The Intersection of Tongue Tie & MTHFR

Ankyloglossia also known as tongue tie is not a condition you hear about every day, but certainly one of great impact, especially for the 4% of newborns affected by it.[1]

For those not familiar with tongue tie, it is a condition where the tip of the tongue is connected to the floor of the mouth by a thick band of tissue, restricting movement of the tongue.

This can result in a host of problems from eating to speaking and many actions in between that require a full range of motion of the tongue.

Who’s affected?

Generally boys are more susceptible to tongue tie as it is a semi-dominant x-linked inheritable trait as well as those with some degree of orofacial clefts.

Research has revealed that those with MTHFR 1298cc have a 7-fold increased risk of cleft palate and those with 677tt have an increased risk of cleft palate, likely of the same magnitude or worse.[2]

Is Tongue Tie preventable?

Genetics can be implicated in an estimated 20%-50% of cleft palate cases, but more importantly the remainder is associated with environmental factors. [3]

Genes, though an easy target, do not hold all the cards. The down regulating puppeteer is SUMO-1 modification which has been implicated in the control of gene TBx22, responsible for oral facial cleft palate expression.

Sumolyation is important in regulating the transcription of genes, nuclear integrity, chromosome segregation, and embryonic viability. With such a heavy job description, sumolyation needs support to ensure a healthy pregnancy.

MTHFR, Methylation & Tongue Tie

So how can SUMO-1 be modified in a positive way? Since lifestyle, environmental factors and viruses affect SUMO-1 modification, it should come as no surprise that reducing risk factors will also decrease the likelihood of tongue tie.

All roads to health (including tongue tie) come by healthy genetic expression, hence the need for sumolyation and methylation.

Risk factors -

  • Smoking
  • Chemotherapeutic drugs
  • Alcohol
  • Lack of nutritional supplements
  • Chemicals
  • Viral Infections – adenoviruses, herpesviruses, papillomaviruses
  • Conditions of Hypoxia
  • Stress

Why is methylation necessary to immunity?

As mentioned above, one of the factors affecting SUMO-1 modification are viruses. What supports immunity? Methylation! DNA methylation is what shuts down the genetic expression of viruses. One of the body’s main methlators is DNMT1, necessary not only for general health, but also virus inhibition.

It follows then that those who have MTHFR have an increased risk of tongue tie.

However, whether you have the MTHFR polymorphism or not, the environment with which most people live in is not conducive to methylation and therefore requires support.

Helpful measures to support methylation:

  • Limit or reduce dietary catechol-containing polyphenols such as coffee, tea, potatoes, and sweet potatoes especially in the first trimester of pregnancy as they inhibit DNMT1.
  • Supplement with folate (in the form of folinic acid or methylfolate) before conception and early pregnancy, whether you have MTHFR or not, folate is an integral nutrient for a healthy pregnancy.
  • Adequate levels of vitamin A seem to support development of the primary palate.

Do you or someone you know have Tongue Tie?

 

References:

, , ,

15 Responses to “The Intersection of Tongue Tie & MTHFR”

  1. OM May 24, 2014 at 5:51 pm # Reply

    Please explain the difference between folic acid and folinic acid and why folinic acid is OK for those with MTHFR. Thank you, the information you are sharing has been very helpful in improving my health.

  2. Lynn_M May 26, 2014 at 1:36 am # Reply

    I am delighted to find an article in this forum featuring tongue-tie, because tongue-tie is a midline defect associated with MTHFR polymorphisms. However, I am keenly disappointed when you write that it is a condition of great impact, “especially for the 4% of newborns affected by it”, and that this article is classified under MTHFR and Pregnancy.

    It’s not just newborns that are especially affected by tongue-tie. It also affects anyone born with tongue-tie and never diagnosed as having it and never having it fixed. It is not a condition that goes away as a person matures – we don’t grow out of it. And it is amazing how blind doctors and dentists are about diagnosing the condition, or about the necessity of clipping the lingual frenum (aka frenulum) under the tongue once the condition is diagnosed, which is much easier done at the newborn stage. In addition to the tongue being tied, there is also the condition where the lips are excessively anchored by labial frenums. Tongue ties and/or lip ties more often occur as stand-alone conditions, without cleft palate, although they do also occur concomitantly with cleft palate or other orofacial cleft conditions.

