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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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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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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