S2E8: The Preliminaries with MTHFR

This week you’re continuing to symptom track and continuing to have patience because right now you are laying the foundation for a good methylfolate start. This phase, what I like to call the preliminaries, is all about priming your system for the giant load of methylated goodness that is going to come in and without this, things can get really rough down the road.

The “Preliminary Phase,” is the first of three phases for that MTHFR folks go through when they start working on this. This phase lasts through a successful 5-LMTHF start and means your body is opening up the metabolic pathways that are dependent on methylfolate. Once these pathways start spinning reliably, then you will enter another phase, which I like to call “Burning Through The Backlog.” When your body has caught up with its mountain of backlog, which can take months or years, then we enter the “Maintenance Phase.”

Each of these three stages is equally important, but the preliminaries are relatively undramatic and underrated next to something as exciting as backlog. Giving your body the luxury of a solid start will help the backlog phase go much more smoothly and hopefully allow it to be faster, although that is my own conjecture.

With MTHFR, our bodies often have a backlog of unfinished business that needed methylfolate, but your body didn’t have enough resources at the time the business got started. These items go onto the physiological equivalent of a to-do list. In some ways the backlog shows up on a day-to-day basis – these are the unmanufactured neurotransmitters, the deficiencies of nitric oxide and glutathione and the excess of homocysteine. Most of these, however, are largely silent.

Toxins that can’t be methylated and therefore get diverted to long-term storage, unmethylated bits of DNA, unmethylated proteins and fats, and generally tasks that need doing. These build up and build up and as they accumulate, your body gets more and more desperate to start doing something about it.

The “something” your body wants to be doing can start to happen once you have reliable methylfolate and the background of other B vitamins, and once your body is confident about that, you enter the second phase, the “Burning Through The Backlog” phase. This is the heavy-lifting of the MTHFR journey and we’re getting ready for it right now.

So for this week, the best thing you can do is to keep tracking your symptoms. If you notice weird energy changes, strange new symptoms, anxiety, nightmares, intrusive thoughts, or any kind of wound-up feeling, reassess the vitamin B12 you started last week or previously with the other Bs. Remember that even though the methyl form is the most biologically active form, it is also the one most likely to cause symptoms. Actually, it causes symptoms specifically because it is the most biologically active form.

At this point you should also be maintaining the good MTHFR lifestyle things that we’ve talked about in the past. This means keeping up those food sources of natural folate – the natural folate, even though it does have to go through the MTHFR enzyme, will begin to get the wheels turning. Especially if you’re getting it in the absence of folic acid, which is known to block up the works. Unfortunately, many people who have had high folic acid exposure for years will continue to have high blood levels of folate on lab tests that we can only assume are mostly unmetabolized folic acid. It seems clinically as though it is difficult for your body to get rid of and so hangs around, cluttering up the works for a while.

Don’t be discouraged – just taking the folic acid out of your diet and supplements is a huge step forward for your body and allows some off that natural folate to reach receptor sites.

Other things to focus on this week are simple steps like hydration. We will talk more about the importance not only of water, but of hydration in a few weeks, but for now, just make sure you’re getting a lot of water. Anything that allows your methylation cycle to begin to move more freely is also going to encourage some detoxification, and you can’t get anything clean without water.

Also, sleep. As your body is able to methylate more, it is going to want the time and rest to do so. Prioritize both sleep and rest this week and through the coming months as your body really digs into this work. Sleep is when a lot of your detox processes happen and you’re going to be doing a lot of that.

I know this week doesn’t feel like we’re doing much, but it really does matter to create a good environment for all of the methylation processes to start happening, and also to open up these pathways in a slow and controlled manner. This is basically building the frame of a house before you put in the tiles and hardwood. The tiles and hardwood are far more interesting and way prettier, but without the frame, they’re useless. The 5-LMTHF start can feel strange at the best of times, but it’s way stranger if you aren’t ready for it.

Next week, we’ll talk about the actual 5-LMTHF start, what you might expect to see, and what weird feelings are “normal” versus the weird feelings that indicate a problem.

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S2E7: B12 and MTHFR

If you’re following along with what we’re doing, last week you added in B vitamins as a group. Typically this goes well for MTHFR folks because other B vitamins help the methylation pathway to turn, but don’t push it too quickly with methyl groups. There is one exception to this, and that is vitamin B 12 – specifically the methylcobalamin form of B12. We’ll talk about that in a minute.

First – let’s check in with where we are in the process. If you haven’t added any B12 yet, then this week we’re going to add it. If you have added B12 then let’s learn a little more about the form that you’re taking and continue to symptom track so we know how your body is responding. Let’s dive into the forms of B12 that are available and what the differences are between them.

If you started with the Seeking health B complex or vitamins then you don’t have to worry about this – they’re designed for MTHFR folks and so don’t have anything methylated in them. If you weren’t able to get those specific products then I want you to go right now to wherever you keep your vitamins and check the label.

The B12 will be called *something*-cobalamin. Cobalamin is the actual vitamin and the *something* is whatever it is bonded to. Just like folate has to be methylated to become its active form, B12 does as well so methylcobalamin is the most biologically active form of B12. It’s also the hardest one for MTHFR folks to tolerate.

This is where your symptom tracking comes in. Now, you wouldn’t be the first person to give me a withering look when I mention symptom tracking for the 800th time. I get it. Everyone is tired of hearing about it. But the problem is, that humans are used to living with symptoms that change on a daily basis and unless you’re paying attention, a lot of these symptoms get dismissed as “normal.” So, it can be “normal” to have intrusive thoughts one day and not other days for no reason you can put your finger on. It can also be normal for one day to be more down or more up than others. Symptoms, especially when they’re minor, changeable, or transient, just get ignored or shuffled off to the side.

This is a great strategy to help you function as a human, but it isn’t so helpful if we’re actually trying to evaluate health changes that you’re making. So if you’ve just added a multivitamin with methylB12 and suddenly you’re having heart palpitations 50% more than you usually do, that is something we need to know. Hence, the symptom tracking. I will step down from my soap box now, and carry on with the discussion on B12.

Vitamin B12 comes in a number of different forms. The most common and widely available is cyanocobalamin. It’s the least expensive form and generally does a fine job for most people. The cyano-prefix is actually short for cyanide, which tends to make people jumpy, but the dose of actual cyanide you get from cyanocobalamin is so negligible as to be a non-issue. Lots of people get nervous about it, but personally I’m not so concerned. It isn’t necessarily the best B12 on the market, but it will do the job. The cyano- group does have to be detoxified, so it does add a small burden that way. This is also the form most commonly found in injectable B12, which is a great option if your absorption is poor or if you have a profound deficiency.

