Question: Can anyone speak definitively on whether a homozygous MTHFR gene mutation can be managed by diet alone, diet + juicing greens, diet + greens powder? Does this mutation in its homozygous form require the fancy supplement? In other words, can it be managed with nature?
The story in my head is that this mutation is teaching us to become obligate foliage eaters again, encouraging us to bring the green back to our planet (therefore oxygen), and take it easy on the critters. I can’t help but think cosmically about these gene morphology changes. I’d just love it if I could create a wellness plan that fits into my ideologic little fairy tale world, but only if effective.
Answer: No. MTHFR homozygous mutations cannot be managed by diet alone.
Most foods contain folinic acid while the supplement ideally used for MTHFR is methylated folate as 5-MTHF.
“As complex as this vitamin is in its structure, it is equally as complicated in its interaction with the human body. For example, most foods do not contain folic acid in the exact form described above, and enzymes inside the intestine have to chemically alter food forms of folate in order for this vitamin to be absorbed. Even when the body is operating at full efficiency, only about 50% of ingested food folate can be absorbed.”[1]
Even Women’s Health.gov agrees:
“Can I get enough folic acid through food alone?
The body does not use the natural form of folic acid (folate) as easily as the manmade form. We cannot be sure that eating foods that contain folate would have the same benefits as consuming folic acid. Also, even if you eat a healthy, well-balanced diet, you might not get all the nutrients you need every day from food alone. In the United States, most women who eat foods enriched with folic acid are still not getting all that they need. That’s why it’s important to take a vitamin with folic acid every day.” [2]
Food typically does not have the methylated folate.
Those with hetero and homozygous MTHFR do have some enzymatic function left which is great; however, the amount of greens one must eat would likely be a lot – and that is difficult for a patient on planet Earth.
In a perfect world with a perfect patient – possibly yes – but given the fast-paced stressful and environmentally toxic planet we live on – no.
Be an interesting study.
One must also look at homozygous mutations from a methylation problem as well which leads to increased toxicity.
This requires detoxification protocols – sauna, peat baths, epsom salt baths, coffee enemas, athletics (sweating) and nutrients -
I regret to say also that all the prescription forms of active folate contain a ton of garbage.
I agree I am quite strict on purity given my passion for environmental medicine – but I am also of the camp of why do pills have to contain ingredients which pose absolutely no benefit to the patient and may even cause harm?
On MTHFR.net, I have an article that has a table with all the ingredients of the most popular forms of prescription meds for MTHFR.
I do recommend the use of the Methylation Profile by Doctor’s Data as it measures s-adenosylhomocysteine vs homocysteine. S-adenosylhomocysteine is a more sensitive marker than homocysteine which may explain why some cardiovascular studies say that lowering homocysteine has no benefit.
My point is this – and my soap box is as well -
If we have the tools to reduce miscarriages, autism, bipolar, cardiovascular issues and cancer – then – as naturopathic physicians – we need to use them – and we do which is awesome.
MTHFR is yet another tool.
I know some of you think I’m over doing it here but I am hearing horrific MTHFR stories every day and most of my day. They pour in. 4 miscarriages in a row, depressed entire life and without work, 4 year old son having a stroke, autistic child, severely chemically sensitive – and most of these patients hear is: “you are heterozygous MTHFR – there is no issue.”
Toxic planet.
I am also frustrated by the fact that the paternal genetics are not evaluated as often as they should be during prenatal screening – if some docs are doing that – my hat is off and I am greatly thankful.
If we step up to the plate and bat .500 here, we can inform the public about MTHFR, how to handle it and empower them with information so they can control their genetic expression.
It is not about fear – it is about empowerment.
So – in short 
– I think with the perfect patient in a perfect environment – perhaps homozygous MTHFR may be controlled by diet. Given the massive use of antacids, stress, toxins, chemicals and depleted soils – I don’t think we can in the general population.
Best
Dr Ben
References:
[1] World’s Healthiest Foods: Folate
[2] Women’s Health: Folic Acid
I know I’m asking a lot of questions. You mentioned autism as being avoidable if the mutation is treated. Can you elaborate on this? Do you mean if the pregnant woman takes for folic acid (the proper form), etc during pregnancy, the child will not be at risk for autism? Or if the child takes the proper supplements, they will not develop autism? Or do you mean that somebody with autism can “fix” it with supplements?
Hello Dr. Ben,
I am writing to you as a person homozygous for the MTFHR C677T polymorphism, but also as a college anatomy/physiology/biochemistry professor who is interested in the specific mechanisms by which this mutation affects other processes.
Would you be able to tell me what, specifically, the serum folate test is measuring? I have been unable to find this information anywhere.
The [very] simplified folate pathway is:
dietary folate –> (MTHFR) –> 5-MTHF
If the folate test measures “folate,” I would think that an MTHFR-deficient person might have high serum folate, due to a blockade at the MTHFR step.
If the folate test measures 5-MTHF, I would think that an MTHFR-deficient person might have low serum 5-MTHF, due to a blockade at the MTHFR step.
In reading the literature from various labs, including Quest and LabCorp, I have not been able to find which form of folate the test measures. Do you know the answer to this?
Thank you.
Carrie –
You are exactly correct.
Labs are required to use the exact terminology of what they are testing for.
