S2E10: Why Starting Methylfolate Can Cause Symptoms.

Most supplements are a piece of cake. You start them and the worst part is swallowing a pill or choking down some kind of liquid concoction. Not so with methylfolate. It can be easy, but it can be a bit of a nightmare as well. If you’re following along with this process, then next week is the week when we actually *start* methylfolate so this week let’s get all prepared for what you might expect.

Why Methylfolate Causes Symptoms

Vitamins are called vitamins because they have two specific attributes. One is that they are absolutely vital for the normal functioning of the human body. The other is that we can’t manufacture them ourselves. This means all vitamins must come from outside of us, and if they don’t, we start to see systems that don’t work very well, symptoms, and potentially even growth or developmental problems.

With MTHFR, we typically have a functional vitamin deficiency. This means that even if the nutrient is available, we have a harder than average time actually utilizing it. Once you start taking 5-LMTHF, then magically you bypass this entire problem – at least you do if you’re also taking the other B vitamins as we’ve talked about because remember you need cofactors for this to work as well.

So suddenly, your body can do a whole bunch of things that it had a hard time with before and that isn’t always pretty. Here’s why:

  1. Neurotransmitters – These guys are a high priority for your body, and the methylation pathway feeds directly into the making of them. Changing neurotransmitters, even a little bit, can produce big changes in mood, behavior, personality, and generally how your mind, physical head, pain levels, and digestive processes work. It has the potential to feel strange, uncomfortable, or downright scary.
  2. Cellular Energy – A lot of what you consider your energy level is actually a reflection of your cellular energy levels and production. Cellular energy can take a big (as in giant) upswing when you start methylfolate or methyl B12, and that can feel pretty scary as well because too much energy feels overcaffeinated, anxious, restless, irritable, and sometimes like flat-out panic. More energy is good for a lot of people, but drinking out of the firehose is always drinking out of the firehose. Too much of a good thing isn’t good anymore.
  3. Vasodilation – Another of your downstream products with methylfolate is nitric oxide, which is your body’s main vasodilator. Vasodilators open up bloodflow, decrease blood pressure, and are generally a great thing. But, when you start making them in larger quantities it isn’t always a smooth and steady release, sometimes it’s fits and starts which means general fluctuations in circulation and blood pressure. That can mean some pretty strange symptoms like dizziness if you stand up suddenly, weird energy highs and lows, and even changes in vision, ringing in your ears, and all kinds of bizarre symptoms.

The bottom line is that there is a lot of symptom potential in the changes that are happening. They are ultimately good changes, but this is really the reason why we take everything so slowly. Even good changes can feel uncomfortable at first.

Other Reasons Why 5-LMTHF Causes Side Effects

To add to the symptom potential, there are other factors. This chemical pathway is vastly complex and it interconnects with all of the other things your body does on a daily basis. That means, there are literally thousands if not tens of thousands of things that can cause minor hitches.

Minor hitches are nothing to your body – you can handle hundreds of minor hitches at once, but you may notice some of them. Picture rolling a big fat tire down a rocky path on a hill. Will the tire do it? Absolutely. Will it roll over all the bumps, dips, rocks, roots, and branches? Sure it will. Will it be a smooth ride? Nope. There will be zigs, zags, little jumps, and dips. Sometimes the tire will go faster, sometimes slower. It will wobble in some places and you might even think it’s going to fall over, but that tire will make it to the bottom.

Adding 5-LMTHF is a lot like rolling that tire down the hill. The tire is going to move forward, your body is going to use the methylfolate. This whole cycle is going to spin no matter what. But, it’ll be a bit bumpy.

The more we do the prep work, the smoother that trail becomes. This is why starting with a good foundation and doing the preliminaries is so important – it’s like smoothing out that trail on the hill. The whole point of moving so slowly and systematically is that we’re trying to minimize the bumps. We probably can’t take them away completely, but we can make them smaller and easier.

5-LMTHF Makes Your Body Change and That Can Feel Like Symptoms At First

The final reason why starting methylfolate causes symptoms is that it is pushing your body to change in a profound way. The stronger the change, the stronger the response, and frankly, changing almost anything feels weird. That is just the basics of medicine. We need change to get better, but that doesn’t always mean that it’s easy or neat.

