Recent Episodes

S2E2: Getting the Folic Acid Out of Your Diet.

I know it’s poor planning on my part to start this season off with the hardest part of this whole process, but sadly this is the only good way to start. If you skip this step, you can create mountains of problems for future you. Keeping folic acid in sounds good to so many people, but folic acid actually blocks the other, more useful forms of folate from being utilized. I talked a lot about the technical details in this post. This basically makes all the work you’re thinking about doing to add in natural food sources of folate or to take expensive 5-LMTHF supplements, worthless. All the money you spend on those things becomes wasted as well.

Let’s start with a bang.

Folic acid also hangs out in your bloodstream as unmetabolized folic acid, or UMFA which contributes to many health problems for MTHFR folks and non-MTHFR folks alike, including increased risk of many forms of cancer.

This is step one, and ignoring it is far, far easier than actually doing it, but you’ll regret it in the long run. Honestly, it won’t even serve you in the short term because eliminating folic acid from your diet can show you a lot about how you react to folates in general. It’s a huge part of this journey and skipping it isn’t a great option. I know it’s hard but stay with me.

Folate is vital to our functioning as humans and especially to the healthy making of babies, which is a pretty big deal. Folate deficiency during pregnancy leads to major preventable complications like cleft palate, spina bifida, anencephaly, heart defects, low birth weight, and stillbirth. Because it’s so important, many governments around the world have adopted programs to fortify commonly eaten foods with the synthetic form of folate, which is our nemesis, folic acid.

This public health measure has had a tremendous impact on the rate of these birth defects, which is wonderful. It just doesn’t take into account people with the MTHFR mutation, or a culture that generally over-eats and over-supplements the way we are prone to in North America.

As a caveat to public health in general, even for MTHFR folks some folate in the worst form, folic acid, is better than none at all. This measure makes sense for society. The problems start to happen when either there is too much folic acid, which is now very common, or when there are too many compromised copies of the MTHFR gene.

So this week, if you want to follow along with this MTHFR adventure, you are ditching all of the folate fortified foods and starting with a folic-acid-free diet. Nothing else should change. Just get the folic acid out of there. This includes supplements as well so if your multivitamin, B-complex, energy-booster, or meal-replacement has folic acid in it or says “folate” on the label, then it’s out. If you’re dropping supplements, try not to add anything back in right now unless it’s absolutely necessary – we’ll look for particular things in the weeks to come and there’s no sense rushing out to buy something you might be changing shortly.

In the US, there are two foods that are fortified with folic acid. Those are wheat and corn, which are pretty much the backbone of every American meal out there. This means your bread, pasta, tortillas, corn chips, baked goods, even the doughnuts have to go. Here’s a bit more about what to eat and what not to eat for MTHFR folks.

This is the moment when people’s eyes bulge menacingly and a tic starts in one of their eyelids. Typically, spittle flies out of their mouths when they say, “But, but, then what do I eat?”

Have no fear. There is actual food left, but you might have to look around a bit. First off, you can still have wheat products as long as they are certified organic. In order to earn organic certification, they have to be unadulterated. In terms of bread, finding an organic option, or a sprouted whole-grain option is probably the best one.

For pasta, there are not so many organic options, but lots of gluten-free options that are not fortified – look for any pasta that claims to be gluten-free, or rice pasta that is made of rice and therefore not fortified.

For the baked goods, you’re going to be in a bit of trouble. There are some gluten-free options but they’re pretty limited if you’re used to the smorgasbord of wheat-based options. Sorry about that. Even baking at home has to be different because wheat flour is mostly enriched. Some whole wheat flour is safe, but some still has added folate so read your labels.

I can see that tic under your eye intensifying, so let me just reassure you that there is also every meat, veggie, fruit, and nut option under the sun. It is really just your major sources of carbs that are taking a hit. I know, that reassurance is entirely too thin for anybody’s liking.

This is the hardest part of the whole thing, so stick with me – it’s all so much simpler from here. Just keep using the symptom tracker that you started last week to see if you notice anything from the folate elimination. People are often surprised to find that something as mundane as bread can be causing them so much mental and physical pain.

It’s a bit last-minute, but I’m just offering a course starting September 15th called Methylfolate masterclass to answer the #1 question I get, which is, “How do I know when I’m taking the right dose of 5-LMTHF?” If you’re interested you can find out more at tohealthwiththat.com but register now because the cart closes at 11:59 pm Monday the 13th.