Strangely, different people respond very differently to the forms of B12 and we don’t really have enough research to understand why, so B12 is one of those vitamins that I suggest doing a bit of your own human guinea pigging with (if guinea pigging is an actual thing). As your health journey progresses, it can be helpful to try the different forms separately and see how your body responds. Personally, I don’t do well with the methyl form at all, but respond wonderfully to the hydroxy form of B12. I notice a positive difference with it, where the methyl form just makes me jittery and irritable.

If you do notice any strange symptoms coming up this week and you did start a B12 last week, then check your form. The methyl form is known for giving people anxious, restless, wound-up energy that doesn’t feel good, intrusive thoughts, anxious thoughts, heart palpitations, and it can even be bad enough to push panic attacks or interfere with sleep.

I don’t want to villainize methylcobalamin. It is already methylated, which is a big help for those of us who methylate poorly and can take a burden off of our systems. It doesn’t need to be detoxified and it’s already biologically active. It is the most effective form of B12 for things like nerve health and if you tolerate it, then it’s probably the best form for you.

The hydroxo- form of vitamin B12 still has to be methylated to become biologically active, but it has the advantage of being almost like a sustained release vitamin B12, and so can be extremely helpful if your energy tends to suffer high peaks and low valleys – this one can help to even things out a bit. It’s not as easy to find as some of the other forms, but it can make getting your B12 far easier to bear.

The adenosyl-form of vitamin B12 is actually unique in that this is the form your body puts into storage, which makes it quite different from the other forms. Typically, excess B12 that you take as a supplement just washes out, but the adenosyl- form might actually go into storage. There is some very compelling informtion showing that this form might actually be the best for chronic fatigue , which is now being called myalgic enciphalomyelitis, or ME/CFS.

Research hasn’t kept pace with what people are doing clinically, and so the research on chronic fatigue shows great improvement for some people with B12 and folate supplementation, but doesn’t yet get into the nitty gritty between different forms of B12 or different forms of folate. In fact, all of the research I have seen is done using the cyanocobalamin form of B12, and plain old folic acid. Many chronic fatigue specialists, patients, and community forums indicate that the adenosylcobalamin form of B12 has the most profound effect for them.

If you have noticed an issue with your B12, switching to a hydroxy or adenosyl form might be easier to bear. They metabolize more slowly and so you aren’t faced with the overwhelming rush of energy. We also talked about the different forms of B12 in Season 1, episode 44 so if this episode isn’t enough, check out that one as well.

Again, this is a personal response situation, so if you’ve been taking one form and either don’t notice improvement or have side effects then try switching to a different form and see how you do. We humans are unpredictable creatures and if I’ve learned anything from MTHFR, it’s that the sum total of a human is so much more than their genes, lab tests, and stressors. We are unpredictable creatures and there are no two of us alike.

I am happy to say that the Patreon page is up and running, even if it is in its baby beginnings. If you feel like you’re learning something here and want more of the podcasts – please become a patron of the show on Patreon. It will help get great information to you and to other MTHFR folks as well. Plus, there are some patron perks. Visit Patreon.com/thwt Thanks for listening!

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S2E6: B Vitamins with MTHFR

If you’re following along with our step-by-step process, then you’re well ahead of most people who start their MTHFR journey with Dr. Google. Congratulations. This week we’re going to talk about avoiding one of the biggest mistakes that people make in their MTHFR quest for health, and that is, forgetting that methylfolate isn’t everything.

This is truly the mistake most likely to be made, followed closely by trying to change everything all at once and getting into a tangle.

It’s really easy to think of MTHFR as a “folate thing,” forgetting that the twenty other steps in the pathway that have to happen for MTHFR to have any impact, need other nutrients. Even the one step we’re obsessed with needs other nutrients.

While our mutation does have “folate” in its name and that seems like a compelling reason to focus on folate, if folate is all you focus on, it isn’t going to work out.

I’m not sure if anybody remembers S1E1 when we talked about how MTHFR was like a magic chair, but lets revisit that idea.

MTHFR is a gene. A tiny genetic code that help your body to build an enzyme of the same name. Enzymes are a special type of protein that I like to talk about in terms of being a magic chair. The magic that happens in this chair is like alchemy – it’s a lead to gold type of transition. Essentially, the magic chair turns something reasonably worthless into something incredibly valuable. Like I said, alchemy.

The MTHFR magic chair turns folate, folic acid, and folinic acid into the active form of the nutrient that actually does something in your body. This folate-gold, is called methylfolate or 5-L methyl tetrahydrofolate, if we want to be specific. Without the magic chair, the methylfolate never happens. If methylfolate doesn’t happen then things start breaking down.

MTHFR in the simplest terms possible – it’s a magic chair.

We see errors in cellular reproduction, problems with turning on or off particular genetic signals, trouble building neurotransmitters, inability to kill off damaged cells, toxins piling up, and big issues with conceiving babies, carrying babies, and building the central nervous systems on which healthy babies rely. The methylfolate gold is vital in helping us prevent cancer, prevent heart disease, reproduce, and maintain our mental, physical, and emotional wellbeing. It really is gold.

So for genetically “wild type” humans, which is what researchers call people with the typical MTHFR genes, this enzyme functions as well as it can given their nutritional status. It can still be compromised by lack of quality folate and lack of cofactors, but those are the only things slowing it down.

For MTHFR folks, the different mutations, most commonly C677T or A1298C, cause the chair to change shape a bit. Essentially, they give the chair a lump somewhere really important, like the seat or the headrest. Something that makes it hard for the folate to effectively sit in the chair so it can undergo the magic that turns it into methylfolate gold.

MTHFR mutations that matter are A1298C and C677T

So as the very basic point, I’m hoping you understand that you need the chair and the folate to click together. What we haven’t talked about, is what is needed for the magic to happen. Remember back to our alchemical change here – we’re making lead into gold and that’s a big deal. So obviously some magic happens, and in this particular case that magic needs another nutrient in order to spark. That nutrient is riboflavin. Riboflavin isn’t in the name of our mutation and Dr. Google doesn’t talk about it as much as he or she should.

So circling back to the initial statement, the biggest mistake that I see in people who have been treating their own MTHFR stuff by themselves, is that they forget about other B vitamins.

