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S2E30: Slow COMT

This week, let’s talk about our first of two COMT pictures. COMT slow. Remember, this means the COMT enzyme is less efficient than normal so the catecholamines it is supposed to break down stay in circulation longer. This leads to high neurotransmitters including dopamine, norepinephrine, and epinephrine. It also means high levels of hormones, including stress hormones, which are really those same neurotransmitters when they operate outside of the brain, and also estrogens.

This is not dependent on one COMT polymorphism, but rather the sum of all COMT polymorphisms again I want to caution you against assuming you know what is going on based on a piece of paper. A genetics report can only show you the genes as written, and not the ways your body has activated or silenced those genes (which is called epigenetics) – that can only be observed in real life. So if you’re trying to determine if your COMT is fast or slow, the most helpful thing to look at is personality and symptoms.  Also, there is research showing that the presence of estrogen may inhibit the COMT enzyme further, meaning that women with slow COMT would be more strongly affected than men.

Signs and Symptoms of Slow COMT

In terms of neurotransmitters, high dopamine, epinephrine, and norepinephrine look like this:

  • Enthusiasm
  • Exuberance
  • Self-confidence. 
  • Ability to focus for long periods of time
  • Workaholism

These neurotransmitters do double-duty as stress hormones and so we also see:

  • Difficulty calming down in stressful situations
  • Dislike of overstimulation – lots of noise, lights, chatter in the work environment, chaotic or messy spaces.
  • Hard time falling asleep
  • Easy irritability
  • Often worse with caffeine or other stimulants.

COMT also affects estrogens and so people with slow COMT often have:

  • Glowing skin
  • Strong bones
  • Often started their menses younger than their peers
  • Slow COMT Symptoms related to high estrogen such as fibroids, PMS, and fibrocystic breasts.
  • Higher tendency toward hormonal cancers including breast and prostate. 
  • Higher estrogen status is generally harder to see in men, but in extreme cases, it can cause swelling of breast tissue, erectile dysfunction, and delayed puberty but milder cases may be harder to detect.

Remember that other gene SNPs can affect these same neurotransmitters and hormones, but if you have these symptom pictures then addressing the situation is appropriate no matter what your gene report says.

The COMT Slow genotype carries with it some superpowers as well. On a surface level, the COMT variants get divided into Warrior and Worrier pictures.  COMT slow, because of the high level of stress hormones, falls into the worrier category.

That doesn’t sound like a superpower but stick with me. People with slow COMT actually have higher levels of dopamine in their prefrontal cortex, which is associated with executive function, decision making, understanding consequences, impulse control, coordinating complex behaviors, and creativity. 

 The signs and symptoms of a slow COMT

In studies, higher dopamine in this area of the brain allowed people to excel at these tasks, especially in creativity. Those with the COMT Val158Met Met/Met allele (COMT slow) showed greater abilities in divergent thinking, meaning they were able to create more different solutions to a given problem in a short amount of time than someone without that polymorphism.

So while those of us with the COMT slow variant (you can’t see it but my hand is up here), have the potential to feel stress more acutely than our COMT fast counterparts but we can also think of 50 ways to solve a problem in no time at all.

Interestingly, the slow COMT state also has better cognitive stability, meaning the ability to stay focused on a task for long periods of time, whereas the COMT fast is better at flipping between tasks effectively.

Managing a Slow COMT

Step 1: Balance Your Methylation.

As we discussed last week, the COMT enzyme is dependent on healthy methylation, so the first thing you would do in this situation, just like in COMT fast, optimizes your methylation. Get your basic B vitamins, find the best B12 for you, and add a methylation driver like 5-LMTHF or SAMe. Optimize your doses of those things based on how you actually feel and how your symptoms look on a symptom tracker. You can get a free slow COMT symptom tracker by signing up for my newsletter at

Keep in mind that with a slow COMT your neurotransmitters look a lot like you’re on small doses of uppers all the time and so overdoing your methylation drivers can take that away, flipping your COMT slow to a COMT fast, and frankly nobody likes anything that downs their uppers. So beware of taking too much or pushing this process too hard. We’ve got to be flexible and responsive in dosing methylation drivers and not get stuck on a target amount we’re “supposed” to take.

Step 2: Optimize Your Diet

Protein boosts dopamine, which is something that you don’t need if you’ve got a slow COMT. Especially at night when you’re trying to get to sleep. Focus on a higher protein meal at breakfast, but lower at lunch and dinner. Slow COMT folks do best with a veggie and carb-weighted dinner.