Thanks so much for listening today and if any of you are brave enough to come back next week, we’ll lighten it all up with talk about some amazing high-folate foods that you can add in to your diet to give your body good sources of natural folate. It will be great! To everyone who didn’t throw their device out the window when I started talking about not eating wheat, thanks for hanging in there!

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S2E1: Preparing To Get Healthy With MTHFR

I know everyone wants me to say “Buy the first 5-LMTHF product you see and gobble it down,” but I just can’t do that to you because after you tried it, you would hate me forever. And with good reason – jumping into 5-LMTHF before you’re ready to do so can create a kind of nightmare scenario for your body in which you’ve suddenly got a resource that has been in short supply, but none of the supportive structures around that resource. So toxins are dumping left and right but can’t actually be eliminated, neurotransmitters are bobbing up and down like pole vaulters, and mood, energy, and sleep are desperately trying to keep up.  In short, starting that way isn’t pretty. 

The only real correlation I can make with the MTHFR journey is the process of pregnancy. You can try to rush it, but it’s going to work out badly 9 times out of 10. You’ve just got to go at the pace of the project and not get ahead of yourself.

This requires laying a good foundation even though that seems like the boring part. Believe me, in this case, we WANT to prevent fireworks. So this week, let’s talk about doing the prep-work at the very baby beginning of the MTHFR journey. This will require 3 things.

  1. A symptom tracker
  2. One heck of a pantry overhaul and some carbo-loading
  3. A talk with the family, significant others, and maybe your pet hamster.

A symptom tracker is key here, even if you aren’t a total data geek like I am.  The goal is to establish your baseline symptoms this week before you’ve made any big changes and while you’re finishing all of the folic-acid enriched food in your pantry.

Knowing which symptoms to track is half the battle.

For many of us MTHFR folks, folic acid enriched food and supplements contribute to the symptom picture and even just the act of taking those out of your diet (which will be next week’s project) will have a noticeable impact on your symptoms. At this point you want to get a feel for what symptoms might be caused by folic acid because that will make things so much easier down the road. Your future self will thank you.

So let’s do a quick rundown of how to use a symptom tracker. That is something you can start today.  First off, there is a free symptom tracker available for download at tohealthwiththat.com – just sign up for the email list and it’s yours along with a couple of other MTHFR-related freebies.  There are also loads of symptom tracking apps if you prefer the technological method. 

Make a list of all of the symptoms you notice on a daily basis, things like brain fog or fatigue, or whatever it is that is your normal. Also, the ones that show up every now and then, like maybe headaches or menstrual cramps. It doesn’t matter if you think they’re related to MTHFR or not, just add them to the list. Every day, rate each symptom on a scale from 0 – 10. If you’re not experiencing that symptom, it’s a zero. If it’s the worst it could possibly be, it’s a 10. What you’re trying to figure out is your “normal” state.

The goal is to be able to tell when you’re progressing or when a change has been worth it, and when it really hasn’t. Also, when adding something might be causing problems because that is really common for us. Responses to different supplements are incredibly varied with MTHFR and so it is important to keep track of what works for you because there isn’t any one-size-fits all.

What we want this week is to get a clear picture of where you are right now. This is because next week we’re going to make a BIG change. Next week, we’ll take all of the synthetic folic acid out of your diet and supplements. 

Taking synthetic folic acid out of your life has to happen with MTHFR.  There is really only one study done in this area, but it’s hugely compelling and essentially indicates that taking folic acid for people with the MTHFR mutation (or taking too much folic acid for everyone else) actually hinders the pathway it is supposed to help. So instead of converting into the active form of folate, which is 5-LMTHF, folic acid blocks up the conversion process and gets in the way of an already compromised enzyme pathway. The bottom line is that with an MTHFR polymorphism, taking folic acid will make your symptoms, and your functional folate deficiency, worse. 

This Vitamin Could Be Hurting YouAt high doses, folic acid is toxic.

This week, to prepare for that pretty major step, I want you to enjoy your bread and pasta. Wheat products are the most commonly fortified foods globally, and they’ve been fortified with folic acid as a public health measure to prevent birth defects. In that regard, it’s a highly successful program, it just isn’t the best program for MTHFR folks.  I do want to say, however, that if it is a choice between no folate at all and synthetic folic acid, then the synthetic folic acid wins. Some folate is better than none in a starvation situation even if it’s the worst possible form. Assuming that nobody listening to this podcast or reaading the blog post is in a starvation situation, it’s best to avoid folic acid as completely as possible.