I have to point out an obvious fact that is easy to overlook. There are no “C vitamins” or “D vitamins.” There is a vitamin C, singular, and a vitamin D, also singular. So why, then, are there so darn many Bs? The bottom line is that the Bs are all Bs because they function largely as a group. No one B vitamin is involved in any big process that doesn’t also involve some or all of the rest of the B vitamins.

Vitamin C is off doing its own thing as an antioxidant, but the Bs are a team. They are all working together all of the time. Folate is a B. Riboflavin is also a B. Guess how many B vitamins you need for all of the functions related to healthy methylation? Well, the trick answer there, is all of them. Especially when you get off into making things like cellular energy or neurotransmitters and detoxifying things. The Bs always work as a team and if you’re missing Bs, then the process is stalled. Riboflavin is nowhere in the name of our mutation, but it is as necessary as folate because riboflavin makes the magic happen.

Is Riboflavin the only other B vitamin you should be taking? Nope. They’re a team, remember? So as you’re following along with the program, now is the time to start the other B vitamins – preferably in a multivitamin. It’s a great way to get everything in one swift stroke, rather than taking an individual pill for each thing.

The issue is that we don’t want folic acid, because it’s essentially toxic for us MTHFR folks, and we aren’t ready to start 5-LMTHF as a supplement yet either. So what can we do? Well, Ben Lynch, another MTHFR mutant who had the foresight to start a supplement company, called Seeking Health, that caters to genetic issues, made some great multivitamins without anything methylated just for this purpose. They can be a great way to start the journey by giving your body the rest of the “B team” without getting into weird territory with the folate.

If you can’t get those particular products, look for a multivitamin that has 5-LMTHF as the form of folate in the lowest dose possible. One a day multis are not the best choice because they usually have 400 micrograms or more just to meet the daily requirement. Many good multis will be in a two per day or even 4 per day format and a lot of times if you start one of those at the lowest possible dose (like taking 1 out of the 4 pills per day that you’re supposed to take) then you can get a reasonable background of B vitamins with a very low dose of methylfolate. Again, make sure the only folate in the product is methylfolate or folinic acid which is also safe for us.

The goal here is to get ready to start a methylfolate supplement by having a great background of other B vitamins.

By this time you have a couple of weeks of symptom tracking since stopping folic acid and since adding in food sources of natural folate. You may have noticed some changes. From those changes we might be able to predict how your methylfolate start will go.

Stopping folic acid made me feel:Adding natural folate makes me feel:5-LMTHF will probably…
BetterWorsebe difficult for me to tolerate so start with none or the very lowest dose possible.
BetterBetterbe a bit easier for me to tolerate. Still start low, but finding a good dose should be smoother.
Worse – – – I’ve never actually seen this so I don’t know.

Interestingly, we can also predict a bit based on your basic state. Last week we talked a bit about basic state so we don’t need to do so again, but overmethylators generally tolerate higher doses of methylfolate than undermethylators do. It’s a guideline and not a general rule so it’s important for everyone to start slowly and carefully.

Make sure you’ve got all the other B vitamins in there first and avoid the most common pitfall people experience when they are relying solely on Dr. Google.

I’m really excited to say that I’m in the process of building a Patreon page, which is a great way for you to show support for this show if you feel like you’re getting something out of it. I love doing the show and I want to keep putting great information out there for free so that it’s reasonably accessible to people of all financial means. But also, at the end of the day, I have to be able to support myself and contribute to my family’s wellbeing. So if you’re able to become a patron on Patreon, I would really appreciate it and I have lots of special content planned. Now, my site isn’t live just yet – I”m in the process of building it out – but when it is it will be found at Patreon.com/thwt. I’ll see what I can do to get it live before next week’s episode.

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S2E5: Patience with MTHFR

I’m pretty sure that this is the most frustrating part of the whole MTHFR shebang. Not the crazy symptoms, the issues if we take too much methylfolate, the dietary changes, or the problems we have from MTHFR in the first place, but the tooth-grindingly frustrating requirement for patience.

I am not a patient person. My nature is to rush headlong into everything, and consequences be damned. It’s actually a family trait – my grandfather once rear-ended a moving vehicle the highway because they weren’t going fast enough. Of course, both vehicles were land-yachts, as was the norm at the time, so the worst that came of it was a very startled driver in the other car. My mother physically can’t stand still, and if there are more than two people standing in one place then it’s a line, and she’s not interested.

My family is not good at resting on our literal or proverbial laurels.

Interestingly, this is a trait shared with many MTHFR folks, which always makes me question whether the universe actually is some giant cosmic joke – a huge “gotcha!” situation in which every human is required to muscle through the tasks that are the hardest for them as individuals to tolerate. It certainly seems to be the case with MTHFR, because so many of us like to push forward and push through, and we are generally capable of doing so.

In general, MTHFR folks fall into two categories, or basic states. Those are overmethylators and undermethylators. If you don’t remember what I’m talking about, this is your MTHFR basic state and represents the two halves of the MTHFR coin. Both faces of this coin have many commonalities, but the differences come down to whether your body likely overmethylates your DNA or undermethylates it. Another way to look at the whole thing is by looking at your histamine levels. Both sides of this coin react to lots of things in the outside world, but undermethylators react in a high histamine way – picture sneezing, hives, watery nose, itchy eyes. Overmethylators react in a low histamine way – think constantly blocked nose, allergy headaches or muscle pains, chemical sensitivites. This idea was proposed and researched by Dr. Wash of the Walsh Research Institute. To brush up on the basics, follow this link to S1E16 on MTHFR basic states.

Overmethylators

Overmethylating MTHFR folks are known to push themselves through all manner of agony for their passion project of the moment. Typically, it is some kind of activism, some sort of making the world better, something that helps others, or an art form they are offering to the world. It could be a skill taken to the level of art or anything these amazing MTHFR folks choose to push forward. If you want more detail on overmethylation, check S1E31 which did a deep dive into the state of overmethylators.

Overmethylators, you’ll recall, tend to excel at the things they’re interested in and the rest of it can go hang. These are often the brilliant children whose parents don’t understand how they can know and understand every map, level, move, and function in a complex video game, but won’t learn to read. These MTHFR folks aren’t concerned with doing well at everything, but they will go above and beyond at the things that interest them. These are the folks who forget to eat, sleep, or do anything while they’re in the flow of their work or interest. As a whole, patience isn’t the watchword here.