The whole reason we’re talking about this is so that you don’t go into this blind. If you know there might be some symptoms then it’s a lot easier to have some faith, when those symptoms pop up, that you’re on the right track and that symptoms don’t mean this is the wrong direction for you. Also, hopefully, so you don’t just start with the first massive dose of methylfolate that you find. That route does work for some people, which is great, but it also backfires for some people so I like to caution people to go low and slow.

Thanks so much for listening today and for caring enough about your health to be here. If you want to meet other people who care about their health too, I’d love it if you’d join us in Genetic Rockstars – it’s a community for people who are making their health better. We’ve got Tuesday tips, monthly themes, polls, questions, and discussions all for you. Also, if you’re enjoying this podcast and have the means to do so, I would so appreciate your support on Patreon. Go to patreon.com/thwt and join for all kinds of perks and to keep this podcast coming.

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S2E12: Week One of Methylfolate And What Is In Your Baggage?

I want to give you a big congratulations – if you’re doing all of this with me, then you’re one week into your methylfolate start. Now, this could mean that you started and had symptoms of too high a dose and so stopped and that’s okay too. This is all a process of learning more about your body. So let’s review the different scenarios that might have come up this week and also what to expect over the next few weeks.

Four Possibilities For Your Methylfolate Start.

As far as I know, there are four things that can happen in your first few days on methylfolate, and so chances are you hit one of these scenarios. If, by chance, you hit a different scenario then please reach out because I would love to hear about your experience.

  1. You hit a dealbreaker. – In this first scenario, you started methylfolate and hit a dealbreaker right out of the gate. If you’ll remember from last week, there are two hard-stops in this game. One is that you have symptoms already of too high a dose. Again, this feels like wound up energy, anxiety, panic, restlessness, intrusive thoughts. All the uncomfortable upper-type feelings. Hitting this kind of wall doesn’t mean you’ll never be able to take methylfolate, but it does mean you should stop for now. We’ll talk about options for this scenario in just a couple of weeks. For now, hang tight, keep taking your B vitamins and getting as much natural folate as you can tolerate in your diet. The other scenario is that you fall into a pit of despair, an absolute emotional black hole of depression. This one is a hard stop and probably means that you won’t be able to take methylfolate because your serotonin is perilously low. We talked about this scenario a bit last week, but also in Season 1, Episode 12 and that is a great place to brush up on the whole SERT transporter and serotonin issue. We’ll talk about it in more detail later on this season as well. For now, stop the 5-LMTHF and try folinic acid plus something that will help to boost your serotonin instead. With serotonin issues it’s best to work with a doctor or practitioner because medications for low serotonin don’t mix well with natural supplement.
  2. You felt a little strange for a few days, but it’s going ok. – This is great news. This is the essence of the successful 5-LMTHF start. The first few days can feel a bit abnormal, but if you’re able to keep taking 5-LMTHF without major fallout, then you’re doing great. Just stick to this dose and keep symptom tracking for at least 3-4 weeks before you consider bumping the dose up slightly. It’s ok to wait longer, too.
  3. You feel amazing. – This is also a successful 5-LMTHF start and I’m thrilled to hear you’re doing great. It’s easy in this scenario to just want to take more, but stay on this dose for at least 3-4 weeks because weirdly, the dose you’re taking can turn into a too-high dose a couple of weeks after you start it with no warning. It’s inconvenient, but true. Plus, the “too much” reaction gets worse if it’s way too much than it feels if it’s just slightly too much so jumping up in doses too quickly can lead to some pretty nasty scenarios.
  4. You felt strange or even amazing, then hit a “too much” feeling – Don’t worry, this is totally part of the journey. This means the dose is pretty close to what you need, but still a bit too much. Stop for a few days to let your body calm down and keep supporting your health, then start again at a lower dose. If you can manage to half the dose you were taking before, that is perfect. If getting down that much is hard, then try something like one day on, one day off or one day on, two days off. We can get creative with this.

You’re On The Right Path, Now What?

If you hit a dealbreaker, then we’ve still got some work to do. Hang tight, we’ll get to you guys. For everyone else, you are on the path. Your feet are in the right place now you just need to keep taking steps forward. You are on the cusp of the second phase of your MTHFR journey, which I like to call “Burning Through The Backlog.”

This second phase is the meat of the MTHFR work and it involves catching up with all of the junk that your body has put into storage over the years because it didn’t have the methylfolate necessary to do whatever it was that it needed to do.