If you want to learn more about this, go back to S1E9, This Vitamin Could Be Hurting You podcast episode, or the show notes including research, here.

When you’re shopping for next week, if you want bread it’s going to have to be either gluten-free, which doesn’t have wheat and is therefore generally not fortified, or organic whole wheat, which is also typically not fortified, but check your labels. If it says folic acid or folate anywhere on the label, then it has aded folic acid and you should exclude it.

In good news, the gluten free and organic options have come a long way and there are many more of them. In bad news, the US recently extended their fortification program to include corn products as well, so check all of your labels including those on things like corn chips and tortillas. Also, double check the regulations in your own country. In most places, wheat is the most commonly fortified food, but there could be others as well. 

It is truly important to get the folic acid out of your diet as completely as possible because for many people, it’s actually causing symptoms. This could include depression, anxiety, inflammatory conditions like pain or overarching issues like fatigue or insomnia.

Also, check your vitamins, supplements, energy bars, meal replacement powders, energy drinks, birth control pills, and prescriptions.  If your doctor has given you a prescription that includes folic acid it is important to talk with them before making any changes and find an alternative that will work better for you.  Especially if you are on an antifolate agent such as methotrexate.

Remember, you’re not actually starting the folic acid elimination this week – you’re just doing the prep work. Clear out the pantry, finish your bread and pasta so it isn’t wasted, check your vitamins, supplements, and prescriptions and talk with any practitioners or doctors to make sure everything is smooth and ready for the transition. I don’t know if anybody remembers the movie Office Space, but what we’re doing here is Planning to Plan.

If you’re looking for a free resource about foods commonly fortified with folic acid, there is one in the MTHFR Library in Genetic Rockstars, our MTHFR community. It also has some ideas for MTHFR-safe substitutions.

The third thing that is probably a good idea this week, is talking to the people close to you. This is a process and you may need some support through it. You may also need to tell people why your favorite brunch place is off the menu for a while, because avoiding wheat products is super strange at first and culturally it’s a big committment. We make everything out of wheat, so this is the hardest change you’ll have to make on this entire journey.

I’m glad I warmed this season up with the hardest thing I’ll be asking you to do. That is great marketing on my part. If any of you stay with me, next week we’ll actually start taking the folic acid out of your life. After that, I should have eliminated my audience completely. Thank you so much for listening and I really hope you stick around for all of this.

I have a plan to get healthy with MTHFR, I promise.
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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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Obstacles with MTHFR – The Bucket and The Backlog

The MTHFR journey to health can be a bumpy one and there are certainly ups and downs along the way. We have talked a bit about this progression before, but I want to clarify the bumps in the road.

Moving toward health with MTHFR can feel really up and down – like you make progress for a little while and then hit a wall. But why? What are these walls and where do they come from? In my opinion, they come from two places. Your bucket, and your backlog.

Your Bucket

We’ve talked about the bucket before – your bucket is unique to you and it represents a container for how many stressors your body can hold before it fills up and symptoms start to spill over. The goal with any form of healing, not just with MTHFR, is to empty out your bucket so that your body has more room to deal with stressors.

So your bucket really is the stuff that is coming in right now – it’s stressors that are actively having an effect on your body. This could be viruses or pathogens, it could be alcohol, it could be inhalants from the perfume aisle or your big deadline at work. It could be a night of bad sleep, food that caused inflammation, or even an injury. This is whatever is actively being dealt with by your body in this very moment.

Your Backlog

Your backlog, on the other hand, is the stuff that needs doing that has accumulated over the years. This could be accumulated toxins that your body didn’t have the resources to process at the time they came in. It could be sleep debt, long-term hormonal imbalance, chronic inflammation, chronic oxidative stress, long-term blood sugar changes, or nutritional deficiencies. These are the big-picture things that your body isn’t quite keeping up with.

Backlog is really easy to picture as the baggage your body has to carry around with it on a day to day basis. You might not be actively adding to it right this second, but your body would like to be able to put some of it down.

It helps to think of your backlog as your body’s long-term to-do list. This is stuff that needs to be done and your body is just waiting on the resources it needs, then it will crack into this in a hurry.

So Why Do Bucket and Backlog Make Healing Bumpy?

The main thrust of working with MTHFR is working to balance your methylation, and that means adding resources, like methyl folate, that your body might not have had in a while (or, ahem… ever).