Undermethylators

Sadly, patience isn’t something these people possess in great quantity either. Undermethylators are our perfectionists and overachievers and they make up about 45% of the population. There are also people who are methylation neutral, but people with MTHFR mutation tend not to be. Undermethylators are the people who will push themselves until they collapse to be the best at whatever it is that they do. They’re the prima ballerinas, the professional athletes, the CEOs, and the people who generally push until they are the best that they can be at everything they do. They are typically perfectionists and expect themselves to excel at everything. If you want a refresher on undermethylators, it can be found in S1E32.

As you can see – both of these groups push forward no matter what, and that typically doesn’t involve patience. But in this game, patience is the essence of what is needed.

Why So Much Patience?

Patience is necessary with MTHFR simply because we are dealing with a pathway that is inherently compromised and that pathway is responsible for many things, but utterly dependent on a couple of nutrients. This creates a situation in which there is a mountain of pressure in all of those un-done responsibilities on a very narrow platform of nutrients. In short, this is a situation that can get messy in a heartbeat.

I think far less patience would be required if we all started managing our methylation at birth. Babies would be raised with all of the good active methylfolate that they need and the other B vitamins would be available too so that there wasn’t a chance for this slightly compromised system to create a backlog of unfinished business.

Most of us are not raised like that. Most of us have a good 20, 40, even 60 years of backlog built up before we actually figure out that there is even an issue with MTHFR, and so we need patience. Changes must be made slowly for a few reasons.

  1. If you make too many changes at once then you can’t tell what is doing what. So if you have any kind of reaction, bad or good, you don’t know what to link it to. So confusing.
  2. If you make a great change, like adding 5-LMTHF, but add too much too quickly, you can get into super scary too-high-a-dose symptoms, which mostly feels like you could peel the paint off the walls just by looking at them hard enough. It’s not fun and it usually makes people give up methylfolate forever or at least for a few years until they get brave enough to try again.
  3. If you make a conservative change – like adding a small dose of 5-LMTHF, but then don’t wait for your body to settle in and be ready for the next step, then you get into massive symptom territory again.

Essentially, the MTHFR journey is like walking a very long boardwalk through a crocodile-infested swamp. You want to stay on the path and not veer off into the muck. There, be dragons.

I know that everyone listening wants the next step. Right now. Do not pass go, do not collect $200. I know that. But the next step is actually waiting to see how you feel without folic acid in your diet and with the addition of food sources of natural folate. It’s symptom tracking.

Some of you won’t notice too much. That’s ok.

Some will notice an improvement, and that’s a great sign that you’ll be able to take the next steps post-haste. This tends to be overmethylators, who typically tolerate 5-LMTHF reasonably well.

A few, will notice that without the folic acid things were looking brighter but adding in the foods high in folate doesn’t work for them. Or, it makes them worse. In fact, some of you might have already known that none of the high-folate foods I’ve mentioned work for you at all. This could be an indication that you’re not going to tolerate folate – and that’s ok. Think of this as an early warning system. We will still eventually try to add in a tiny dose of 5-LMTHF, but the red flags are already up – we know in this scenario to take it extra slow and to watch for bad reactions.

Thanks for listening and just as a heads up – I am launching a patreon page because I love making this podcast and I want there to be as much free information out there for MTHFR folks as there can be. If you feel like you’re getting some help with this information, I would be delighted if you could contribute a bit there. My page isn’t live yet, but it will be by next week, so stay tuned.

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S2E4: Adding Food Sources of Folate

Food sources of folate (natural folate, not foods enriched with folic acid) are some of the best foods out there, so with MTHFR we truly are blessed that our healthy foods are also some of the foods that taste the best. Also, high folate foods are heavily represented in Tex-Mex, so there’s another reason to be grateful.

The average person should shoot for about 400 mcg of natural folate daily. For the full nutritional requirements and more information about it, read this post.

Almost all natural food sources – beans, pulses, some meats, fruits, and vegetables, have natural folate in them. It’s easy to come by in a healthy, well-rounded diet. That doesn’t mean that everyone gets good amounts, but if you’ve made any healthy changes to your diet, you’re probably in better shape folate-wise than you think you are. Let’s talk about major food sources.

Beans, Pulses, and Legumes.

These miracle foods are high on the best-foods-for-health list anyway, but if you’re an MTHFR mutant, then so much the better. A few bean-related tips:

  • Cooked from dried beans always have more folate in them than canned.
  • Soaking dried beans before cooking helps to reduce cooking time.
  • Cooking from dried generally takes a while.
  • Mashed beans can be added to almost any recipe in place of oil to add moisture (as you might add applesauce)
  • Bean flour can be used as well – checkpea flour is reasonably easy to find.
  • Beans are high in fiber so if you suddenly start eating them you’ll notice more gas, but as your body gets used to a higher fiber diet the gas will settle down.
  • Beans and other high fiber foods are great for your digestive health and help provide a happy environment for all those good bacteria everyone keeps going on about.
Food typeFolate (mcg) per 100gFolate (mcg) per cup
Lentils (cooked from dried)280358
Black beans (cooked from dried)200256
Black beans (canned)119152
Chickpeas (cooked from dried)220282
Chickpeas (canned)126161
Edamame (frozen)311 398
Red kidney beans (canned)102131
Black eyed peas (cooked from dried)280358
Black eyed peas (canned)95122
Peanut butter (all natural, 100% peanuts)92118
Peanuts237.5304

You’ll notice that a cup of beans will typically provide 50-90% of your daily recommended folate in one fell swoop. Easy peasy.

Fruits and Vegetables

There are a number of great fruit and veggie sources of natural folate as well, and fruits and veggies with two meals will go a long way to racking up those natural folate micrograms.

Food typeFolate (mcg) per 100gFolate (mcg) per cup
Asparagus7 spears – 15412 spears – 264
Avocado81 152
Broccoli6178
Okra5874
Papaya4153
Spinach (cooked)205263
Green peas6685
Orange3646

Condiments

This entire category is pretty much for one line item, which is marmite. Marmite is a yeast extract that is very popular in Great Britain and was the original source from which folate was discovered. 100 g of marmite has a whopping 1250 mcg of folate (unhelpfully labeled folic acid because the terms are interchangeable) but there is no earthly human who could possibly choke down 100g of marmite in one day under threat of mortal peril. A “serving size” on the marmite website contains 100 mcg but it is unclear what the serving size actually is. I’m guessing, it’s enough marmite to spread a thin layer on a piece of toast.

