I went through pharmacy school AND medical school being taught that folic acid was the same as folate. In 2012, when I started really reading on my own about nutrition for my health, I smirked when I read alternative sites claiming to people that folic acid was “bad,” and I disapproved of their scare tactics. Eventually, I was overwhelmingly dismayed to realize I had been taught incorrectly and had swallowed a half-truth, hook, line, and sinker. I followed the basic biochemistry, my arrogance dropped, and I realized that folic acid can be detrimental for many people. You’ll find some biochemistry in these posts and also some discussion of MTHFR deficiency. There is also some practical information in the form of recipes and prenatal vitamin exploration. I do also have a post on methylcobalamin, also called vitamin B12, which I include here.
Folic acid or folate? What’s in your vitamin? What’s in your food? What makes a difference?
Two Follow-Up Articles to Read on Folic Acid in Pregnancy
Fabulous Folate Smoothie (recipe)
Folate Delivery Dressing (recipe)
Thoughts on Choosing a Prenatal Vitamin
What Was the Role of Methylcobalamin in the Alzheimer’s Study? (This is not about folate, but it is about another B vitamin which is commonly prescribed/taken as a synthetic form: Vitamin B12.)
The HSD 
Thanks for all you’re doing! Here’s another great resource from Dr. Ben Lynch: https://www.youtube.com/watch?v=cWFPRI6X7P4
Dear Karlie,
Thank you for the link. I apologize for delaying my reply to you. We’ve been on vacation with poor internet access.
I watched a segment of the video you linked to. I didn’t have time to watch it all. But I’ve always enjoyed reading Ben Lynch’s, ND internet site devoted to MTHFR issues. He seems to keep things balanced and real, which makes him nice to “learn from.” Definitely a good place to read on folate, folic acid, and MTHFR concerns.
Thanks! Have a great day!
Terri
Hello, Dr. Fites:
Interesting blog. I just stumbled upon it, via Google search. Any thoughts on the following article I received about a year ago in a newsletter?
Best regards,
Walt
_______________________________________________
Medicine’s Shiny New Thing: the MTHFR Gene Mutation
Pamela A. Popper, N.D., Ph.D.
While there have been many medical discoveries that have saved lives (like antibiotics), and improved lives (such as joint replacement), many medical discoveries have proven to have little usefulness. An example is genetic testing. Even advocates for the practice acknowledge that we don’t know what to do with most of the information learned from genetic testing, and that in many cases we are just turning healthy people into worried healthy people after they find out that they have an abnormality. If we look hard enough we can find something wrong with almost any human, but this does not mean that the human benefits from knowing about it.
It appears that this is the case with the MTHFR gene mutation. More and more doctors are testing for it, but it is not clear that anyone other than the labs that run the tests are benefitting from this practice.
The MTHFR gene, or methylenetetrahydrofolate reductase gene, produces an enzyme that assists in the regulation of homocysteine levels in the body. Homocysteine is a byproduct of the breakdown of methionine, an amino acid concentrated in land animals, dairy, and fish. High homocysteine levels are associated with increased risk for atherosclerosis, blood clots, heart attacks, and stroke.
It is estimated that as much as 50% of the population has a mutation of the MTHFR gene. Humans have two MTHFR genes, one inherited from each parent. In order to cause any detrimental effect on health, mutations must be present in both copies of the gene. But even when mutations are present in both copies, studies have not shown that those with the mutation have reason to be concerned. Research shows that as long as homocysteine levels are normal, having the gene mutation does not increase the risk of heart attack or stroke. Some studies have shown a slight association between the mutation and venous blood clots, but most have shown no association.
For people who do have high homocysteine levels, with or without the gene mutation, the best remedy is to increase dietary folate. Folate is found in plant foods, so a plant-based diet that includes lots of green vegetables is the best treatment. In addition to lowering homocysteine levels, a plant-based diet can improve other markers for cardiovascular disease and lower the risk of a cardiovascular event.
Women are frequently tested for the mutation, a practice justified based on the claim that women with the mutation have an increased risk of having a baby with neural tube defects. But most people who have the mutation do not have neural tube defects and their children are almost never affected. According to the National Institutes of Health, the nutritional status of the mother (specifically folate intake) and homocysteine levels (with or without the gene mutation) are much more important factors than the gene mutation.
As for the claim that the mutation can increase the risk of complications of pregnancy such as preeclampsia, placental abruption, miscarriage, and intrauterine growth restriction, a meta-analysis showed that there was no association between the gene and miscarriage, and a only small increase in the risk of preeclampsia and placental abruption.
