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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What Is The Goal With MTHFR?

I know this sounds like a bit of an odd question – the goal is to get healthy, right? And yes, of course it is. But sometimes people have mistaken ideas about health goals, so I think it deserves a little bit of a conversation.

First off, What Concrete Goals Are We Looking For?

This is actually pretty simple.

  • Normalize lab values like homocysteine, B12 and folate levels.
  • Feel reliably better
  • Minimize the risk of chronic illness both related to and unrelated to MTHFR.

Simple, right? Except that we are a society used to taking a pill to fix things and then eventually being done with that pill. That is where we get into trouble with MTHFR.

MTHFR Is For Life

This isn’t a get balanced and then go back to ignoring it kind of problem. MTHFR is a genetic difference. It has always been with you and it will always be with you. There is no quick fix for that. I believe we can achieve the goals above – get your basic numbers back in line, get you feeling great, and reduce your risk down the road. Absolutely all of that is possible, but it is also ongoing.

Your body and your health are dynamic. You respond to changes in diet, in stress level, in weather, in close relationships, in sleep quality in very real ways that might be easy to perceive or might be hidden. Still, every one of those factors and hundreds of others besides add up to your total state of health on any given day or in every moment. Essentially, it’s a lot of moving pieces and in any day there could be hundreds of small factors that determine how your body functions. That is a lot.

For example. Say you get up in the morning, have an extra coffee because your dog/cat/spouse/hookup decided they wanted to sleep on your pillow. You grab a whole grain bagel with cream cheese and run out of your door, only to get stuck behind the slowest driver on the face of the planet. You can feel your blood pressure escalating and you try to take a few deep breaths so that you don’t just run into the back of their car four or five times to vent some spleen. When you get to work your boss pulls you aside and thanks your for the amazing job you’ve done on your latest project. Nice! After work you go to the gym but the parking lot is full and you end up driving around for 15 minutes before you decide you’re too tired anyway and head home…

This day is filled with pretty normal things:

  • not ideal sleep
  • extra coffee
  • food choices
  • rush and stress
  • frustration and maybe a bit of road rage
  • surprise good news
  • inconvenience
  • sedentary lifestyle

Plus, there were all the things you weren’t aware of that your body was dealing with – that tiny little pocket of inflammation in your arteries, the virus that has been lurking around the office causing your immune system to ramp up, the low-pressure system that is floating in, the minor vitamin C deficiency you never knew you had, and the lingering emotional stress that comes from a strained relationship with auntie Mabel. Add to all of that your hundreds to thousands of polymorphisms.

Every one of those seemingly tiny factors affects your physical state of health in some way. We all know the emotional impact, of course, but physically every one of those factors affects your cortisol and sex hormone levels, inflammation, metabolic pathways, neurotransmitters, parasympathetic functions like digestion, and gut flora. Every small thing ripples out into the much larger picture of who you are and how your body feels and functions. Frankly, it’s a wonder any of us can get out of bed in the morning.

Outside of Goals, What Is The Actual Aim?

This, to me, is a whole different thing. The goals are tangible. We can check them off of a list and be done. The aim, is perhaps a bit softer than that. In my opinion, the aim of working with your MTHFR and your methylation pathway is about reaching potential. Every human has strengths and weaknesses, we all have ups and downs and as far as I can tell, that is the crux of being human. I know precisely zero people who have perfect states of being. We just have to slog through the mud sometimes. So my aims in my own MTHFR journey, and for you as well are:

  • Live up to our potential as flawed humans. This isn’t about being superman or superwoman. It’s not about being a TV character – glossy and perfect. I actually think fostering the idea that we CAN be that is damaging. This is about feeling well, have a positive impact on the people around us, and feeling like we’ve done something worthwhile.
  • Maximize health for whatever years we have. Nobody, even with a perfect diet and self-care, can actually predict what their health is going to be like throughout their life. People with perfect diets get cancer too. We can work to make it better than it might have been, but that doesn’t mean we’ll all be blessed by the perfect health fairy. It doesn’t work like that. When we reach the end, I want us all to be able to look back and know we cherished ourselves and treated our bodies like they mattered.
  • Have more good days than bad days. Of course, we want good days – lots of them. But it is also important to live into the bad ones and not be discouraged by them. This means continuing to develop a toolkit of coping strategies for the not-great days.

Aiming for perfect is misguided

amy neuzil,

The point is that aiming for “perfect” is misguided. People reach for it in health, looking for a meaningless continuity of perfect days. Culturally we reach for it in goal setting, and self-perfect and it becomes both unattainable and deeply damaging. There is no perfect. Ever. Embracing that is freeing. What there is, is BETTER.

Thanks for listening this week – don’t forget to rate me on your favorite podcasting app, and tune in next week for some gentle detox strategies, because god knows we MTHFR folks need them.

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