If marmite isn’t a thing you have grown up with, it is something of an acquired taste. I love it and eat it daily – typically on rice cakes because I’m gluten free and typically with a bit of butter and avocado. It’s divine. Two rice cakes like this, you will notice, is also my 400 mcg of folate because it’s marmite and avocado combined. Food genius. Plus, it’s heavenly.

On the marmite website, there is an additional product, which I have not ever seen, called marmite and peanut butter. If you’ve never tried marmite you are probably not as appalled by this thought as I am. I am also very curious. Marmite is salty-tangy and peanut butter is, well, peanut-buttery. The two don’t go together in my mind, but obviously, people like the combo enough to make a mixed product. So what do I know? I do have to point out that peanuts are also high in natural folate.

So the goal here is 400 mcg daily, which is easiest to do if you just plan to accommodate some beans, some fruit and veg, and maybe some marmite to spice things up. Also, if you’ve never tried marmite before I highly recommend you film your reaction the first time you eat it and join the thousands of other marmite reactions on youtube because it’s a pretty vivid flavor. If you do this thing, please loop me in and send me the video – I would love to see it.

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S2E3: Food Cravings And What They Tell You

Alright, so you have done the big scary thing and taken folic acid out of your diet. That. Is. Huge.

Now, you’re in the scattered and strange landscape of the food that is left over. I can’t speak for everyone, of course, but for me, this was a martian landscape. When I eliminated wheat it wasn’t because of the folic acid. It was, in actual fact because I was testing it out to see if I had a food sensitivity. About three years later I discovered my own MTHFR mutation and the whole thing clicked in a big “aha” moment. But I digress.

I took out all the wheat-based foods, which, upon reflection, was about 80% of my food. Let’s face it, I had a little wheat problem. I lived for a good crusty bread dipped in olive oil with a little bit of salt, pepper, and lemon zest. My god. It still makes my mouth water. When I wasn’t eating that, I loved my pasta, tabouleh, barley soup, and I used to make a sprouted grain and nut mixture for breakfasts that was a base of wheat and oats.

Losing most of my food wasn’t pretty. The first three days all I could think about was bread – not the absurd, cardboard based product they passed off as gluten-free bread at that time, but real, crusty, fragrant, lovely bread. At this time I had a bick and mortar practice and was running a wellness center and I’m pretty sure that all of my patients in those three days heard me wax poetic about bread. My office manager, who was on a diet at that time, had to politely ask me to shut up about the bread for a minute because I was making her hungry.

On day three, I remember I sat in the parking lot of a Whole Foods and had to give myself a stern talking-to to prevent the purchase of a Seeduction loaf, which was one of my favorites at the time.

It was a bit sad.

Mysteriously, on day four I woke up entirely indifferent to bread. Like all of a sudden, I just didn’t care so much. It was literally like a switch flipped. If you’re listening to this and nodding sagely, then you know about this switch. Perhaps this switch flipped for you too.

It turns out, this switch is a really great signal from your body, and if you experienced this switch, then you have just learned something incredibly valuable. So let’s talk about the craving switch for a minute.

The Craving Switch

Food cravings are a thing that many people are familiar with. Cravings, especially cravings that are frequent or repeating, can tell you a bit about yourself. They could indicate one of several things:

  • A nutritional deficiency.
  • An emotional hole to be filled.
  • A food sensitivty.

Let’s take a look.

Nutritional Deficiency Cravings

Some cravings arise because your body is looking for a nutrient that is found in a particular type of food. This could be a beneficial fat, a mineral, or a vitamin.

Bear in mind, macronutrient cravings if you’ve been hungry, calorie-deprived, on an intense workout program, or if you’re growing, pregnant, or nursing are a different thing. I’m not talking about a marathoner craving a plate of pasta after a race or a pregnant mama’s pickles and ice cream. Those are somewhat exceptional situations. I’m talking about normal-situation cravings. The hallmarks of this type of craving are:

  • The food you’re craving actually has some nutrition in it. (Hint – it isn’t a snack cake, any kind of candy, or found at the top, middle, or bottom of a bag of chips.)
  • It usually seems a bit random. Like, why-do-I-suddenly-need-oysters? Type random. It can also be why-do-I-always-need-oysters?
  • It may be several different foods that seem unrelated – like if you can’t have oysters, then it’s going to have to be pumpkin seeds.

These types of cravings are surprisingly common and strangely, overlooked. It’s a lot easier to ignore the craving for oysters or pumpkin seeds than it is to ignore the craving for chips. Unfortunately, this one is actually pointing to a nutritional deficiency. Sometimes it takes a bit of work to find it – like why oysters? But with a bit of help from your nutritionist friend on instagram or from the expert internet gremlins at Google, you can figure out what might be provided from that food or group of foods that you’re craving. This could point you to a useful supplement, or possibly to a dietary modification. In the case of oysters, it’s cheaper but far less satisfying to supplement, so choose you own path there.

Emotional Cravings

I think we all know about these. For me, I know it’s an emotional craving if I want creamy carb foods or salty crunchy foods. Those are my emotions talking through that fetuchinni alfredo, lasagne, queso, cheese-smothered nachoes, or pre-menstrual bag of Doritoes. It isn’t nutritional value I’m craving, it’s the filling of an emotional need for comfort, for food-love, for the warm hug that can only be provided by melted cheese.

Sometimes, it’s easy to see the source of the problem. A bad day at work, a crappy relationship bump, or a little pandemic can be enough to trigger these cravings. Sometimes, however, knowing your trigger foods can be a good window into your emotional world – especially if you’re “fine.”

I know lots of people who are “fine” and I myself have been “fine” from time to time. In this context, by “fine” I mean willfully ignoring and or denying any emotional problems exist. Sometimes you’re consciously “fine” and just soldiering on through a stressful situation, but many times you’re unconsciously “fine” and just not letting yourself see how bad things really are internally. If that’s the case, then watching when you reach for your own personal emotional foods can be a great way to pay attention to how your heart is really doing.

This also gives you a good opportunity to either indulge in your emotional craving knowing that you’re doing it as a gift to your soul-self, or to choose a different way to explore and liberate some of those emotions that need a bit of extra care.

Sensitivity Cravings

Finally, we circle back to my wheat cravings and talk about the cravings generated by food sensitivities. Interestingly, three of the “big four” food sensitivity foods have something called an “exorphin” in them. This is basically a food-derived substance that acts on opioid recepors in the gut and brain. You heard me right – opioid receiptors. Like the ones that react to morphine or, say, heroine. The same opioids of the much-talked about “opioid epideminc.”

