S2E8: The Preliminaries with MTHFR

This week you’re continuing to symptom track and continuing to have patience because right now you are laying the foundation for a good methylfolate start. This phase, what I like to call the preliminaries, is all about priming your system for the giant load of methylated goodness that is going to come in and without this, things can get really rough down the road.

The “Preliminary Phase,” is the first of three phases for that MTHFR folks go through when they start working on this. This phase lasts through a successful 5-LMTHF start and means your body is opening up the metabolic pathways that are dependent on methylfolate. Once these pathways start spinning reliably, then you will enter another phase, which I like to call “Burning Through The Backlog.” When your body has caught up with its mountain of backlog, which can take months or years, then we enter the “Maintenance Phase.”

Each of these three stages is equally important, but the preliminaries are relatively undramatic and underrated next to something as exciting as backlog. Giving your body the luxury of a solid start will help the backlog phase go much more smoothly and hopefully allow it to be faster, although that is my own conjecture.

With MTHFR, our bodies often have a backlog of unfinished business that needed methylfolate, but your body didn’t have enough resources at the time the business got started. These items go onto the physiological equivalent of a to-do list. In some ways the backlog shows up on a day-to-day basis – these are the unmanufactured neurotransmitters, the deficiencies of nitric oxide and glutathione and the excess of homocysteine. Most of these, however, are largely silent.

Toxins that can’t be methylated and therefore get diverted to long-term storage, unmethylated bits of DNA, unmethylated proteins and fats, and generally tasks that need doing. These build up and build up and as they accumulate, your body gets more and more desperate to start doing something about it.

The “something” your body wants to be doing can start to happen once you have reliable methylfolate and the background of other B vitamins, and once your body is confident about that, you enter the second phase, the “Burning Through The Backlog” phase. This is the heavy-lifting of the MTHFR journey and we’re getting ready for it right now.

So for this week, the best thing you can do is to keep tracking your symptoms. If you notice weird energy changes, strange new symptoms, anxiety, nightmares, intrusive thoughts, or any kind of wound-up feeling, reassess the vitamin B12 you started last week or previously with the other Bs. Remember that even though the methyl form is the most biologically active form, it is also the one most likely to cause symptoms. Actually, it causes symptoms specifically because it is the most biologically active form.

At this point you should also be maintaining the good MTHFR lifestyle things that we’ve talked about in the past. This means keeping up those food sources of natural folate – the natural folate, even though it does have to go through the MTHFR enzyme, will begin to get the wheels turning. Especially if you’re getting it in the absence of folic acid, which is known to block up the works. Unfortunately, many people who have had high folic acid exposure for years will continue to have high blood levels of folate on lab tests that we can only assume are mostly unmetabolized folic acid. It seems clinically as though it is difficult for your body to get rid of and so hangs around, cluttering up the works for a while.

Don’t be discouraged – just taking the folic acid out of your diet and supplements is a huge step forward for your body and allows some off that natural folate to reach receptor sites.

Other things to focus on this week are simple steps like hydration. We will talk more about the importance not only of water, but of hydration in a few weeks, but for now, just make sure you’re getting a lot of water. Anything that allows your methylation cycle to begin to move more freely is also going to encourage some detoxification, and you can’t get anything clean without water.

Also, sleep. As your body is able to methylate more, it is going to want the time and rest to do so. Prioritize both sleep and rest this week and through the coming months as your body really digs into this work. Sleep is when a lot of your detox processes happen and you’re going to be doing a lot of that.

I know this week doesn’t feel like we’re doing much, but it really does matter to create a good environment for all of the methylation processes to start happening, and also to open up these pathways in a slow and controlled manner. This is basically building the frame of a house before you put in the tiles and hardwood. The tiles and hardwood are far more interesting and way prettier, but without the frame, they’re useless. The 5-LMTHF start can feel strange at the best of times, but it’s way stranger if you aren’t ready for it.

Next week, we’ll talk about the actual 5-LMTHF start, what you might expect to see, and what weird feelings are “normal” versus the weird feelings that indicate a problem.