Adding in high magnesium foods helps as well because magnesium is one of the best nutrients for a slow COMT. Look for dark green leafy veggies, low-fat dairy, nuts, and legumes. Fortunately, these are also foods that are high in natural folate, so you’re eating them anyway, right?

Boost your fiber. Help your body to eliminate those excess estrogens by eating lots of fiber that can help to bind them in your gut and make sure they get eliminated.

Symptoms and signs of slow COMT

Step 3: Calm.

Such a big part of this picture involves high-stress hormones, so minimizing stress is crucial to keeping balance. This means:

  • Declutter your home and keep it tidy. A calm, chaos-free environment helps reduce stress hormones.
  • Go for quiet environments or soothing background music when you’re trying to focus or wind down.
  • Meditate, take a minute to breathe deeply, or try the technique Martha Beck outlines in this episode of her Bewildered podcast with Rowan Mangan.

Step 4: Balance the Hormones.

While balancing hormones is an entire podcast series in itself, there are a few constants. I mentioned fiber in the diet section and if there is only one thing you can do, fiber should be it. Otherwise:

  • Seed cycling. It’s too much to get into right here, but here’s a link to a detailed article. It’s a lovely way to help balance and regulate hormones safely.
  • Bump up your broccoli. Broccoli and other cruciferous veggies like cabbage, brussels sprouts, cauliflower, and kale specifically help to detoxify estrogen. If you’re going for bonus points, then look to broccoli sprouts for the win.
  • Avoid plastics and pesticides, many of which mimic estrogen in your body. Getting these artificial estrogens out will help your body deal with your natural estrogens more easily.

Thanks so much for listening today and next week we’ll dive right into the COMT fast picture. Please subscribe so you don’t miss any episodes and if you like what we’re doing here, I’d really appreciate it if you’d leave a review. Thanks so much!

Having the slow COMT polymorphism does not mean that you will develop a certain health condition, as the effects of this polymorphism are complex and can be influenced by many other factors. It is likely to change the level of stimulus you prefer in your environment and your ability to handle stressful situations.  Having a slow COMT means that you metabolize some neurotransmitters, including dopamine, norepinephrine, and epinephrine more slowly than average and so resting levels of those neurotransmitters are higher. This means you will be more strongly affected by stressful situations or emergencies, and also that you are likely to do better in a calm, quiet working environment. It is always good to be informed about your genetic makeup but it is not something to be worried about. Consult with a healthcare professional for more information about how this polymorphism may affect your health.

Yes, in some cases the slow COMT polymorphism can affect the metabolism of certain medications. For example, some studies have suggested that individuals with the slow COMT allele may metabolize certain antipsychotic medications more slowly. Also, because COMT is involved in estrogen breakdown, people with a slow COMT might do better with progesterone based birth control pills rather than estrogen based.  It’s important to inform your healthcare provider about your genetic makeup and any medications you are taking, so that they can adjust the dosage or type of medication accordingly.

Some studies have suggested that the slow COMT polymorphism may be associated with certain mental health conditions such as schizophrenia and depression, but these associations are not well understood and more research is needed. Additionally, the effects of the slow COMT polymorphism on mental health are complex and can be influenced by many other factors. If you have concerns about your mental health, it’s important to consult with a healthcare professional.

The slow COMT polymorphism (methionine allele) is relatively common and it’s estimated that around 30-40% of the population carry this allele.

It’s worth noting that while the slow COMT polymorphism has been associated with certain health conditions, it’s not the only factor to consider, and more research is needed to understand the impact of this polymorphism fully. Additionally, the effects of the slow COMT polymorphism can vary depending on the individual, and the treatment plan should be tailored to the specific needs and circumstances of each patient.

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MTHFR is a common genetic mutation that can contribute to anxiety, depression, fatigue, chronic pain, infertility, and more serious conditions like breast implant illness, heart attack, stroke, chronic fatigue syndrome, and some types of cancer. If you know or suspect you have an MTHFR variant, schedule a free 15-minute meet-and-greet appointment with MTHFR expert Dr. Amy today.

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Amy Neuzil
Amy Neuzil

Dr. Amy Neuzil, N.D. is a leading expert in MTHFR and epigenetics, and she is passionate about helping people achieve optimal health and wellness for their genetic picture. She has helped thousands of people overcome health challenges using a simple, step-by-step approach that starts with where they are today. Dr. Neuzil's unique approach to wellness has helped countless people improve their energy levels, lose weight, and feel better mentally and emotionally. If you're looking for a way to feel your best, Dr. Amy Neuzil can help. Contact her today to learn more about how she can help you achieve optimal health and wellness.

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