These exorphins have been shown in research to exert influence over such major neurological functions as pain perception, emotion, and memory. Also gut-related fuctions like motility, hormone release, appetite, and local immunity.

The major players in this game are wheat and grains, which contain gluten exorphones, milk and diary products, which contain casomorphones, and soymorphins from soybeans. Interestingly, spinach also contains an exomorphone called rubiscolins, but for whatever reason spinach sensitivities and also spinach cravings are thin on the ground. As you can imagine, the bulk of these food-sourced opioids set up an addictive response in your neurological cascade that is similar to the one set up by, you guessed it, opioids themselves.

Interestingly for MTHFR folks, there is also some remarkable research showing that these exorphones, specifically the casomorphones decrease glutathione, which is an end product of the methylation cycle, and also SAM, which is our universal methyl donor. This was studied specifically in the context of autism, but applies to everyone with the MTHFR mutation because solid science is showing that gluten and dairy actually slow down the methylation cycle – something that we are forever working to boost.

So if you, like me, experienced the wild cravings after taking the folic acid (and subsequently the wheat and/or corn) out of your diet, then you might want to consider that there is more than just folic acid going on. That you, like me, might have an underlying sensitivity. If you do have a sensitivity, then actually getting the gluten 100% out of your diet – out even from things like soy sauce, licorice, salad dressings and other such micro-sources, could be incredibly worth it.

Now that I am feeling solidly like a fountain of good news, I”ll sign off. I promise, next week we’ll talk about adding in some wonderful foods that are rich in natural folates.

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Relax and Enjoy August. Season 2 is Coming Soon.

August is the perfect time for lazy days by the beach, sparkling pools, drippy ice cream, picnic blankets, and laughs with your favorite people. I’m not going to clutter up your August with anything other than the joy of summer days, so the To Health With That! MTHFR podcast will be taking a small break. For the Southern Hemisphere listeners out there, cuddle in with a hot tea and a great book and enjoy some cozy nesting.

We’ll come back in September with Season 2 – Feeling Better with MTHFR. It will be practical steps to make your life better, improve your health, sleep better, have more energy, and balance that methylation. Look forward to simple steps to transform your health. The aim is one year of healing. MTHFR is the priority and we’ll take a step-by-step approach to eliminate folic acid, find your best dose of 5-LMTHF, and add any support you need to feel amazing with MTHFR, but we’ll cover the most common issues that come along with MTHFR as well. Energy, sleep trouble, hormone imbalance, heart disease, cognitive decline, and mental health. We’ll even talk about strategies for healthy weight balance and fitness.

I can’t wait to get started. In the meantime, enjoy a bit of stargazing, camp-firing, popsicle-melting summer.

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Empty Bucket, Fix Backlog.

I feel like this is getting into Zen slogan territory – Chop wood, carry water… Empty bucket, fix backlog. Actually, for us MTHFR folks, this could be tantamount to a personal mantra guiding us through life.

Emptying Your Bucket

Your bucket, you’ll remember, is all of the stuff that is happening to you right now. It’s anything ongoing that your body is dealing with. It includes lots of things that happen all the time in the background, a few things that you can change or modify, and the rest we can just chalk up to life.

  • Metabolism of food
  • Daily maintenance of oxidative balance, hormone levels, fluid balance, neurotransmitters, and all the amazing things your body does without you being aware.
  • Healing, cell turnover, and cell regeneration.
  • Immune defenses against viruses, bacteria, molds, fungi, yeast, parasites, and other pathogens,
  • Pollutants in the air, water, food, self-care products
  • Food additives – artificial colors, flavors, sweetness, preservatives, etc… (fixable)
  • Ingested Irritants – especially food sensitivities (fixable)
  • Dehydration (fixable)
  • Nutritional deficiencies (fixable)
  • Lack of sleep (fixable)
  • Sedentary lifestyle, work, or habits (fixable)
  • Too much UV exposure (fixable)
  • Work, family, and life stress (life)
  • Big changes – moving, marriage, births, deaths, new pets, new jobs, loss of jobs, financial changes, relationship changes (also life)

This part of the Empty Bucket, Fix Backlog mantra comes down to making conscious decisions about your health. This is the 99.9% of healthcare that has nothing to do with your doctor and everything to do with the decisions you make throughout the day. Will you have the extra helping of mac and cheese? Another martini? Two more hours of TV at night? Another glass of water? This is the part that is entirely under your control (and often feels entirely out of control).

It comes down to valuing your health over the momentary pleasure you’re going to get from that bag of chips or the candy bar in the checkout line, and also knowing that if you make decisions that prioritize your health 90% of the time, the other 10% can slide. There is and always has to be room to be human.

Bear in mind an optimal diet has lots of room for treats, you just have to know what is a treat your body can handle vs. one that triggers the worst for you. This is where working with a great practitioner, health coach, or ideally a healing group on the same journey, like the MTHFR Academy where you can get help from a group of peers to stay on track.

In terms of biggest-impact changes, for MTHFR folks, balancing methylation is always the biggest because that is the heart of the problem with the MTHFR mutation. After that, eliminating food sensitivities and working on your sleep have the biggest and most pervasive impact on your health.

Fixing Your Backlog

Your backlog is stuff that used to be in your bucket that your body didn’t have the resources to deal with at the time. The only safe way for your body to handle something that it doesn’t have the resources to address at that moment is to store it, wall it off, isolate it, and otherwise keep it away from vital tissues. This isn’t ideal – your body would rather eliminate it completely, but sometimes that isn’t an option. For MTHFR folks who haven’t had good methylation balance, it may not have been an option to deal with lots of things for a very long time.

What I’m really saying here is that we MTHFR folks have a lot of baggage.

Your backlog may contain:

  • Heavy metals
  • Hormones we couldn’t process
  • Plasticizers, pesticides, herbicides
  • Synthetic fragrances, parabens, petroleum products
  • Persistent organic pollutants
  • Tissue repair/remodeling
  • Sleep deficit
  • Unaddressed cell regulation (this can be destroying cells that are dysregulated or cell regeneration)
  • Chronic or subclinical infections of any type
  • Chronic inflammatory processes
  • Genetic repair

You may have spotted a couple of big differences between your bucket and your backlog here. One is that your bucket has things you’re aware of. These are stressors that you probably recognize and have some awareness of. Your backlog, on the other hand, is mostly made up of things you don’t know about at all. They were once in your bucket, but they passed through the bucket a long time ago. Another big difference is that nothing in the backlog is under any kind of conscious control. Even addressing the backlog is unconscious – your body will do it when it’s ready and has resources, but it’s not really your brain’s decision.