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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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What to Expect When You’re Starting Methylfolate

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. We talked about it in a whole post here. As a quick recap, you can expect one of three big reactions.

  1. This is the miracle of miracles.
  2. This started really great and went south.
  3. This is a nightmare.

No matter which of those big reactions you fall under, there can still be a bit of an adjustment when you’re starting. I couldn’t describe my adjustment reaction to you in any way other than to say that my brain felt “weird.” It wasn’t awful, it was just not normal. If it is awful, then stop dosing and read the above post to find out your immediate steps. Here, I want to talk about longer-term expectations and what you might see.

Good Days and Bad Days

As you continue for longer periods on your MTHFR journey, the good days and bad days smooth out and things get a lot more regular and predictable. In the beginning, though, your body is still struggling out of its own personal sand pit and so you’re a little more susceptible to ups and downs. This is normal and expected and gets so much better over time. Just be gentle with yourself and on days when you’re feeling a little yucky, add in some great self-care. That could be scheduling a little nap or some outdoor time, it could be a hot bath or taking 5 minutes to meditate. It could be sitting and staring at a wall for 15 minutes, unplugging, or even watching funny videos during a break to get your dose of laughter. Just be extra gentle with yourself and take some extra care. Your body is working hard and some days it needs extra love and support.

Starting methylfolate can be rough, but things smooth out with time.

Detox Symptoms

One of the biggest processes that is happening with appropriate methylation support is detoxification. This is great news and we want it to happen, but if detox is happening too quickly, then it can feel crappy. Like, really crappy. Detoxing too quickly looks like:

  • brain fog
  • headaches
  • nausea
  • irritability
  • general yuckiness
  • usually it reminds you a lot of a hangover.

This means you’re pushing your body to detoxify, but it’s getting stuck somewhere.  Here is what you should do:

  1. Decrease your dose or take a break from any methylated supplements or methylfolate that you’re taking. Your body needs a break for a minute.
  2. Rest more
  3. Get extra water and some good mineral support (like adding a bit of Himalayan pink salt, lemon juice, or apple cider vinegar to your water).
  4. Do some gentle detox. This could be:
    1. Sweating in a sauna, hot car, hot bath, or wherever else you can sweat.
    2. Hot bath with Epsom salts (for the sweat, and the magnesium)
    3. Castor oil pack
    4. Boosting your fiber intake
    5. Taking something to bind to toxins like bentonite clay (food grade), activated charcoal (also food grade), or spirulina.
    6. 24 – 36 hours of fasting.

As an MTHFR mutant, gentle detox is going to be part of your life, so it really helps to familiarize yourself with your body’s toxic signals. My first one is always irritability – it’s a sure sign that I’m pushing too hard.

Learn Your Boundaries

I feel like one of the biggest and most important factors to really taking care of your body as an MTHFR mutant, is to learn to understand your body’s tolerances and limits. None of us like the word “limits” it implies that we aren’t superhuman, that we have to stop some time or take breaks. It *almost* sounds like a weakness. We have got to change that idea, and fast. Understanding and listening to your body if it is approaching a threshold helps you to avoid the big fallout times, the horrible days, the emotional days, the exhausted days (or weeks), the brain-foggy-can’t-focus days. Believe me, without those, your potential skyrockets and it’s like you’re launched to the next level of life as a human, both personally and in your professional or creative life. This is a lot like learning the subtle language of your body so that you can stop problems before they start.

The best way I know of to start this process is to use a symptom tracker – maybe even daily. Rank symptoms and also traits from 1 – 10 every day and after a while, patterns will pop out at you. Like I said above, if my irritability starts to rise I know to add in some extra detox. If I don’t do that, then I can expect 2 – 3 days of headaches, irritability, brain fog, and general misery. Believe me – it’s better to just make time for that hot bath and convert those to good days.

Likewise, if I start feeling my stress-levels ratchet up, or my level of work-obsession rise, then for me that is a signal that I need more methylfolate, more antioxidants, and more exercise. A couple of days of that will right the balance and put everything into perspective again.

