MTHFR has its sticky little fingers in everything important and energy production is no exception. In fact, fatigue is one of the most common symptoms that I see in my MTHFR clients. Truth be told, it’s one of the most common symptoms I see in *all* of my clients and perhaps fatigue is in fact the modern epidemic we should be most concerned with.
Nevertheless, there is a link between fatigue and MTHFR issues and like everything else about this mutation, it is complex and multi-factorial. More like ten links than one.
Factors that can play into fatigue for MTHFR folks
- Low neurotransmitters – if your norepinephrine, epinephrine, serotonin or dopamine are compromised (or some combination of all of those things, which is highly likely with MTHFR issues), then your subjective experience of having energy is going to be different from average. Mostly, it’s lower than average, but occasionally it can be higher, trending toward states like mania or hypomania, ADHD, agitation, and restlessness. Neurotransmitters are no joke and they color our experience of ourselves strongly.
- Low melatonin – melatonin is your main sleep hormone, and it’s a direct offshoot of serotonin and needs the same pathway (the BH4 pathway, which is linked directly into the methylation cycle) to be formed. Poorly managed MTHFR issues can slow that pathway and compromise your melatonin. That means poor sleep, inadequate nighttime repair functions, and daytime sleepiness.
- High inflammation – MTHFR is highly linked to inflammation, through the obvious pathway of increasing homocysteine (an inflammatory marker), to far less obvious factors like slowing detox, increasing free radicals, and decreasing glutathione. Inflammation is far and away one of the greatest causes of pathological fatigue. Here is a great article about it, that also dissects different types of fatigue and fatigue measurement.
- Oxidative stress (low glutathione) – MTHFR, when unmanaged, can increase resting levels of oxidative stress (meaning it leads to more free radicals and fewer effective antioxidants). This is partly because of the metabolic byproducts of a dysfunctional methylation cycle, partly because of impaired detoxification, and partly because of decreased glutathione production. Oxidative stress can be used as a marker of fatigue in healthy people as well as those diagnosed with chronic fatigue syndrome.
- Toxin buildup – you may recall that MTHFR is actively necessary for many detoxification reactions and if those aren’t happening, then the trash builds up. Toxin accumulation certainly makes you feel tired because your body has a mountain of work waiting to be done and no resources with which to do it (that would make anybody feel tired.)
- Cellular energy deficit – the Krebs cycle cogs in with the folate cycle and so if things slow down or get stuck at the MTHFR enzyme, then the production of your cellular energy, called “ATP,” is affected. It might be a slight difference, but over time that can add up to a massive change in your body’s capacity.
Ok, So MTHFR And Fatigue Are Linked. Now What?
Obviously, MTHFR is right in the middle of the fatigue problem, but digging your way out of fatigue, especially when it’s turned into a deeper issue like chronic fatigue or adrenal fatigue, can be a real challenge. Where do you start?
We have talked about diet quite a bit and I won’t belabor the point, but if you need a refresher here is an article about folic acid toxicity and another about starting on an MTHFR diet. Diet is and always will be the first step – for any chronic health issue, but especially for MTHFR. Skipping this step will likely make your issues worse, no matter what fancy drugs or supplements you throw at it. Here is a full Start Here Guide to MTHFR.
Step Two Is Sleep
Let’s really talk about sleep, because the sleep and fatigue link seems obvious, but sleep can be a thorny problem and isn’t always easy to fix. Also, in a weird demonstration of human behavior, sleep is often overlooked in the treatment of fatigue.
- Practice good sleep hygiene. I know if you’re a parent with young kiddos or a shift-worker this entire idea makes you cringe, but try. This means:
- No screens one hour before bed (not even phone screens).
- No lights in your bedroom – cover all the little indicator lights on electronic devices, the screen on your alarm clock if you still have such a beast, and cover windows and doors completely. The best sleep happens in the true dark.
- Set a regular bedtime every night – preferably by 10:00 pm.
- Schedule at least 9 hours for sleep. I know this is a sticky one in modern society but try. Your body needs it.
- Set a regular wake time. It can seem counterintuitive to wake yourself up when you so desperately need sleep, but our bodies thrive on rhythms and patterns and sleep-wake cycles are no exception.
- Keep your sleep environment quiet, or use white noise. We are designed to wake up if there is an unusual noise.
- Get some good light exposure in the morning – preferably to actual sunlight, which helps your body establish a good circadian rhythm.
- Don’t forget about caffeine! Try stopping your caffeine intake by noon to see if it makes a difference to your sleep quality. If you can’t fathom noon, try 2:00 pm.
- Try Magnesium. Magnesium is a mineral that we all need in large quantities. It is responsible for physical relaxation, countering the action of calcium (which is responsible for physical contraction.) It is also well researched for sleep, both alone and in combination with melatonin and zinc. 225 mg is a good starting dose, but you might need more. Especially if you suffer from restless legs.
- Melatonin. This is your actual sleep hormone and also acts as an antioxidant for your brain, so lots of benefits here! We talked about it at length when we talked about MTHFR and neurotransmitters because, as we discussed earlier, MTHFR can slow down your own production of this much-needed hormone. 3-5 mg is a great place to start and it can be safely increased (up to 20 mg) or decreased as needed. If you don’t see sleep benefit with a lower dose, try increasing. If you find you’re waking up too early feeling like it’s time to get up, then try decreasing your dose.
- Zinc. The MMZ combo makes for some good Zzzzs. See what I did there? Studies used a reasonably low, 11.25 mg dose at bedtime. Just take a look at the graphic for starting doses.
Step Three Is To Make Sure Nothing Bigger Is Going On
- Talk to your doctor. Always talk to your doctor before making changes, and in this case it’s important to make sure there isn’t something else affecting your sleep or your energy. Fatigue is a common symptom, but it is also one of your body’s best ways of communicating that something isn’t right when there is actually deeper pathology. Testing for thyroid disorders, anemia, deeper sleep issues, and chronic illness is important and shouldn’t be overlooked.
- Consider deeper fatigue issues like chronic fatigue and adrenal fatigue. If you have low energy for a long time without clear pathology, there could be something bigger going on. MTHFR folks are prone to both chronic fatigue (see the methylation hypothesis) and adrenal fatigue. Both of these are complex problems that will respond well, if slowly, to appropriate care, But to get appropriate care you have to know what you’re working with. Again, talk to your doctor, naturopathic doctor, DABCI Chiropractor or Traditional Chinese medicine practitioner about it.