When we add these resources it suddenly allows for all of this work to start happening and your body gets really excited that it can clear up some of the junk it’s been holding on to, and there can be a bit of a flood at the gates, so to speak. Your body starts working through the to-do list but this takes both energy and resources.

If you happen to be having a full bucket day (more stressors than usual) or a busy backlog day (more processing than usual) it can feel like you’re hitting a wall or like your symptoms are worse.

Fixing the Bad Days

I know everyone wants a picture of healing that doesn’t have any bad days in it, but unless you can move to an ashram or a spa in thailand and devote yourself entirely to healing for the next year, it isn’t realistic to expect it to progress smoothly upward. There are going to be some bumps because real life happens.

Bumps are ok as long as you have a toolkit to deal with them. Here are a few suggestions:

  • Keep your bucket clean – really try to limit your bad days by minimizing what is coming in right now. This means you should get rid of:
    • Toxin exposure as much as possible.
    • Food sensitivities
    • Folic Acid (synthetic) in your diet and supplements
    • Excess alcohol
    • Tobacco
  • Sleep – getting good sleep gives your body that time to help clean house, recharge, and prepare for more work. If sleep is difficult, read more here
  • Watch your diet – good nutrition gives your body the resources it needs to deal with the bucket and the backlog.
  • Boost your antioxidants – if you’ve had a lot of stuff coming up lately or if you feel like you’re hitting a wall and having more symptoms, it can be a good idea to boost antioxidants or try different antioxidants to help your body cope with the excess.
  • Rest – rest is actually a different thing than sleep and your body needs both. Take some downtime to recharge mentally and physically, especially when you’re having a low day.
  • Use your gentle detox strategies – if your body is mired in the backlog, help it out with detoxification support that will move the process forward and help clear up the symptoms you’re experiencing. These include:
  • Be patient. Getting through the backlog takes time, energy, and patience and you will start feeling better from day one, but it will take time to work out all of the kinks.
Starting methylfolate can be rough, but things smooth out with time.

Bad days aren’t the most fun thing in the world, but they are a good signal that your body needs more support. If you haven’t been using a symptom tracker, I highly recommend starting today because your detoxification symptoms have a particular pattern and if you can recognize them, then you can begin to deal with them appropriately when they arise. This saves a lot of fuss and bother in the long run.

Also, you’ll begin to see patterns emerging that could give you more information about the way your body is dealing with certain foods, sleep, hormones, and other stressors. Symptom tracking makes all the difference.

If you don’t have a symptom tracker, you can download one for free by signing up for my email list (below or on the right-hand side of your screen) or you can find it in the MTHFR library in Genetic Rockstars, the entirely free MTHFR healing community.

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How Do You Know When Your Methylation is Balanced With MTHFR?

It’s great to talk about “balancing your methylation” and finding your right folate dose, but how do you know when you’re actually there? This question matters a lot because I’ve seen so many clients who are on a constant upward trend with their methylfolate dose – always pushing to take more simply because they can tolerate it.

The point is, do you need it? Is it helping you? This isn’t a contest in which the person who takes the most methylfolate wins a prize, this is about listening to your body and finding balance – balance meaning not too much and not too little. This goes for MTHFR folks, but also people without an MTHFR polymorphism, because you don’t have to have MTHFR to have imbalanced methylation.

So where is this elusive magical place in which balance is reached? It may not be nearly as elusive, nor as magical as you’re thinking.

Does Balanced Methylation Mean All My Symptoms Are Gone?

Goodness, I wish it did. It usually means most symptoms are better, and some of them are gone, but all of your symptoms being gone is not actually realistic. We’re all human and human bodies are built differently for lots of reasons. One of those is MTHFR, but each human has hundreds of polymorphisms along with a whole life history of pathogens, traumas, nutritional factors, lifestyles, and varying degrees of self-care. Balancing methylation can’t compensate for all of that, it just takes a big chunk out of the bottom.

Having said that, the process of balancing your methylation usually helps people tremendously – decreasing anxiety, softening depression, improving sleep, reducing inflammation, normalizing hormones and generally getting things closer to where they should be.

What Is The Easiest Way To Tell If My Methylation Is Balanced?

There are two great ways. The first is to look at the work you’re doing around methylation. The second is to look at your labs.