My signals are probably going to be different from your signals, but by using a symptom tracker you will start to see those repeating patterns and can use them to develop coping strategies to keep most days as good days.

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How to Dose Methylfolate for MTHFR

MTHFR is for life, and you’ll feel best if you are working on making your methylation great for the rest of your life. That doesn’t usually mean finding a dose of whatever you’re taking and sticking with it, it means rolling with the punches and allowing your body to change and evolve as your health changes and evolves. Generally, there are three different dosing strategies that can be used.

I certainly find that in myself and my clients, times of higher stress of any kind usually need more methylfolate. If I get sick I usually need a little more, if I’ve had less sleep than usual, or if I’m starting a new project and my brain is constantly churning I find I need more. Also, at those times I might need more support of different kinds. Likewise, if things are breezy in my life and I have good sleep, time to relax and lower stress then I probably don’t need to take anything – I just keep a good diet. 

It gets easier to adjust and listen to your body as you get more familiar with your own red flags – both when you’re low and need support and when you’re a bit too high and need to stop for a bit. By really understanding your signals you can dose in my favorite way, which is intuitive dosing. We’ll also talk about Dr. Ben Lynch’s “Pulse Method,” and a mixed dosing strategy.

Intuitive Dosing – how to dose methylfolate and other supplements.

Intuitive dosing, to me, is the absolute ideal way to dose your supplements because you can check in with your body to see what you actually need that day – you don’t have to have any supplements that you take every day like clockwork, it can all be much more individualized to your own needs in the moment. There are two things you need to understand for this to work and those are:

  • Your personal red flags (which are easy to see if you use a symptom tracker) and your energy level.
  • What each supplement does for you.

To do this effectively, you need a symptom, and you need an appropriate response. I’ll give you some examples from my own life just to help you understand.

If I get up in the morning feeling sluggish (symptom), I definitely take my multivitamin, 5-LMTHF, and a vitamin E with breakfast because the multi and methylfolate will give me an energy boost and the vitamin E will help to neutralize any oxidative stress that might be happening because I’m tired. I also add electrolytes to my water and really focus on getting enough water for the day because that can also help with energy. (Appropriate response to boost energy and counteract any excess stress on my system). Also on these days I try to support my body more with lifestyle factors. I get to bed earlier in the evening or try to fit a short nap into my schedule, give myself some down time and generally take better care. 

If I’m having a bit more joint or muscle pain (symptom) that day, which is my biggest issue, then I am likely to also add a high dose of fish oils for their anti-inflammatory properties and boost the magnesium in my water (appropriate response for inflammation and pain)

There are also some supplements that I take just to maintain good levels in my body, like vitamin D.  I don’t take these daily, but I incorporate them when I’m taking other things – so if I’m having a day where I need some supplements, then I’ll throw a vitamin D into the mix just to make sure I’m getting it regularly. 

Some supplements need to build up in the bloodstream to certain levels to be effective.  For example, I have mold allergies that will typically activate in the fall.  If I take my allergy supplement as needed, it is less effective then if I take a higher loading dose for five days then a steady lower dose for the duration of the season. So this one I do take regularly and not on an intuitive basis so that I don’t have to experience any allergy symptoms.

There are some things that must be taken daily. Those include:

  • Prenatal vitamins and supplements while you’re trying to conceive, building a baby, or nursing because that is an unusual situation for your body and you do need extra support.
  • Prescription drugs from your doctor must be taken as directed – always. 
  • Support when you’re acutely ill. When you’re actively going through a disease process, sick with a short-term illness, or starting an intensive weight loss program you probably need more consistent support.

Benefits of Intuitive Dosing:

  • You get what you need, when you need it.
  • You save money on supplements because you’re not taking them every day
  • You retain optimal absorption – I believe anything your body gets absolutely every day is easily ignored and gets lower priority, in terms of absorption, than things that show up sometimes but not others. 
  • Less waste because typically if your body doesn’t need something, it just washes it out in urine or feces, so if you’re’ taking something when you don’t need it, it is essentially just washing through (unless it’s building up to harmful levels, which is actually worse).
  • Easier to avoid toxicity reactions – there are things that build up in your system and just because it’s helpful when you need it doesn’t mean it isn’t harmful when you have too much!
  • You become more aware of your body’s needs, which also makes it easier to maintain a great MTHFR lifestyle.