    I think your article would have been more helpful if you would have spent more than one sentence talking about the problems that ankylglossia causes. To begin with, a baby with tongue-tie usually cannot breast feed successfully, because it is quite painful for the mother, and because a tongue-tied baby cannot pump the milk out of the breast very well. So the baby will suffer from use of baby formula instead of breast milk, and the bonding opportunity between mother and baby is lost if the baby doesn’t breastfeed.

    Babies with tongue-tie develop an improper tongue posture, with their tongue resting on the floor of the mouth instead of against the upper palate. This leads to a narrow, deep, more V-shaped upper arch, and a long, more narrow face. One consequence of the deep upper palate and lack of tongue pressure against the upper palate, which acts to stimulate the pituitary, is that pituitary function is reduced.

    Tongue-tie leads to the development of a tongue-thrust swallow, which can cause digestive difficulties. It leads to a tendency to breathe through the mouth and sinus problems. It leads to improper dental development and often orthodontia. If the underlying tongue-tie is not corrected, the teeth often regress to their pre-orthodontia condition, because of the unnatural pressures exerted on the teeth by the tongue. It can cause gum recession and abnormal wear on teeth. Tongue-tie is often associated with improper speech development and speech impediments.

    The internet has many sources that show pictures of tongue-tie and first-hand stories. Dr. Brian Palmer has a good website. If someone can’t touch their upper palate with their tongue, they are probably tongue-tied. Often a thick frenum causing the tongue-tie is readily visible, but there is also an even rarer type of tongue-tie called submucosal frenum where the frenum is embedded in the base of the tongue, so hidden although still restrictive, and often undiagnosed.

    Don’t expect that a doctor or dentist will necessarily recognize a tongue-tie condition, even though it’s usually obvious. An orofacial myofunctional therapist or an ENT may be the best professionals to consult for diagnosis. For a newborn, the frenum can simply be clipped. For older children or adults, some dentists or doctors can use either a laser (simplest method) or a scalpel to cut the frenum. For a submucosal frenum, an outpatient surgical procedure called a Z-plasty frenuloplasty is performed.

    I am a 67 year old female. I am homozygous for a number of MTHFR SNPs, including 1298C+/+, and I had a congenital thyroglossal duct cyst condition, which could possibly be a factor in my tongue tie. My parents told me I had my tongue cut as a baby – probably a simple frenectomy. At 16, when I went to get orthodontia treatment, I couldn’t hold the molds up for my upper teeth with my tongue. I then had an outpatient frenectomy procedure in a doctor’s office, which enabled me to touch my tongue to my upper palate. I had orthodontia with 4 bicuspids extracted, but over the years my lower front teeth twisted and regressed back to their pre-braces condition, and I developed major gum recession and unusual occlusal tooth wear. Last year, I went to a new dentist, and he surprised me by telling me I had a tongue-tie. I consulted an orofacial myofunctional therapist, who informed me I had a tongue-thrust swallow and some speech defects. The dentist lasered my frenum, and I worked with the myologist doing exercises 3x/day for several months. She showed slides of my laser frenectomy at a conference, and one of the experts there recognized that my frenum wasn’t cut enough in the laser procedure. Given my history of procedures, though, she suggested I might have a submucosal frenum. The ENT I consulted confirmed that, and I am scheduled for an OP surgery Z-plasty frenuloplasty in 3 weeks. Then I have months more of myofunctional exercises to achieve normal speech, swallowing, and tongue movement.

    All of these complications can be avoided if tongue tie is corrected as a newborn, or failing that, the earlier in life the better. It usually is so simple to fix, but if not, the consequences are multiple.

    • Sherry July 9, 2014 at 4:03 pm # Reply

      Wow Lynn! That’s quite an experience! I have 1298c and I *think* I am tongue tied. I have had the same experience with orthodontia as you and have been researching orofacial myology for me and my kids :) Please keep us updated to know if you find that your gums become healthier. I am having terrible gum problems!!