Caring For Your Methylation

You know you’re at a place where your methylation is balanced when these things are happening:

  • You understand the signals your body gives you when it needs more support and when you’re taking too much methylation support
  • You respond appropriately to those signals
  • You aren’t hitting major walls coming from detox symptoms or up and down methylation crashes
  • Your symptoms are slowly but surely softening and resolving. THey may not be fully resolved, but you’re on an upward trajectory. Some of this just takes time.
  • Your body’s basic needs are regularly met – you’re getting good nutrition, good sleep, gentle exercise.

I see the same panic-stricken look on many faces when I say this, especially from folks at the beginning of their journey. Don’t worry – this all becomes clear over time and this is a journey that takes time. In good news, the best way for it to all unfold, is softly. This is a lot like pregnancy in that you can’t really rush it – it’s best to just support the process. For everyone who has just muttered something grumpy under their breath, the next section is more concrete. I promise.

Ok – So What About Lab Work?

Basic bloodwork can tell you a lot about what your body is doing at that moment. Values that are most specific to methylation are:

  • Serum Folate
  • Serum B12
  • Serum homocysteine

There are also some tests that are suggested on various MTHFR forums that I am less inclined to use including:

  • Serum MMA
  • RBC Folate
  • Urine MMA
  • Urine FIGLU

We’ll go through the tests I use one by one. The tests I am less inclined to use we’ll cover in a different post.

Serum Folate Test

This is the standard folate testing t and sadly doesn’t differentiate between useful folate that is bioavailable and folic acid or worse, unmetabolized folic acid. So this test will tell us if there is an overt folate deficiency, but not much else. Still, knowing if you have a folate deficiency matters with MTHFR. Levels below 4 mcg/L indicate a folate deficiency, but outside of that, the guidelines are vague. I don’t like to see the numbers creep too high either and >8 mcg/L can also be a red flag for over-supplementation, or for high lingering folic acid and unmetabolized folic acid in the blood.

Serum B12 Test

This test measures levels of B12 in the serum and is reasonably accurate, but has a broad reference range. The reference value is typically 180 – 914 ng/L and anything in there is considered normal. Anything below 180 ng/L is considered to be deficient. Because it is such a broad range, I tend to look at anything even close to 180 ng/L with suspicion. Remember reference ranges give us the average numbers where people begin to experience symptoms, but that doesn’t mean it’s the ideal number for you, so aim for the middle of the range (somewhere between 450 – 650 ng/L). Also, if you test normal but still have symptoms of B12 deficiency, then extra supplementation could be warranted.

Serum Homocysteine Test

We’ve talked a lot about serum homocysteine and there is a normal range and also an optimal range. If you’re outside of normal, then obviously there’s a problem, and for MTHFR folks it’s a good idea to aim for optimal. The normal range is 5 – 15 umol/L with optimal being 6 – 9 umol/L (in my opinion. Follow the link to see my reasoning.) Homocysteine, remember is an inflammatory marker in the blood that is a direct measure of how well you’re methylating methionine and so is the clearest measure of MTHFR function.

Are There Other Tests?

There are other tests, namely serum MMA, urine MMA and urine FIGLU. These tests are less commonly used and deserve a post of their own when we have more time. I find the serum folate, serum B12 and homocysteine to be the most useful of the bunch.

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MTHFR and JoyHacks – Boost Your Happy

Joyfulness is a beautiful and elusive thing. It’s easy and common to get bogged down with the everyday life stuff. The things that need doing, or cleaning, or getting, or disposing of. There are lots of repetitive activities, frustrating waits, stressful rushes. I get that. There is also, in all of these moments, an opportunity to be happier.

We’ve just finished talking about MTHFR and the different neurotransmitters – serotonin, dopamine, norepinephrine, and epinephrine as well as my somewhat offbeat neurotransmitter theory so it seems like a good time for some joyhacks. Small, everyday things you can do to boost your joyfulness long-term.

#Joyhack – a small everyday action, activity, or behavior that will actually boost your joy. Proven by science.

Amy Neuzil from tohealthwiththat.com

Simple Joyhacks with A Big Impact

I am 100% sure you’ve seen a list like this before, but the question is, have you acted on it? I talk to so many people about joyhacks who say they’ve heard of some of these actions but haven’t actually added any of them into their daily routine.

Almost all of these will take 5 minutes or less, with the exception of exercise (shoot for 7 – 10 minutes at least) and meditation (if you can get 10 minutes, you’re great!) These aren’t hard, you just have to remember to do them.

