so it’s a welcome relief like rain in the desert – all functions get better and you’re ridiculously glad to have some resources to work with.  In other cases the flood of 5-MTHF is literally a flood and you’re stuck trying to clean up the mess.

Methylfolate Side Effects:

  • Mood changes: depression, irritability, severe anxiety
  • Pain: sore muscles, joint aches, headaches, migraines
  • Physical Symptoms: rash, acne, heart palpitations, nausea, insomnia

You will notice that some of these side effects are exactly the symptoms we’re looking to fix by taking the methylfolate, which seems a little ironic and inconvenient.  Such is the way of medicine, no? Like the drug you take for constipation that may cause constipation.  Thankfully here the benefits far outweigh the risks, you just have to know how to do it right.  Remember that methylfolate is something your body actually needs, so it’s important to find a way to take it well.

Avoiding Methylfolate Side Effects:

    • Start slow:  Some people with the MTHFR mutation have no trouble taking methylfolate and feel a world of difference from it.  For the rest of us it’s a little too much, a little too quickly.  If that is you then backing the dose way down to what might be in a good multivitamin (400 – 800 mcg) is a great way to start.  From there you can slowly adjust your dose to find your own optimal dosage level.
    • Personalize: When we’re talking about your genes it really is all about YOU.  Just because something works for lots of people with the MTHFR mutation doesn’t mean it will work for you, so above all trust your body and your symptoms.  If you’re having a problem doing something one way (even though that way works for your doctor or your neighbor or everyone else on a forum) trust that and change your strategy.
    • Pulse Your Dose: For some people it helps to have some days on and some days off, meaning to take methylfolate at whatever dose your body can tolerate for some days but not others.  For my body personally the best strategy I’ve found so far is taking lower doses five days per week and taking weekends off (convenient too!) For some of my clients it’s a week on/week off plan at a higher dose.  This really does come down to experimenting with your body to find what is right for you.
    • Expect Some Adjustment: Remember that your body has been compensating for all of your mutations for as long as you’ve been alive so suddenly changing the entire playing field is bound to create a few waves.  Before you make a snap judgement about what works for you and what doesn’t give things a few days to calm down. Your body will constantly astound you with it’s flexibility, it’s adaptability and it’s ability to cope with ridiculously huge changes but even your miraculous body may take a couple of days.
    • Niacin to the rescue: 50 – 100 mg of time-release niacin can be incredibly helpful to counteract some of the side effects of methylfolate if an alternative dosing plan isn’t enough to make you feel awesome. Niacin helps your body to use excessive SAM (S-adenylmethionine) which can build up in some people taking methylfolate. It’s important to also experiment with your dosing to find the right level of niacin for you, and in larger doses niacin, even in it’s time-release form, can cause flushing.




  • Antiinflammatories: Some of the problem is just basically that your body was probably inflamed going into the methylfolate therapy and changing your protocol can stir everything up.  Also by taking 5-MTHF you are allowing your body to start to catch up on detoxification and repair, which can also increase your level of inflammation while everything is being sorted out. Good strong natural anti-inflammatories can help to decrease symptoms and help your body to adjust, especially while you’re finding your optimal dosage. A lipid-soluble form of curcumin (from turmeric) like Meriva® can make your life far easier.  Other great natural anti-inflammatories include fish oils, green tea, pycnogenol, boswellia, resveratrol and cat’s claw. Following an anti-inflammatory diet is tremendously helpful as well.
  • Hydroxycobalamin: In an odd twist this non-methylated form of vitamin B12 can help to control some of the side effects of 5-MTHF as well.  One of the benefits of taking methylfolate is that it increases your levels of nitric oxide, which is the signal that helps your blood vessels dilate.  Which is exactly why it helps with cardiovascular risk and headaches and lots of the other things it helps with.  Like with everything else in life, too much of a good thing is sometimes a really bad thing.  So if your nitric oxide levels end up becoming too high then your body starts to make free radicals, and those free radicals create side effects.  Hydroxycobalamin can help you to counter this effect. Again, experiment with your dosing.

Remember that if you have MTHFR mutations then your body will function better on so many levels by getting the methylfolate that you’ve literally been starving for, so it’s worth it to find the right dose and the right way of taking methylfolate for you.  This can save you from heart disease, stroke, heart attack, periodontal disease, anxiety, insomnia, depression, mood disorders, reproductive problems, even birth defects in your children. Just because you have methylfolate side effects doesn’t mean your body doesn’t need it, so keep trying to find the way that works for you.



MTHFR mutation, or How to Know if You’re a Mutant.