  3. Cinbad May 30, 2014 at 3:09 am # Reply

    My older son (hetero c677) was tongue tied. He had surgery to correct it at the suggestion of a speech therapist. My younger (same mutation) has a bifis or split uvula, a precursor to cleft palate, I’ve been told. We suspect that he also has other anomalies in the throat as well due to speech issues and reactive airway that seems atypical.

  4. June June 18, 2014 at 4:48 pm # Reply

    My seven-month old is tongue-tied, and I was recently diagnosed with the MTHFR mutation (667TT). I’m really anxious to get on supplements, but I imagine it wouldn’t be safe to start while breastfeeding (due to the detoxification). Would you agree?
    I really don’t want to stop breastfeeding, and I realize the folate could help my baby. Would the detox process take long, or could I pump and dump for a while? Any input would be appreciated.

  5. Debbie The Paleo Hygienist September 2, 2014 at 8:33 pm # Reply

    I recently wrote about my breastfeeding experience on my blog with my now 3mos old daughter who was born with a tongue and lip tie. We had both ties revised by laser when she was 4weeks and breastfeeding immediately improved. Thankfully my daughter did not suffer with weight loss during those early weeks, but nursing was very painful for me and she had to nurse for 45-60min to be satiated, which was exhausting for her.

    I was directed to your website from a commenter on my blog and have read several of your articles. Guess I’m looking for an easy answer on how to prevent ties if we decide to have a second child in the future. The ENT that revised my daughter’s ties stated it was genetic. I have a visible frenum/tie under my tongue, but my mother said there were no breastfeeding issues with me. I also was advanced in my speech at a young age. I am able to fully reach my palate with my tongue, so tongue ties are not always problematic. On my husband’s side of the family, several members had speech therapy in the past…undiagnosed tongue ties? I’m wondering what else I could do in a potential future pregnancy. With my daughter I was taking a naturopathic made (Dr. Ron’s) B-Complex with 600mcg folate, not folic acid, for months prior to conception and during pregnancy. And as fr vitamin A, I took Green Pastures fermented cod liver oil preconception and during pregnancy. I continue to take these supplements postpartum. I have read you recommend 800mcg folate, and although my supplement had only 600mcg I feel I got the rest from my diet since I ate pastured/farm fresh eggs daily, pastured meats (even occasional liver) and leafy greens, all good sources of folate.

    Any other suggestions?

    My breastfeeding and tie revision story: http://thepaleohygienist.com/2014/08/22/the-5-second-newborn-check-all-parents-should-do/

    • Lynn_M September 3, 2014 at 11:06 pm # Reply

      Debbie the Paleo Hygienist,

      You wrote: “I am able to fully reach my palate with my tongue, so tongue ties are not always problematic.” Being able to reach your palate with your tongue is not a sufficient test to know if a tongue tie is causing issues or not. I was able to reach my palate with my tongue after my second frenectomy at age 16, but an evaluation with an orofacial myofunctional therapist at age 66 revealed that, unbeknownst to me, I had a tongue-thrust swallow and minor speech defects. Also, my previously undiagnosed submucosal frenulum (a more serious case of posterior tongue-tie) had caused my center lower incisors to rotate inward, causing a relapse in my orthodontic work, as I wrote about above. Furthermore, my tongue being tethered down may have been a factor in my chronic neck stiffness and tension. So until someone has had an evaluation by a myofunctional therapist, I wouldn’t conclude that a tongue-tie is not causing problems.

      Regarding how to avoid tongue-ties in a future child. Make sure you are methylating well. It might be worth having lab work such as a MMA or a whole blood histamine test (Dr. Lynch’s and Dr. Bill Walsh’s favorite test of methylation ability. The usual folate (actually a measure of folic acid) and B12 serum tests are fraught with problems, because the result reflects the total of active and inactive forms of those vitamins.

      Dr. Lynch seems to be adamant that leafy greens need to be raw, since folate is destroyed by cooking. Also, a person needs to be taking methylcobalamin (or perhaps hydroxycobalamin, depending on a person’s genetics) in order to be able to utilize folate, otherwise the body dumps the folate because methylcobalamin is a critical cofactor in utilization of folate. In addition to methylcobalamin, adenosylcobalamin is also helpful (it’s the form used by the mitochondria and is what is measured by a MMA test. It intercoverts with methylcobalamin, which is in the cytosol. L-carnitine fumarate also helps with methylation. Only about 1% of oral methylcobalamin is absorbed. It needs to be applied either injected (IM or subcutaneous) or as a transdermal oil for maximum effect, although sublingual forms will provide some benefit.