Overall the consensus seems to be that there are many factors that can increase risks associated with pregnancy, and more research is necessary in order to determine just how much (if at all) the MTHFR gene actually increases those risks.
There are no guidelines at this time as to who should be tested for the mutation, but The American Heart Association says that “In the absence of elevated homocysteine levels MTHFR mutations appear to have no clinical relevance.” Therefore one could argue that there is no indication to perform MTHFR genetic testing.”
In light of this information, why are so many people being tested for this mutation? There are several reasons – the same reasons why medicine invests so much money, time, and effort in so many other useless and harmful practices:
* Money. As long as doctors are paid for doing things instead of producing results, they are going to continue to look for more things to do.
* Fascination with almost anything new. Some doctors think that almost anything new must be a good idea, which is rarely the case (see the next point).
* Failure to demand evidence of efficacy before adopting a new practice. The history of medicine includes hundreds of years of adopting new practices without evidence that they are effective or safe, and refusal to discontinue those practices even when evidence is overwhelming that they are useless and/or harmful.
* Failure to consider the consequences of getting more information BEFORE recommending a test. The MTHFR mutation is common – as many as 50% of Americans have it – but having the mutation does not change anything for most people. Therefore knowing about the mutation is useless for most people. Humans have difficulty forgetting about an abnormality, however harmless it may be, once it is discovered. This means that knowing more is sometimes not better. There are times when ignorance truly is bliss.
It appears that the “MTHFR craze” is here to stay. A colleague recently informed me that a naturopath in her town tests all patients for it. I receive at least one email per week from someone who has the mutation, is concerned and wondering what to do about it. And a growing number of members are reporting that they have tested positive and are also seeking information.
I encourage you to stay away from doctors unless you have a good reason for seeing them, such as symptoms that do not resolve after a few days, injury, or the need for emergency treatment. Unless you are in need of emergency treatment, refuse any and all tests until you know how the test will benefit you, the risks of having the test, and what you will do differently once you have the test results. Enthusiasm for most tests usually lessens after reviewing this information
____________________________________________________________
Ray JG, Shmorgun D, Chan WS. “Common C677T polymorphism of the methylenetetrahydrofolate reductase gene and the risk of venous thromboembolism: meta-analysis of 31 studies.” Pathophysiol Haemost Thromb. 2002; 32: 51-58.
Klerk M, Verhoef P, Clarke R, Blom H, Kok F, Schouten E. “MTHFR 677C-T polymorphism and risk of coronary heart disease: a meta-analysis.” JAMA. 2002; 288: 2023-2031.
http://ghr.nlm.nih.gov/gene/MTHFR
Rey E, Kahn SR, David M, Shrier I. “Thrombophilic disorders and fetal loss: a meta-analysis.” Lancet. 2003; 361: 901-908.
Varga E, Sturm A, Misita C, Moll, S. “Homocysteine and MTHFR Mutations: Relation to Thrombosis and Coronary Artery Disease.” Circulation 2005;111:e289-293
Dear Walter,
Glad you landed here on a Google search. I try to hide in the corners.
I feel Dr. Popper’s frustrations regarding unnecessary testing, but I am more middle ground. I think there are indications (including, but not limited to, things like premature strokes, depression, recurrent miscarriages) for knowing one’s MTHFR genetic status. The hype surrounding it is excessive. And I don’t like to see people worried or anxious. But I do think it plays a part in certain health conditions. The research is back and forth. When I see that in research, I do not think that it implies lack of importance or validity, but more that there are confounding factors not accounted for. Some people more affected than others perhaps. And we just don’t quite understand enough yet.
I think an optimized diet can make a difference in MTHFR concerns, negating the need to know one’s genetics in some ways. Yet, some people may find it empowering–promoting their ability to stay resolute with necessary health and eating habits.
I don’t like the specific MTHFR tests. I see physicians ordering this genetic test or that genetic test. From what I know (someone correct me if I’m wrong), something like 23 and me contains all of this information at a much cheaper price. But it then has to be sifted through and if a person is easily overwhelmed, well, it’s overwhelming to say the least. Then, that leads to thousands of dollars in consultation… Also, with something like 23 and me, I do think it’s important that those not be traceable such that they might impact your children’s futures if somehow breached. Or yours.
I’d better close. I hope I addressed something about what you were thinking. I prefer to do an overhaul on diet, lifestyle, relationships, etc and then see what’s left nagging health. Then, think about what testing may be appropriate—gut testing, genetic testing, a more extensive thyroid panel, etc. But—ha!–since I’m not practicing, I’m just an armchair quarterback.