Serum folic acid = folic acid which is also the same as folate.
A lab is working on a profile right now which will measure both serum folate and serum 5-MTHF. I cannot specify who but I can tell you I just got off the phone with them
The test should be available in a few months time.
If someone sees a high serum folate, then they are not methylating it. This means they are not able to utilize folic acid until it is converted to 5-MTHF.
High folic acid levels are a risk for cancer. Low folic acid levels are a risk for cancer.
They must be optimized.
Excellent.
MTHFR is difficult because there is so little information available. The very few MTHFR doctors I’ve found online indicate that people with MTHFR polymorphisms show low serum folate. This did not make sense nor correlate with my lab results; I like your explanation better.
Please keep us updated on when the 5-MTHF test becomes available!
Hi Carrie –
MTHFR polymorphisms can show low folate or elevated folate – it depends on the individual.
Some MTHFR polymorphisms are so severe that they do not process folate well at all; while other MTHFR polymorphisms only partially destroy the methylation of folic acid.
The 5-MTHF lab test will be excellent – especially as it is combined with standard serum folic acid.
Doctors need to keep an open mind and look at the biochemistry.
Best
Dr Ben
Dr Ben,
Is this test available yet? I am heterozygous for A1298C and have elevated folate levels. I would love to be able to test whether I have any methylation problems, at least converting folate to methylfolate.
Thanks!
Carlos
Carlos –
As a carrier for the heterozygous A1298C, you are able to convert folate into methylfolate just fine.
If you have elevated folate levels, then perhaps you are low in methylcobalamin, supplementing with too much of it, or eating foods that are enriched with folic acid.
Thank you, Dr. Ben!
Do you think the heterozygous A1298C mutation has any chance of causing any kind of mild BH4 deficiency? I ordered the Neopterin/Biopterin profile from HealthEGoods just to be on the safe side.
I am indeed taking quite a bit of methylcobalamin together with just 400ucg of methylfolate. So I went ahead and also ordered the Methylation profile to see if I am overdoing it or not.
Thanks!
Carlos
Carlos –
I do think the heterozygous A1298C MTHFR mutation may play a role in the reduction of the BH4 pathway – how much – not sure.
There are other mutations that also contribute to lowering BH4 – not to mention inflammation, infections, heavy metals or ammonia.
Good idea to check on your levels – cannot hurt. Price is reasonable. Once they are in, I’ll send them over with some notes.
Dr. Ben,
With either heterozygous or homozygous C677T I totally agree, diet alone is not going to cut it, but I have to disagree about the utility of diet alone for MTHFR management with regard to A1298C mutations.
My husband’s grandmother is now known (post-mortum) to have been homozygous for A1298C, she died at 105.5 years old and was quite active, mentally alert and in good physical condition until she had a stroke at 105 (six months later she died). Flip side of that is that her husband was homozygous for C677T and died of a massive heart attack when he was 58 years old. How do we know he was homozygous? Well, it’s a good guess when we consider that all three of their sons are compound herterozygous with A1298C + C677T; statistically strange if they’re father was just homozygous.
My grand-mother-inlaw never knew, nor did we, until she was dead and we’d used samples preserved from her participation in centenarian studies to confirm what was suspected. She never took supplements, nor did she ever have any problems with the genetics that we can tell – what she did do, her whole life, was consume an insane level of vegetables and she loved her meat. When we look at her dietary habits, her shunning of nutrient poor starches in favor of nutrient rich vegetables and roots, along with B12 rich meat and fish, she ate her way to health in spite of her genetics and lived for a very, very long time.
Maggie -
Great comment. Thank you.
I want to debate a little if I may
Your husband’s grandmother lived in an era which was less toxic and hectic in some ways than our current environment.
Soils are depleted now of nutrients and instead are chock full of pesticides, herbicides, ammonia, and GMO seeds. Then add on processing, transport, preservatives and refining.
Then add on pasteurization.
Our food is dead and void of nutrients for the most part.
Now I agree if you grow your own food in nutrient rich soils which you make yourself from compost and worm bins (I do).
Buying organic foods are also critical as they are researched to contain more nutrients than industrialized farm foods.
I am all in favor of Mr Hippocrates where he said, “Let food be they medicine and medicine by thy food.” Or something like that..
If we lead our lives eating healthfully, limiting toxic exposures and stress, we reduce the need significantly to have to supplement.
Your husband’s grandmother certainly sounds like she led a fantastic and healthy life.
Unfortunately, many of us are not as fortunate as your husband’s grandmother and need to supplement.
Every two years, I take my entire family (my wife and three boys) to the remote country of Russia for the entire summer and live in a 100 yr old very rustic cabin.
There we grow our own food, have no plumbing, no showers, an old fashioned well, outhouse and bathe in the river. We wash our clothes by hand and all the dishes out by the well and canal. Here, we can lead a life without supplementation I believe.
Back in the States, in Seattle, it is more difficult.
So – in short – I fully agree with you and support it. I only am saddened to say it is not possible for the majority of people as our mindset is stuck on packaged foods, quick meals, taste and easy to prepare. Add to this the fact that we are so busy texting, cell phoning, commuting to and from work and stressed – most of us need to supplement.
I do not own a cell phone, work from home and enjoy as much as I can in order to reduce stress. I still supplement a few times a week.
Best,
Dr Ben