      It might be helpful to have a 23andMe genetic test to determine if you or your husband have MTHFR or other genetic polymorphisms that would predispose your children to midline defect problems. You can still get your raw genetic data from 23andMe and use other websites to interpret that data.

      I read your blog and kudos to you for persevering despite that first doctor’s ignorance. I’m glad you found the right doctor. And for anyone else reading, it’s never too late to fix a tongue tie. It takes more therapy to rehab as an adult, but it’s doable.

  6. Debbie The Paleo Hygienist September 3, 2014 at 11:48 pm # Reply

    I apologize if you misinterpreted what I wrote because I also stated right before that that I did not have, nor my mother, breastfeeding issues as an infant and I was advanced with my speech development. I did not mean to imply that touching your palate is the only indicator that a tongue tie is not problematic (although it is a much better indicator than being able to stick your tongue out). Being able to touch the palate gives the palate the needed stimulation for development and allows for proper speech pronunciation. My point was to prevent parents of newborns from simply seeing what they believe is a tie and seeking to have it corrected even if their are no symptoms present. If breastfeeding is going well, I’d advise waiting to see how a child’s speech develops as well as how the teeth are coming in during the toddler years first.

  7. Lynn_M September 4, 2014 at 2:01 am # Reply

    Many of the problems resulting from tongue tie are beyond the ability of a layperson to evaluate, and the problems that develop with age are not always obvious at an early age. Most doctors are clueless. With a laser procedure to correct a tongue tie being such an easy procedure, with no downsides that I am aware of, particularly if done when a child is very young, I would contend that it makes more sense to correct a tongue tie when it is first diagnosed. Why wait for symptoms to develop? Dr. Brian Palmer, DDS has an extensive website presentation about tongue tie. He was of the opinion that there is no benefit to not correcting a tongue tie.

  8. Debbie The Paleo Hygienist September 4, 2014 at 2:29 am # Reply

    I understand that point of view. I was stating the preference of the doctor I saw for my daughter’s tongue tie. But many out there either can’t afford the procedure or do not have insurance. (The procedure wasn’t cheap, although covered by my insurance thankfully.) So many simply wouldn’t just have it done if there were no symptoms and not all providers will do it without symptoms as well. Insurance likely wouldn’t cover it with a lack of symptoms. But I agree it is a simple procedure with minimal risks/downside.

  9. Sarabeth Matilsky September 6, 2014 at 11:59 pm # Reply

    My third child was severely tongue-tied, a fact that we missed until she was five weeks old, not gaining weight, nursing round the clock (uselessly), and I was in more pain that I’ve ever experienced in my life. Despite having nursed two other children for a total of seven years, I did not have any idea what was going on. (It turned out that both of my eldest were tongue-tied, which was probably why nursing was painful with them…but at least they were able to extract the milk they needed.)

    Unfortunately, after my daughter’s first frenotomy, her lip- and tongue-ties fused back. We had it re-done with a laser when she was 2.5 months, and despite the horrible-awful experience of stretching the incision multiple times per day, while she screamed in what appeared to be agony, the ties fused back partly. (I say this not because I think that the frenotomies were a bad decision, but because I _do_ think they are procedures that can have negative “side effects,” even if “just” psychological ones. I can imagine that some babies whose mouths are allowed to remain tied, but who experience loving bottle feeding, may be about tied with the ones whose ties get cut, experience some or a great deal of pain, and are then able to breastfeed.)

    My daughter never learned to nurse effectively, and this alone was devastating. I also pumped eight times per day for over a year, so she could have breastmilk…which she could barely swallow from a bottle, due possibly to thrush she contracted after the frenotomies, or due possibly to the “silent reflux” that she also appeared to suffer from. The pumping literally took all of my energy, and my baby’s first year is a haze of incredible challenges: http://www.lifeisapalindrome.com/updates/micro-macro-or-when-tiny-things-are-devastating

    Anyway…I mention some of these experiences because I think that midlines defects are not only the _cause_ of trauma, but they also _coincide_ with many other health issues, possibly sharing the same root causes of MTHFR and other issues of epigenetics. And…I don’t think that even an effective frenotomy will effectively fix things in all cases.

