MTHFR - is what I'm doing working?
That's the topic of today's video.
Hi. I'm Dr. Chris Masterjohn of
chrismasterjohnphd.com. And you are
watching Chris Masterjohn Lite where
the name of the game is
“Details? Shmeetails. Just tell me what works!”
And today we're going to talk about
the most important blood work to look at
when you're trying to make sure that
you're managing your nutrition
for optimizing your MTHFR
mutations properly. So the first thing
you want to look at is homocysteine. You
want homocysteine to be between
5 and 9, probably 7 is somewhere
around the sweet spot. You're not going
to get it lower than 5 and if
you're above 9 you're getting into
territory where you need to optimize it
better. Now homocysteine doesn't tell you
it's about MTHFR, it doesn't tell you
it's about folate. In fact homocysteine
could be high for reasons relating to
B12 or even for reasons relating to B1,
B2, B3 and B6. So, nevertheless, it's
important to look at because if what
you're doing for MTHFR really isn't
working you're homocysteine is
probably going to be high. The second
thing you want to look at is your blood
levels of folate. One thing that's
underappreciated is that the folate
outside of your cells is almost
exclusively methylfolate. So if you want
to estimate whether you have low
levels specifically of methylfolate,
which is the specific problem of MTHFR,
you want to look at folate in plasma or
serum and not in your red blood cells.
Nevertheless I think it can be helpful
to look at both because inside your red
blood cells you see the totality of
folate forms and if your methylfolate is
low, which we're estimating based on
serum or plasma folate, and your total
forms inside your red blood cells are
not, then that is very suggestive that
your problem is specifically related to
MTHFR. Whereas if your total folate
inside your red blood cells is low you
probably just need to eat more folate, period.
Now if your methylfolate is low then
either you need to increase your dose of
methylfolate through foods or through
increasing the dose of your supplement
or you need to conserve it better.
The way you conserve it is you get more
choline, and the reason that that
helps conserve it is because choline can
substitute for folate, or you get more
creatine, and the reason that conserves it is
because it reduces your need to use it.
So by increasing the alternative supply
in choline and by decreasing the demand
with creatine you can conserve your
methylfolate better. You can't really
tell from the methylfolate level which
strategy is best, maybe look at which one
you seem to be placing the least
emphasis on and start with that, but
you'll have to play around with it and
see what normalizes your blood work best.
The third thing you want to look at is
glycine. MTHFR causes you to waste
glycine as methylated metabolites.
This is harder to look for. Everything that
we've talked about so far can easily be
gotten through a single measure, a single
purchase from any of the major
laboratory providers. If you're looking
for glycine you want to look for two
amino acids, glycine itself and sarcosine.
Yyou're going to have to
order a plasma amino acid analysis for
this. It's more expensive because you're
looking at a lot of amino acids. You
also have to make sure that both glycine
and sarcosine are on the list of
analytes. I prefer to use Genova Ion
Panel with 40 amino acids. This is a
panel of both plasma amino acids and
urinary organic acids. I like it because
whenever I'm looking for something it's
the panel that's most likely to have
what I'm looking for. You can also use
other ones from Quest, LabCorp or Great
Plains. If you use those other ones
make sure that they have glycine and
sarcosine in their list of analytes.
Now what you're looking for is you want
glycine to be in the middle of the range
and you want sarcosine to be as low as
possible. If your glycine is down
drifting towards the bottom
of the range or below the
range or and/or your sarcosine is
elevated or even high within the range
then that indicates that you haven't
optimized for your MTHFR well enough
yet to preserve your glycine. And that
might mean that you just need to
supplement with more glycine, but the
reason you waste glycine is because you
don't have enough methylfolate.
So what we'll say then is that if
glycine is low and/or sarcosine is high
you need to either boost your
methylfolate or conserve it better in
the ways we were just talking about, or
you need to add glycine into the mix.
And it's probably best to attack it in a
multi-faceted way so that you're
conserving your glycine as much as
possible and you're compensating for
whatever you can't conserve by adding in
extra glycine. Now those are the three
most important things, but I'll throw in
a few bonuses. So if you google HDRI
Methylation Panel you will find the HDRI
Methylation Panel. This looks at all your
intracellular folate metabolites and
it can be really helpful to see if, for
example, is your methylfolate low versus
all your other metabolites of folate.
HDRI is measuring a lot of things that no
other companies measure and it's why I like to
use them, but I will offer a note of
caution, which is that they're very
difficult to work with, they usually take
a lot longer than they tell you they
will to get your data back to you, and
often they're not responsive when you
ask them questions. So I find the company
frustrating to work with, but I'll throw
it in there as a bonus test. And then
another bonus test is the Quest Creatine
Biosynthesis Disorders Panel. The reason
I like this is because if you're MTHFR
isn't working right you're probably not
going to synthesize enough creatine
inside your body, and if that's true what
you will see is that on this panel you'll have an
increased ratio of guanidinoacetate to
creatine. The problem with this test is
that it's optimized to look for severe
genetic disorders in creatine synthesis
and so there's no reference range
designed to tell you if you're managing
MTHFR properly. So if you're on your own
and you're just looking at your own
health I wouldn't bother with it, but if
you're a clinician and you order lots of
tests for lots of patients and clients
then I think it would be good to start
seeing whether you can generate enough
data in your own practice with the Quest
Creatine Biosynthesis Disorders Panel to
see whether there's a range where you
can find that people feel better, if
their symptoms are lowest or their other
markers of methylation are all optimized
best when that ratio is in a certain
narrower range, and if that's the case
then maybe we can start making real
recommendations around how to use that
panel to optimize your MTHFR. In any case
remember the three most important things
are Number 1: homocysteine should be in
the optimal range, Number 2: plasma
or serum folate should be high enough,
not red blood cell necessarily, and
Number 3: your glycine should be in
the middle of the range, sarcosine as
low as possible.
All right. I hope you found this useful.
Signing off. This is Chris Masterjohn.
You've been watching
Chris Masterjohn Lite.
And I will see you in the next episode.