Drawbacks of intuitive dosing:

  • This can be hard, especially for people who are really out of touch with their bodies or who have had a lot of physical or emotional trauma and tend to dissociate, because they may not notice what their body is feeling. It is beneficial to work on it in the long run because it will help you tune back in to your body and work through some of the trauma, but that can be a process.
  • Some people really need a routine to help them remember supplements. For these people, a mixed dosing strategy might be the most appropriate.
  • This takes some practice for you to learn to trust your body’s signals and respond appropriately.
  • It can be difficult to keep track of what your supplements are doing for you. It is important for everyone to learn, but especially important if you’re dosing intuitively.

Times when you are more likely to need to take higher doses of supplements:

  • If you’ve had a bad sleep
  • If you’re going through a stressful time at home or work
  • At particular times in your menstrual cycle – this varies from woman to woman, but if you have a time in your cycle that tends to be difficult, you may need extra support.
  • During cold/flu season or if everyone around you is getting sick
  • If you’re actually sick
  • If you’re not being as careful with your diet
  • If you’ve had alcohol or other substances
  • If you’ve had exposure to something toxic (like if you’ve just done some home renovations and had to use solvents or caulk or any other chemical).

Pulse Method of Dosing as Per Dr. Ben Lynch – how to dose methylfolate.

In his book DIrty Genes, Dr. Lynch talks about the Pulse Method of dosing. In this method he says to:

  • Stop or reduce a supplement when you feel great. 
  • “First lower your dose—then keep lowering it, until you’re down to little or no dose at all.”
  • “If you feel bad again over time, you can increase the dose gradually.”
  • “If you start getting different symptoms, that might mean you’re taking too much.”

In many ways, this is similar to intuitive dosing – you’re still using your own symptoms as a guide and when you feel great, you probably don’t need much, when you feel poorly, you need more. This would also take a little bit of practice to perfect, but works for lots of people.

Mixed Dosing Pattern – How to Dose Methylfolate.

This is the best way to dose methylfolate and other supplements if you feel like the other two are too difficult or if you’re a person who thrives on routine.

Here’s the routine:

  1. Take a low-dose mutli and low doses of whatever you take routinely every day. This shouldn’t be your maximum tolerated dose, it should be maybe half of that.
  2. Take weekends off of everything (I still want some days away to optimize absorption)
  3. If you feel bad, take a little extra of the thing that is most likely to help.

Benefits of Mixed Dosing:

  • This type of dosing adds a level of routine and stability that some people really thrive on.
  • It still gives you some flexibility to add when you need additional support
  • Because you’re taking a lower than your maximum dose daily, we’re minimizing your risk of causing overdose reactions.
  • You get a break on weekends

Drawbacks of Mixed Dosing:

  • It still helps to know when you need extra support because on those days you can adjust your dose. If you’re not good at knowing that, then you may not be getting optimal dosages on those days.
  • You may be taking supplements on days when you could have skipped them entirely.

No matter what, with MTHFR, it is important to know what works best for you. If you’re a routine person, mixed dosing might be best. If you are in good touch with your body and your symptoms, intuitive dosing is just right. If you like being flexible but want simple ground rules, then Dr. Lynch’s Pulse Method could be the best way forward.

No matter what, with MTHFR, it is important to know what works best for you.

– dr. amy neuzil, tohealthwiththat.com
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I Have MTHFR, How Do I Start 5-LMTHF?

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:

  1. 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.
  2. 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.
  3. 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.
Be like the snail when you start 5-LMTHF

Start 5-LMTHF:

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

  1. 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.
  2. 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).
  3. 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. 

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.

amy neuzil Tohealthwiththat.com

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.

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