    My goodness, how I hope that NO ONE has to endure a baby’s first year like my family did with Eliza!

    Regards,
    Sarabeth

    • Lynn_M September 23, 2014 at 6:40 am # Reply

      Sarabeth,

      Since your daughter still has problems even after having two frenectomies, it’s quite possible she has a posterior tongue-tie and needs a surgical procedure called a Z-plasty frenuloplasty to truly fix her tongue-tie. Dr. Brian Palmer’s website shows pictures of a Z-plasty procedure. It’s an OP surgical procedure, much more complicated than a laser frenectomy, but more complex conditions can require more complex procedures.

      A frenectomy (which I think is the same as a frenotomy) can correct an anterior tongue-tie. My ENT’s opinion is that it will not correct a posterior tongue-tie, that a Z-plasty is needed to free up more tissue. I had both an anterior tongue-tie and a submucosal frenulum, a type of posterior tongue-tie. Each of my 3 frenectomies, at the ages of a newborn, 16, and 66, provided a bit more release, but they did nothing to correct my submucosal frenulum. My submucosal frenulum wasn’t diagnosed until I saw a particular ENT, recommended by my orofacial myofunctional therapist, after we found the last frenectomy (laser) still didn’t provide enough release. My reading indicates that a posterior tongue-tie can be very difficult to diagnosis. My ENT said he had to clear out a lot of scar tissue under my tongue, presumably a result from the previous frenectomies. I have photos of before and after my Z-plasty surgery in June, and I find the difference in my ability to extend my tongue now is truly amazing.

      So I totally agree with you, an effective frenectomy will not fix things in all cases. A frenuloplasty may be needed instead.

      I found my orofacial myofunctional therapist to be very knowledgable and helpful, more so than speech therapists, dentists, or most doctors. I highly recommend consulting with a myofunctional therapist. Their association has an online directory. Mercola.com has an article and interview about his work with a myofunctional therapist. I think I’ve seen you post at Microbial Nutrition yahoo group, so you’re probably familiar with Dr. Mercola.

      The ramifications of having a tongue-tie extend well beyond the issue of inability to breastfeed.

  10. Alicia September 19, 2014 at 5:40 am # Reply

    I’m beginning to look at this and am glad for the article and comments so far. My second and third children were both tongue and lip tied, a daughter and a son. Both were clipped. My daughter seems slower in verbal articulation, so I’m not sure if that is related. She was clipped at 2.5 mo, and my third child was clipped at 2 weeks of age. I had a lot of breastfeeding struggles with my daughter before and while she was diagnosed, and we persevered thankfully. No nursing issues with my son, even though he was 4 weeks premature and took a couple weeks to develop with eating – once he got that, nursing has been a breeze with him.

    We would like to have another child, so I’m taking a closer look at this now to hopefully prevent this midline defect in a subsequent pregnancy. Lynn’s comments on the testing to do were helpful.

    • Alicia September 19, 2014 at 5:43 am # Reply

      I wanted to add that manual therapy and craniosacral therapy were helps for both my kids, especially my second baby with all the issues we had. She had a lot of tension from a fast, bumpy birth that played into her demeanor as a young infant.

  11. JennH October 2, 2014 at 6:47 pm # Reply

    Half of our children have tongue ties, which is what led to us investigating MTHFR. It turns out that both my husband and I have 1 copy of MTHFR C677T meaning most of our children probably have at least one copy (children’s tests pending). The question I have is whether a baby before birth takes care of the methylation process by itself or does mother pre-break down everything for baby. In other words, if mother is taking methylfolate and methyl-B12, will the baby in the womb be okay even is hetero or homozygous until after birth?

Leave a Reply

Read previous post:
MTHFR and Methylation Podcast – by ND Update

Matthew Strickland, a current medical student at Bastyr University, interviews me about the topic of MTHFR and Methylation. He definitely...

Close