  • Set small goals, and meet them. The simple joy of crossing something off a list actually boosts your dopamine. It also boosts your self-confidence because every time you set goals you can meet you are showing yourself that you can finish things and you can meet your own expectations. It’s a joy double-whammy. 
  • Don’t set yourself up for failure. Be realistic about what you can achieve given your time, energy, and other demands (family, sleep, etc…) Failure has a negative impact on your joy.
  • Sleep. No matter what else you do, prioritize sleep. If you can, take a small dose of melatonin at bedtime. It helps boost serotonin, helps clear excess norepinephrine, and protects your brain from oxidative damage. Also, it improves your sleep
  • Sunlight early in the day. Getting 15 minutes of sun exposure in the morning as early as possible is a great boost to your vitamin D and all of your neurotransmitters. If sunlight isn’t possible, invest in a lightbox or a good full-spectrum bulb.
  • Exercise. Not only is exercise good for literally every health parameter we know about, but it’s also amazing for your neurotransmitters and helps your body to optimize literally every one
  • Balance your methylation. This is all about MTHFR after all…
  • Meditate. If you can meditate regularly, even if it’s just 10 to 15 minutes a day 4-5 days per week, your mental health will change rapidly. This is one of the simplest, quickest ways to hack your headspace. Meditation isn’t just sitting quietly for a few minutes, it’s an active process. There are a ton of great free or low-cost resources out there. When you first start meditating expect to notice your mind getting busier before you notice it getting calmer. That is totally normal.
  • Hold a pencil in your teeth every day for 2 minutes. This forces your body to make a smile, even when you don’t feel like it and smiling boosts your serotonin. Seriously.
  • Trade massages with someone close to you. Or, pay a professional. Human touch and massage are a big deal for neurotransmitter levels, plus it feels awesome. 
  • Listen to beautiful music, appreciate art, appreciate nature, sing, or play. You have so many great options here and each one of them will help to boost your dopamine. Whichever one makes you smile to think about. When you do this activity, do it with your whole attention. Don’t listen to music while you work on the computer – take 10 minutes and really listen.
  • Every time you notice a negative thought, come up with a positive one. Optimism and joyfulness are as much about habit as anything else. We did a whole post on breaking mental bad habits and also what to expect when you’re breaking mental bad habits, and this trick is a simple balancing act. Every time you notice yourself getting down on something, try to find three things you’re happy about or that you appreciate about that thing, person, or situation.
  • Minimize your hassles. A body of interesting research shows that the small things have a much greater impact on happiness than the big things do. That’s small hassles and also small rewards. If you can find ways to minimize your small hassles – like shifting your hours so you don’t drive in rush hour, or taking the extra junk out of your closet so the only clothes that are left are things you truly love, like a capsule wardrobe, it has a significant impact on joy.

These are all small things, and even small things can feel overwhelming when you’re overly anxious, stressed, or depressed. But go through the list and find the one that makes you smile. Maybe you’d like to play and blow bubbles in the park, or maybe the idea of holding a pencil in your teeth for two minutes a day is absurd enough to get a smile out of you. But whatever it is, pick one small thing and do it every day. Every day for at least a month – then let me know how you feel.

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MTHFR and Neurotransmitters – Amy’s Neurotransmitter Theory

These past few weeks we’ve been talking about the link between MTHFR and the production of different neurotransmitters via the BH4 pathway. This includes serotonin and melatonin, dopamine, and norepinephrine and epinephrine.

The research seems to mostly agree that people with mental health issues like depression or anxiety, often have imbalanced neurotransmitters. Somehow, however, that has translated into a locked-in, fixed idea pattern culturally in which depression and anxiety are always neurotransmitter issues and so supplementing or augmenting neurotransmitters is the best path forward medically.

Everyone Agrees Mental Health Is All About Neurotransmitters.

I do want to say that there are people who find a supplement or drug that works for them, stay on the same dose for 15 years, and feel great. There are those cases. These are the shining examples of neurotransmitter-based therapies working and I love seeing them because in the end, it’s a simple solution.

Unfortunately, there are also cases of people chasing down a feeling they had briefly. They get on a drug or supplement, go through the adjustment reactions, it works for six months or a year and then they’re back where they startedmentally, but taking a pill. They increase the dose, increase again, switch to a related drug or supplement and still aren’t where they want to be. They can’t match that time period when the pill was working. They switch to a different class or category of drugs or supplements, and give that a try. Each time with a six to eight-week adjustment window and a host of new or different side effects. I see this all too frequently.