The first things your body will tackle are immediate things – like daily tasks, healthier cell reproduction right now, decreasing homocysteine, boosting nitric oxide, boosting glutathione and helping to balance neurotransmitters. This is all very immediate and in the moment. It won’t all change overnight, but you’ll get closer to caught up every day.

After that, it’s all about the backlog. This is a collection of products that needed to be methylated, tasks half-finished, and most importantly, toxins stored where they would be the least harmful while your body was waiting for resources. This is part of why this journey can be so up and down.

Unpacking toxins from storage is a task your body desperately wants to accomplish, but it can be messy and unpredictable. This is the reason why symptom tracking is so important – you are going to want to keep track, partly so that you can recognize detox days when they happen and give your body a bit of extra support. This whole burning through the backlog phase is a long period, for me it was about three years, in which symptoms keep slowly improving, but days can be up and down and detox symptoms pop up.

Keep in mind, you’re more likely to have more detox days popping up in the beginning of this process and shortly after making upward dosage changes because that pushes your body to do some work. As the journey continues to move forward the detox days will become less and less frequent, which is lovely. Sure, you can still induce a toxic feeling day when you do something to fill up your bucket, but you aren’t being blindsided by detox days anymore. If I sound like a crazy woman to you with all of this backlog and bucket nonsense, it might be a good idea to check out Season 1, Episode 51, which goes in-depth about the bucket, backlog, and what those mean to you.

So keep moving forward and try not to get discouraged if you do have a difficult day pop up because it’s actually a sign that your body is doing the work it’s supposed to. Next week we’ll talk about what to watch out for in your symptom tracker that will help you deal with detox days. A couple of weeks after that we’ll talk about coping strategies for those days and how you can make them easier.

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S2E11: Starting 5-LMTHF or SAMe with MTHFR

This is it! The big methylfolate start. You’ve got all of your preliminaries done – folic acid is out of your diet, or at least 80% out. It’s out of your supplements too (100% please!) You’ve ramped up the natural folate from food sources and you’re tracking those symptoms. You’ve even got a good background of other B vitamins on board. Now…. drumroll please… the moment you’ve been waiting for.

Starting 5-LMTHF or SAMe.

I know, I know. No other vitamin gets this sort of wind up so let’s talk about it.

First off, I do want everyone to start with a small dose of 5-LMTHF, but if you hit a dealbreaker scenario then it could be a good idea to switch to SAMe instead. If that happens, it’s best to treat SAMe the same way you would 5-LMTHF because it can cause a lot of the same symptoms if the dose is wrong, so follow this same process there as well. So let’s talk about the different things that can happen in a methylfolate (or SAMe) start.

5-LMTHF Dealbreaker Scenarios.

There are two scenarios that mean you are probably not going to tolerate 5-LMTHF, and so it’s important to know what to watch out for.

  1. Your tiny starter dose is too much already. This is a thing that happens. You start out with a tiny baby dose of 5-LMTHF and right out of the gate you’re starting to feel crazy-pants. Wired, wound-up, uncomfortable, restless, hyper, anxious, irritable. These are all words that I’ve heard (or experienced) to describe the this-dose-is-too-much feeling. Also it can be physical symptoms like heart palpitations, racing heart, flushed skin, hot feeling, prickly or itchy feeling, or difficulty sleeping. This usually means that even this tiny baby starter dose is pushing your body too fast. Now. I do want you to be honest. If your tiny baby starter dose was 1000 mcg, then re-assess your idea of a starter dose. If it really was a small dose – like 200 mcg or less – then you might just not be able to tolerate the 5-LMTHF. For some people in this category, even small amounts of natural folate in foods push them over the edge. If this is you, stop the methylfolate and wait a few weeks. We’ll talk about what options there are for non-tolerators, I promise.
  2. Methylfolate makes you fall into the darkest, blackest, pit of despair possible. This happens very rarely, but it certainly happens. This happens to a small segment of the population whose serotonin levels are perilously low to begin with and adding folate of any kind drops the bottom out of this neurotransmitter pathway. It’s interesting because folate actually increases serotonin production, which sounds like it should make a positive impact, but it also up-regulates something called SERT even more, SERT is a selective serotonin reuptake transporter that helps to clear serotonin out of your synapses and pulls it back into the releasing neuron. When SERT is unregulated the serotonin you have becomes less effective because your body doesn’t get very much time to enjoy it before it’s gathered up. If your serotonin is extremely low then this can push you over the edge and make it just not worth it to take folate. We talked about this in Season One Episode 12 (Methylfolate Makes me Feel Bad) and that one is a good review of the serotonin situation.

