Once you’ve adjusted your diet, you have a new baseline. This is your new normal and it may be great, it may just be getting there (but not great yet). Make sure you give yourself about a month on your new diet — with MTHFR it’s way better to go slow and give your body time to adjust to things properly before you jump into something new. This is when you should start to think about supplementing.
Three rules to successfully start 5-LMTHF supplements:
- Always start low – use the lowest dose you can find. You can always add more, but once you’ve taken it, it’s hard to get it back out. Start with a low dose.
- Always go slow – give your body time to get used to the low dose before you increase. At least a week, but two if you know you’re particularly sensitive. It is really common for someone to be able to take something for three days and then start to have symptoms because the dose is actually a bit too high and they’re pushing too hard. Make changes slowly and be as willing to decrease the dose as you are to increase the dose. There is no right dose for everybody, only the right dose for you.
- Change only one thing at a time – I see it happen all the time that people get excited about a new health journey, add five supplements from internet research, then have some kind of symptom and have absolutely no idea where it came from or what is causing it, so they end up dropping all of those supplements. This isn’t the best way forward. If you make small changes with only one supplement at a time, you can avoid this problem and you’ll always know exactly how you respond to something. That doesn’t mean that adding another supplement might not change the dose you need of something else, but at least it helps you to know where to look.
If you’ve already:
- Taken folic acid out of your diet
- Added in natural folate
- Started a multivitamin or B complex without folate or B12
And you’re tolerating these changes well, then you’re at the point where you might consider adding some extra 5-LMTHF.
Start with the lowest dose you can find and if you can only find high doses, cut them (if they’re tablets) or take the powder out of capsules and divide it. If you typically react strongly to things you take, which is common for in MTHFR issues, then start even lower than you think you need to.
The Three Possible Reactions to 5-LMTHF
- Miracle! – It starts out as a miracle (although it might feel weird the first couple of days because your body is adjusting), it keeps being a miracle and everyone is happy.
- Bait and switch – It starts out amazing and you love this thing. A couple of weeks later you find yourself either spackling minuscule cracks in your ceiling at midnight because you have too much energy and can’t sleep (overdose), or hating everything and everyone because you feel toxic (too much, too fast).
- 5-LMTHF is the devil – If it always feels bad, there is a good chance you will either never tolerate it, or only tolerate tiny doses later on in the process.
It is normal to feel a little strange for the first few days. Remember, 5-LMTHF is the only form of folate that bypasses the MTHFR enzyme and that means it can feel a bit odd the first time you take it. That enzyme has been dysfunctional, to some degree, your whole life and your body is going to need a minute to adjust. For me, the only way I could describe it was that my brain felt “different.” This is a useless description, I know, but there wasn’t really anything I could put my finger on, it was just … “different.”
5-LMTHF has the potential to change your neurotransmitters, your cellular energy, your antioxidant balance, and lots of other things very quickly, so it can feel a little odd. Your body has probably never experienced this before.
Outside of a normal adjustment reaction, it is also possible to have a bad reaction. The most common ones I see are anxiety or restlessness, edginess, depression, or difficulty sleeping.
Any big uncomfortable symptom should be considered a bad reaction and if that happens, stop the 5-LMTHF and wait until the symptom clears before you try it again. If the symptom was really bad then try again at a much lower dose. Even if you can tolerate natural folate in food, you might not handle 5-LMTHF well.
If you have an adjustment reaction, but it clears in a few days and you’re tolerating the dose of 5-LMTHF that you’re taking, that’s great news! Stay at this dose for a couple of weeks and then try increasing it by a little bit. Dosing is very individual with MTHFR and there isn’t any way to give you a target dose, but there is a right dose for you out there somewhere. It’s just a matter of slowly working your way up until you find it.
What If I Can’t Tolerate 5-LMTHF?
This is a surprisingly common issue. If you just can’t take any 5-LMTHF at all, try a tiny dose of folinic acid instead. Folinic acid is metabolized differently than 5-LMTHF, but it’s a natural form (like the natural folate in foods) and is often easier to tolerate for MTHFR folks, even though it still needs the MTHFR enzyme to be activated. If you need a refresher on folinic acid or the different forms of folate, check out this post. Here is a diagram of the methylation cycle showing where the different types of folate come in.
Folinic acid still goes through the MTHFR enzyme, but it bypasses the DHFR (slow) enzyme and the DHFR (fast) enzymes. For many MTHFR folks, it gives them the benefits of natural folate but is easy to supplement as a pill form (which natural folate isn’t because it isn’t shelf-stable) and it metabolizes more slowly than 5-LMTHF, which means that most people have fewer side effects.
Once you’ve taken folinic acid for a while you might be able to tolerate a small dose of 5-LMTHF because some of the accumulated problems from a functional folate deficiency have been worked out, so your body might be better able to handle it. Again, start low, go slow and change only one thing at a time. You might still find you can’t take 5-LMTHF, but this whole journey evolves so just because something was true when you began the journey doesn’t mean it will be true three months in, three years in, or three decades in. Remember, MTHFR is for life.
Next week we’ll talk about dosing strategies because for many of us, taking the same dose every day isn’t a great idea. After that, we’ll dive deeper into what to expect when you first start taking 5-LMTHF, what to do if symptoms arise, and how to manage any reactions you might be having.