There are several possible problems with the neurotransmitter-only model. We’ll start with the simplest and most obvious problem and work toward more controversial issues.

“Depression” Is a Big Word

And it seems to mean something a little bit different to everyone who says it. Likewise, with anxiety. Over the years I’ve had hundreds of clients tell me they’re depressed. They are always surprised when I ask what that means to them. Not surprisingly, the answer to that question varies greatly.

One man was highly offended at having to educate me about such a basic question. His answer was, “What do you mean what do I mean? I’m depressed! I get up in the morning, the toaster doesn’t work so I slam it on the counter four or five times, and then run out of the door without eating because it’s just too difficult. I’m depressed.” Another client told me she got up in the morning, cried in the shower, cried in the car, smiled all day through her work as a high-level executive, cried the whole way home, then smiled through dinner with her family.

You might notice that the pictures these two people have painted are very different. And these are just two examples out of a seemingly endless variety. The point is, “depression” isn’t something uniform. Sadly, when many people go to their doctor or practitioner and say “I’m depressed” there are only really a handful of standard neurotransmitter-based treatment options for such a myriad of different pictures.

Neurotransmitter Overlap

Another issue I see with the idea of working with mental health from a purely neurotransmitter direction is that the neurotransmitters have significant overlap.

Say you look at something like attention. Serotonin, dopamine, norepinephrine and epinephrine are all heavily involved in attention. Much the same with enjoyment and even alertness. In situations like this engaging in lifestyle changes to actually boost all of these neurotransmitters is a great idea and will help to cover all the bases, but taking a drug or supplement that boosts one pathway leaves plenty of gaps in the system.

It’s obvious, when you look at it this way, that boosting one pathway out of many might lead to imbalances elsewhere that show up as side effects.

It Is Not A Tug Of War

Medicine has become very mechanistic since the advent of penicillin because so many drugs, which do one precise thing in the body, have been lifesaving. I’m all for lifesaving drugs, but this model comes at a cost. We’ve backed ourselves into a corner in which we tend to oversimplify the body into being akin to a constant tug of war between opposing forces or directions of imbalance.

If we suspect serotonin is low – meaning the low side of the tug of war is winning – then we just boost up the other side so it gets higher. Easy. The problem is, neurotransmitters are less like a tug of war and more like a web, with forces pulling at twelve points instead of two. We can, of course, boost up one of those points but it becomes difficult to predict how the other twelve will react and where that will place new stressors on the body.

Your Body Is Smarter Than That

The last issue with boosting a particular neurotransmitter chemically is that for very many people this turns into chasing a dream. Think back to the scenario in the outline where someone started neurotransmitter therapy, had a golden year or nine months, then chased that for the next three years. What happened there?

Well, it is my belief, although this is not a well-researched area, that your body is pretty smart at adapting to the outside world. If your body has set your neurotransmitters at a certain level, and you do something to change that level, I have every faith that your body can reset so that they’re at that same level again, even with the new influence.

The point is, that we’re not getting to the WHY question. WHY did your body set the neurotransmitters at that level to begin with?

Maybe it really is a disfunction or pathology in which your body can’t keep up with production. That is a legitimate possibility (and MTHFR folks – if your methylation isn’t balanced then this is entirely possible because your BH4 pathway is impaired). But what if the problem isn’t production? What if there is a more complex reason for the neurotransmitters being set where they are? What if they are there to compensate for something else that is out of balance?

Your body is the most amazing thing you will ever see, touch, or possess. It is working constantly to return to health, to compensate for damage, to adapt to a dynamic world full of challenges and resources of which you aren’t consciously aware.

So If It Is Not All About Neurotransmitters, Then How Do We Fix It?

The wonderful thing is that working with neurotransmitters is still an option, but this opens up a lot of other options as well. Before you look to neurotransmitters it is important to look to other causes of mental health issues. We did a whole post previously on this topic but some of the more common ones are:

  • Low folate
  • High homocysteine
  • Low thyroid
  • Imbalanced hormones
  • Low testosterone
  • Estrogen dominance
  • Trauma or mental health history

Nobody likes that list because it’s just easier if there’s a pill for it. Sometimes the pills really are the best thing, but it’s a good idea to be open to other types of treatment as well. Be willing to let go of the idea of the magic pill if it just isn’t serving you.

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