If you happen to hit one of these dealbreaker scenarios, then we’re going to stop methylfolate and look to an alternative. The alternative could be folinic acid or SAMe or something else – stay tuned for more on this topic in a few weeks. Until then, just hang tight with other B vitamins, no folic acid, food sources of natural folate as much as you can tolerate and healthy lifestyle choices.

5-LMTHF Start Expectations

Most people who start 5-LMTHF won’t hit anything like a dealbreaker scenario. Those happen to a tiny minority of people – especially when you’ve done all of the groundwork properly. But even when things go right, stariting methylfolate can feel weird.

When I first started the things I noticed were nothing like what I was expecting. I felt a bit buzzy in a pleasant way, my vision seemed brighter, and my head felt strange. Like my physical head, not my brain or mind. I have no idea why my head felt strange, but in good news all of those feelings wore off after about three days. Here are some other things that I’ve heard from folks just starting methylfolate:

  • Don’t notice anything at all – I feel totally normal.
  • Ringing in ears
  • More talkative
  • A bit grumpy or moody
  • Sweat more
  • Dreams are more vivid
  • I feel amazing.

Let’s face it – we’re moving around some big internal chess pieces, so a few minor changes can be totally normal and for most people they go away quickly. By far, the biggest group either feels nothing, or feels great.

There is another group who feels great at first and then a couple of weeks down the road starts feeling like they’re taking too much. Like they’re feeling speedy or buzzy or anxious in an unpleasant way. This is really normal too.

What Can I do To Make This Easier?

Honestly, I am erring on the side of overly cautious so most of you will start 5-LMTHF and wonder what all the fuss was about. That is completely ok. I would rather you were over prepared than underprepared. Also, it is likely that as you’re working through the MTHFR process, there will be some point at which you take too high a dose of 5-LMTHF. Since you’re prepared, you will know what is going on and not freak out. At least, that’s the goal.

Having said that, if you tend to be sensitive to supplements or if you just want to give your body the best start you can, then make sure you are doing some of the basics.

  • Drink plenty of water and add some lemon juice or a pinch of sea salt for optimal hydration.
  • Sleep more. Sleep helps everything.
  • Don’t overstuff your schedule during this time – take it a bit easy if you can.

What Can I Do If I Take Too High a Dose of 5-LMTHF?

During this whole process of working with your MTHFR, it is really normal to have feelings of too high a dose at least once (if not a number of times.) It isn’t a problem, as far as we know you aren’t actually doing any harm to your system. What it is, is great information. Your body is telling you something and all you have to do is listen. This is your signal that the dose is a little too high and you could decrease it. Here are some ways to manage this:

  1. Decrease your dose – Decreasing your dose can mean finding a lower dose supplement, or finding some kind of alternate schedule like one day on, one day off. Even one day on, two days off. It just depends on how your body responds.
  2. Stop your dose entirely – if your symptoms are extreme, then this is the best course of action. Just stop, take some other steps to help your body calm down, and re-assess after a couple of weeks.
  3. Exercise – if you’re in the middle of symptoms of too-high a dose, exercising can help your body to use up some of those methyl groups and get you through the strange symptoms faster.
  4. Niacin – 50 mg of niacin in the straight “niacin” form helps to eat up those excess methyl groups as well and can help to relieve symptoms. The only problem is that it can cause a flushing reaction, which feels like a hot flash complete with red face, itchy or prickly skin, sweating, and generally feeling super weird. It doesn’t last long, but it’s very vivid. You can re-dose after an hour, but don’t do this more than 3 times total in a day and watch your blood pressure because niacin can really lower it.

In any event, this week is the week we start. Make sure 5-LMTHF is the only thing you change right now and that you’re starting with a LOW dose – 200 mcg or less. Also, keep symptom tracking and make note of anything new that pops up. This should be the only change you make for at least two weeks but four is better, just to give your body time to get used to this new thing and to tell you if the dose becomes too much. Remember that symptoms can pop up after a week or even two of being on the same dose, so don’t make any sudden moves.

Thanks so much for being here and for doing this process with me.

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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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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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