What I’m saying here is that we MTHFR folks have a lot of baggage.

Amy, mutant-in-chief at Genetic Rockstars.

This means there is nothing you can really do to encourage the processing of your backlog. In good news, your body will happily get to it as soon as it has some resources available so balancing your methylation is also the biggest and most important step here.

If there is anybody reading or listening who is thinking “ok, Amy, but what do I actually have to do to balance my methylation,” here’s the super quick and dirty.

  1. Join Genetic Rockstars or MTHFR Academy so you have the support of other people who are on the same journey.
  2. Eliminate folic acid from your diet – this is fortified foods like wheat and sometimes corn products, and also from your supplements first thing.
  3. Add good food sources of natural folate – things like beans, avocados, asparagus, fresh-squeezed orange juice, and marmite.
  4. Begin with a background of other B vitamins without folate or B12
  5. Add a B12 that suits you
  6. Add 5-LMTHF
  7. Adjust as needed.

That is really the crux of it! Thanks for listening today and I can’t wait to see you in Genetic Rockstars. Also, I’ll be taking a break from the podcast for the month of August, but we’ll come back the first Sunday in September with Season 2. In Season 2 we’re going to walk through a year in the life of the MTHFR journey, starting with your very first steps.

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Methylfolate Dose Changes – The MTHFR Journey Over Time.

We’ve talked about folate dosing strategies because the best dose of methyl folate for your body will change through the course of your MTHFR journey. The three strategies we have covered are:

  1. Intuitive dosing – this is my favorite and is perfect if you and your body communicate well together. When you’re stressed, have a difficult day coming up, feeling not perfect, or know you’re doing some extra detox work, increase your dose slightly. If you’re feeling amazing and don’t need extra support, then don’t take it. Just listen to what your body needs at that moment (I do this with all my supplements, not just methylfolate).
  2. Mixed dosing – this is better if you’re a routine kind of person. You like the stability of taking a small dose each day (smaller than your maximum tolerated dose) and you can add up to your maximum on days that are harder.
  3. Pulsed dosing – this is the method championed by Ben Lynch. He says if you feel great, decrease your dose and if you feel poorly, increase.

These dosing strategies cover day-to-day fluctuations, but at the beginning of your MTHFR journey, you will have longer-term fluctuations. Let’s talk about that.

Long-term Changes in 5-LMTHF Needs

First off, what is going on here? Why do 5-LMTHF needs change over time? Can’t this just be easy?

When I get frustrated with the general weirdness of MTHFR, I try to remember the amazing journey my body has been on with this mutation for my entire life. That journey goes something like this:

  • Birth – My bucket is mostly empty (if you don’t know what I’m talking about, click here), I”m fresh and clean and the world hasn’t started to hammer me with crazy crap yet.
  • Childhood – Things are moving along. Life has some stressors like navigating family, socialization, schooling, and eating my greens, but mostly things are pretty good. My bucket is taking a few hits, but it isn’t full yet.
  • Adolescence – The hormones kick in, the moods kick in, and full-blown teenage angst really adds a bunch of stress to that bucket.
  • New Adulthood – Life starts getting a whole lot more real. There are bills and jobs and maybe even career prospects. There are relationship stressors, toxin exposures, new car smells, and ratty apartments. That bucket is getting close to the top.
  • Your Bucket Fills Up – This can happen anytime, really, but for many people, it is in adolescence or new adulthood. Some people are lucky enough to wait until their later years. Your body has dealt with enough stressors that your bucket (which is your natural tolerance for stressors given your genes, nutrition, and epigenetics). This is when big symptoms start, and the wheels fall off the cart. This is also when a lot of people go digging through their medical stuff and find out they have MTHFR.
  • You Start To Work With Methylation – This is quite possibly the moment when you’re reading this post or listening to the podcast. Awesome! At some point you’ll add in 5-LMTHF. I’m hoping you start with a low dose and don’t make any sudden move – in the beginning, tolerances change slowly.
  • There are Some Bumps On the Road – this happens and it’s all totally normal.
  • Your Dose Increases – Gradually, you’ll find that your body can tolerate more methylfolate without having a total meltdown (if you haven’t experienced the meltdown yet, please be confident that this is a thing that happens on the MTHFR journey, and it’s going to be ok.) Bear in mind that you will try some dosage changes when your body isn’t ready and have mini-meltdowns, but slowly and steadily your dose will increase. This phase can last for months or even years.
  • Suddenly, The Dose You’ve Been Taking For Weeks/Months/Years is WAY Too Much – because MTHFR is like that. We talk about this a lot in Genetic Rockstars, which is our MTHFR Community, but too much 5-LMTHF feels crazy. Anxious, hyperactive, jittery, sleepless, or completely black depressed. It’s a bit different for everyone, but if you’ve ever felt it, you know exactly what I’m talking about.
  • Your New “Normal” Dose Is Lower – you don’t need as much 5-LMTHF most days, and you can start to use intuitive dosing. Take a little more if it’s a more stressful time for your body, and a little less if it’s easy breezy. This phase can comfortably last the rest of your life.

But Why Does My Body’s Need for 5-LMTHF Go Up And Down?

Let’s take a behind-the scenes look at what is going on in the above progression.