So, everyone kind of freaks out when I use a word like mutant because it sounds so sci-fi and X-men-ish but the MTHFR mutation doesn’t give us anything nearly so exotic as superpowers, more like just more of the usual problems. The thing is, we’re all mutants in one form or another. We all have a tremendous degree of genetic variability that gives us the amazing and awesome diversity of looks, personalities, traits and oddities that make us human. These mutations, or genetic variances, can make our enzyme processes work differently; meaning more slowly, more quickly or not at all. This is why some people are still doing great after five cocktails and others are bleary-eyed and drooling.

MTHFR gene mutations. Here portrayed, wildly inaccurately, as mutant carrots.

Behold the mutant carrots. Muah hah ha… Don’t worry, MTHFR mutations aren’t quite this funky.  Thanks to simply-sharon.com for the great photo.

For the most part, genetic variance creates relatively small changes because there are so many overlapping systems in the body. It’s all part of the great mystery – our bodies are designed with a plan A, plan B, plan C and probably the back-up super-secret plan X just to make sure everything goes right.  There are, of course, a few places where no matter how many overlapping systems we have, our bodies can’t compensate for how many little things have gone wrong.

One of the places this can happen is in the various genes for a process called “Methylation.”  Methylation, as you might have deduced, is the process where your body adds a -methyl group to some other molecule to help it become more active.  One of the most important places this happens is in the gene that methylates folate (the B vitamin) into it’s active form.  This group of genes are called “methylenetetrahydrofolate reductase,” or MTHFR for short. If you have too many genetic variances in these genes then you may not be able to activate your folic acid or other B vitamins.

MTHFR Mutation Problems Include:

  • High homocysteine levels in your blood and urine – this increases your risk for heart disease including high blood pressure, heart attack and stroke.
  • Increased risk of neural tube defects and preeclampsia if you become pregnant.  Neural tube is your baby’s brain and spinal cord so it isn’t generally an area you want to be defective.
  • Improper neurotransmitter production – this can lead to depression, anxiety, mood disorders and complex psychiatric illness.
  • Increased risk for the eye disorder glaucoma.




So – none of these complications are good things.  Generally they’re not issues you want to be dealing with in your life and certainly not a combination of them (bad enough to be depressed, but to be depressed with heart disease sounds worse). This leads to two questions, which naturally I will endeavor to answer for you.

Who Should Test for MTHFR?

MTHFR has a lot of variability and different people notice it in different ways. Usually I suggest testing for people who have had anxiety or depression since childhood, for people who have parents, siblings, children or themselves with spinal cord defects that might be related, or for people who have anxiety, depression or mood disorders “in the family.” This being a genetic mutation we usually see it show up in parents, aunts and uncles, siblings and children so if many people in the family are struggling then it’s time to look at your genes. Also if your homocysteine tests high at your doctors office even if you’re taking B vitamins then there’s a good chance there’s a problem.

How Do I know If I’m a MTHFR Mutant?

Great question! The best way to know, is to test. Your doctor can run a complete genetic analysis which will give you all of this information and is by far the best option if you have insurance.  This would also mean you could get a prescription methylfolate to help your body compensate.  If you don’t have insurance then there’s a great not-too-expensive way to do it at home, which comes with the added bonus of learning just how much neanderthal you have in you (I’m 3%!!!).  It’s called 23 and Me, and it’s an at-home saliva DNA test kit that gives you all kinds of great information about yourself like your neanderthal percentage, your ancestry, and also more serious things like your disease risk, certain gene markers for serious disease and also genetic differences that may cause you to react differently to certain drugs or chemicals.  All in all it’s pretty nifty.

Once you get your DNA info from 23 and Me, then you can plug it into the neatest service ever, which is donation based, called Genetic Genie.  Genetic Genie can run a full methylation analysis (for a suggested donation of $10).  I can tell you from looking at mine that this gives you an overwhelming amount of info and lots and lots of great ways to compensate for any genetic oddities you might find.

What Do I Do if I Have A MTHFR Mutation?

The short version is don’t worry, and take a methylated B vitamin.  This means the folic acid should be methyl-folate or some variation thereof, including L-5-Methyltetradydrofolate, L-5-Methyltetrahydrofolinic Acid, or 6(S)-5-methyltetrahydrofolic acid (the longer the word, the better apparently).  The B12 should be Methylcobalamin, and you may see something extra in there to just add extra methyl groups like trimethylglycine or betaine anhydrous.  Also, you should NOT take regular folic acid or anything that isn’t a methylated folate, simply because all of those will compete with the methylated folates and just continue the problem.  It isn’t always this simple because there are additional mutations that can interfere as well so some people have side effects when they take methylfolate, which you can read about here. If you find out you have an MTHFR mutation it’s not the end of the world, there is plenty we can do. It’s a good idea to check your kiddos too, or just switch them over to the methyl forms of B vitamins, and also if you have other genetic relatives who are struggling to pass on the good word about methylated B vitamins and your own new super-mutant status.