  • All the Stages Before Your Bucket Fills Up – In these phases, your body is meeting stressors and it’s ok. You have enough resources to keep up and enough room in your bucket that you aren’t having major symptoms. Toxins are constantly coming in, and if you can’t deal with them you just pack them away into your long-term storage, the backlog.
  • Your Bucket Fills Up – Symptoms start and it can feel like your body has completely changed overnight, but it actually hasn’t, it just reached the tipping point where your bucket ran out of room and so ALL of the things that have been hiding under the surface are coming out into the open. It’s pretty messy!
  • You Start To Work With Methylation – you eliminate folic acid, add in natural food sources of folate and finally add 5-LMTHF. There are up and down days, but mostly things are moving forward. Your body is starting to work on the bucket and you’re actively taking out stressors (like folic acid, which is harmful to MTHFR folks, and like the nutritional deficiencies around methylation, which also adds to your bucket).
  • There Are Some Bumps on The Road – as your body gains resources and starts to move toward more balanced methylation, it can start to take a look at some of the toxins in long-term storage. This is your backlog. Backlog can cause bumps because if your body gets too excited and mobilizes too much, then you can feel toxic. Backlog is also behind the dosage increase.
  • Your 5-LMTHF Dose Increases – as your body gets stronger and the flow of methylation resources gets more stable and reliable, then the trickle of backlog increases to more of a flow of backlog. Your body is really digging into this and so your need for methylation increases. This process can last for months or even years. For me, I took 5-LMTHF for somewhere between 2 and 3 years before I hit the next phase.
  • Suddenly, Your Usual 5-LMTHF Dose is Too Much – actually, when this happened to me it took me a few awful days to figure out what was the cause of my sudden burst of manic energy. I had been taking 3 mg 5-LMTHF most days for the last couple of years and it didn’t occur to me that it was suddenly causing problems, but it was. This was the point where the eager flow of backlog tapered down to a trickle again. My body wasn’t so urgently clearing out the long-term storage anymore because it finished dealing with the worst and most pressing of my backlog baggage.
  • Maintenance – now, at a lower dose, your body can do its daily work (your bucket) and its trickle of backlog without so much extra support. Awesome! This is where we want to stay.
Too much methylfolate makes me feel like… THIS. Photo by Andrea Piacquadio from Pexels

This progression is completely normal, and not as smooth as I’m making it sound in this blog post. Over the years there are ups and downs with dosage and there can even be weekly or monthly fluctuations. Still the overall trend follows this predictable pattern. It’s important to remember that your bucket is never completely empty because there are always stressors around and your backlog is never completely gone because we’re humans in a toxic environment of our own making.

It’s also interesting to note that if you stop supporting your methylation completely, then things will stay stable for a while, but as your body runs out of the resources to methylate, then your bucket begins to refill as does your backlog. Eventually, we’re back to the crisis point where your bucket overflows. It is far easier just to stay in maintenance mode.

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MTHFR Questions From Listeners.

MTHFR is such a strange journey, and it seems like no two people’s experiences are the same. I kind of backed into MTHFR by accident. I found a multivitamin that I then told all of my clients about because it was the only multivitamin that had ever worked for me, ever. Turns out, I felt such a difference because it happened to have 5-LMTHF in it, as opposed to lesser forms of folate. I didn’t know that at the time. It was a few years after that that I heard about MTHFR and discovered my own polymorphism. Others find out about MTHFR as a part of their search for symptom relief and tackle it that way.

The weirdest part about it, as we’re finding in the MTHFR community Genetic Rockstars, is that small experiences often overlap, but big overarching patterns can vary widely.

This week, we’re tidying up some unfinished business. A few of you have been kind enough to leave questions for me on the website. Let’s get to those!

Does Amy Still Take Appointments?

First, we’ve got one from Sandy. She writes, ” I would like to know if Amy sees patients. I have an interesting combination of issues, one being severe folic acid/folate/B12 intolerance. Such great information on these pages, but I wonder if she takes appointments. Thanks very much, Sandy.”

In good news, we have so many options, Sandy! First off, it sounds like you’ve got a definite challenge on your hands, which is always fun. Secondly, here are the options. There are three ways to work with me, Amy.

  1. Join the MTHFR community, Genetic Rockstars: I know a lot of people consider this to be less of a therapeutic option and more of a social one. I can honestly say, it’s much more than that. The community is a place to connect with other people who have the same challenges, talk as a group and get questions answered – including by me. The goal is for the community to be both joyful and real-life helpful.
  2. Join the MTHFR Academy: This is an in-depth group coaching circle. We are all MTHFR folks and three weeks out of four we’ll be having coaching talks about specific topics and/or classes as a group. We also have office hours, which is group zooms with Amy to ask any and all questions, especially questions about where or when you get stuck on your MTHFR journey. As a part of this, you’ll have free access to the 10 week MTHFR 101 class and every other course, workshop, or masterclass that Amy puts out during your membership.
  3. Get one-on-one coaching: I do still see some one-on-one clients. I actually think group coaching is more effective long-term because the amount of time together and the focus on learning is so much greater, but having some one-on-one visits can be really helpful if you’re deeply stuck or have concerns that you don’t feel comfortable talking about about in a group setting. If you’re interested in this option, the first visit is always an hour and a half and you can find out more about scheduling and frequently asked questions at tohealthwiththat.com/about/ or click the Amy + Coaching link at the top of the page.

Thanks so much for your question, Sandy.

Contrast in MRIs

The second question comes from Sam. She writes, ” I am a mama of boys with the homo 677T mutation. I’m curious about contrast in MRIs when you have this mutation and also if I the mom should avoid a contrast MRI when nursing a baby with the homo 677 mutation?”

This is a great question and not one that is easy to answer. First, there are a number of contrast mediums for MRIs and the selection of those depends partly on the area, organ, or body part that is being studied. There are other factors as well.

Each different contrast medium has to include a magnetic component (it is magnetic resonance imaging, after all). Often the magnetic component is some kind of metal atom. Generally, many of the heavy metals do need to be methylated in the detoxification process, so this has the potential to be more difficult for MTHFR folks.

Many MRI mediums also contain what is called a chelating agent, which is something that helps your body to enhance excretion of the substance, reduces storage in body tissues, and reduces toxicity. Some, however, do not.

To make the conversation a bit more complicated, there isn’t actually any research that I am able to find that addresses MRI contrast mediums and genetic polymorphisms of any kind.

I would say, find out everything you can about the specific contrast agent your doctor plans on using, including the pharmacokinetics and any information they have about how the substance is cleared from your body. Also, the average rate of clearance if that data is available.

In terms of having an MRI while you’re nursing, there are several factors to consider. Certainly, nursing mamas can pass toxins, especially fat-soluble toxins, down to their kiddos through breast milk. If the MRI is potentially life-saving or treatment-altering (as it could be in tumor-related MRIs) then it is probably worth the risk. If it can be delayed without major health consequences, then that would be the most prudent option.

If you do choose to have an MRI while breastfeeding, see if you can pump and store milk before the procedure enough to feed your baby for a while after the procedure and pump and dump any potentially contaminated milk during that time. Work with your doctor to find the most critical period of time after the procedure in which excretion via breast milk is most likely.

Thanks for the great questions, and if anyone who is listening right now happens to have a question, go to tohealthwiththat.com and about half-way down the page you’ll see me asking for your questions in a video – you can ask your questions there in video, audio, or written form.

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