Your Guide to Understanding MTHFR Support

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Read Part 1 Now!

MTHFR Support and Treatment

MTHFR support and genetic variationJust because you have the mutation does not mean you will show symptoms or develop conditions associated with MTHFR. Not all MTHFR sufferers need to be treated. Many have a marginal expression of MTHFR and lead a normal life. Others may need MTHFR support.

If you learn that you do have significant MTHFR variants that are symptomatic, MTHFR support with the activated form of folate (vitamin B9) and B12, also known as methylfolate and methylcobalamin respectively, is recommended.

Methylcobalamin, more commonly referred to as vitamin B12, is naturally found in foods such as meat, seafood, and dairy products. As long as the dosage is properly titrated methylated vitamin B12 is safe for most people and may be taken as a nutritional supplement. Methyl B12 is best taken as an intramuscular shot, nasal spray, or sublingually in high doses, especially if used as MTHFR support.

Excessive vitamin B12 supplementation can cause anxiety, jitters, rapid heart rate, heart palpitation, and fatigue. Most of these side effects are mild, but medical evaluation is recommended because some of the possible side effects can be serious and should only be treated under supervision. Each person requires specific nutrients tailored to his or her own body and titration is necessary to obtain the optimal dosage with minimal side effects.

Methyl folate is taken orally. Physician supervision is best as the dosage needed is high. Methylfolate side effects include: severe anxiety, irritability, palpitations, acne, rash, sore muscles, achy joints, insomnia, nausea, headaches, and migraines.

On top of oral supplementation, prescription medications are also available. Drugs such as MetanX, Deplin, and CerefolinNAC contain methylfolate and may be beneficial.

Treatment of MTHFR also needs to be directed towards toxin control if the body is strong enough to handle it. This is important because the body’s toxic load and toxin clearance capability is reduced. Household chemicals, such as artificial scents, cleaners, and pesticides should be avoided. Chronic chemical exposure should be curtailed as much as possible. Use safe chemicals and organic pest control chemicals whenever possible.

From a diet perspective, it is important to avoid hydrogenated fats and processed foods. Increased consumption of fruits and vegetables are vital to alkalize the body and help the liver metabolize normally.

MTHFR and Glutathione

MTHFR support and glutathioneOne reason that MTHFR variants are linked to a variety of illnesses is their common pathway and connection to glutathione production. Glutathione is the body’s main detoxifying agent and intracellular antioxidant. Glutathione is also called the master recycler as it recycles other vitamins such as vitamin C and E. People with MTHFR anomalies typically present with lower levels of glutathione. This makes them more susceptible to toxins, which can lead to liver congestion.This makes glutathione an excellent form of MTHFR support.

Supplementation of glutathione is therefore very important in all suspected MTHFR conditions. Since oral glutathione is poorly absorbed, a liposomal form using nanotechnology is recommended. N-acetylcysteine (NAC) or alpha lipoic acid may also be taken, but they are not very effective.

In many cases where MTHFR is mild, oral glutathione supplementation alone is sufficient to effect dramatic improvement. This is particularly relevant to those who are weak or when methylated B12 or methylated folate may be too strong a therapy to be considered.

Adjunct Therapy

In terms of supplementation for MTHFR support, adjunct supplements can be helpful provided that the body is healthy and strong. These include methyl donors (such as DMG, TMG, betaine), fatty acids to help reduce inflammation (such as fish oil, flax seed), minerals (such as zinc, magnesium), herbs that support liver detoxification (such as milk thistle), vitamin C, and amino acids. They do not apply to those with advanced Adrenal Fatigue Syndrome (AFS).


AFS represents the neuroendocrine deregulation of the body under excessive physical and emotional stress. Common symptoms include fatigue, insomnia, and lethargy. Symptoms in advanced stages can include hypoglycemia, heart palpitation, depression, anxiety and loss of libido. Sufferers usually have a wide variety of non-specific complaints that seem to defy conventional medical wisdom because laboratory tests are usually totally normal.

It is unknown whether MTHFR is associated with AFS or not. If it is indeed associated the degree of correlation is also unknown. Much more research is necessary.

Due to the concurrent hypersensitivity of AFS sufferers to nutritional supplementation, paradoxical reactions can occur frequently. The use of methylated folate and B12 for MTHFR should proceed with care. Those that have mild AFS with moderate symptoms can have a trial of this supplementation under proper supervision. If MTHFR variant is indeed the culprit, relatively quick resolution and improvement of symptoms is expected. The failure of significant improvement is an alert that MTHFR may not be the dominant cause of fatigue even if MTHFR testing is positive. Over aggressive use of methylated folate and methylated B12 is a common recovery mistake in those with AFS as they can mask the underlying problem and worsen AFS. Energy output may be up, but the underlying adrenal weakness is overlooked.

Be cautious with MTHFR supportThose with advanced stages of AFS need to be very cautious because they usually fare quite differently. Because of their already highly sensitized bodies and low threshold of stimulatory excitation response, any product including methylated folate or methylated B12 can further increase an excitation response and trigger an adrenal crash. The more advanced the AFS the higher the risk. Using such compounds should only proceed under the guidance of a health care professional.

Alternatively, a much gentler way to approach MTHFR deregulation if suspected in both mild and severe AFS cases is to use liposomal glutathione to start. Glutathione is part of the pathway of many methylation enzymatic responses. As mentioned earlier, most MTHFR sufferers are found to have low glutathione. Supplementing with glutathione therefore is a direct and gentle way to overcome MTHFR without causing excitation and unintended negative consequences.

Glutathione through its direct supply into the body, have the additional benefit of helping the liver to detoxify. It therefore has direct and indirect benefits. To put it simply, glutathione helps the body methylation process without being overly aggressive. We believe that this is a much gentler first step approach. Methylated B12 and methylated folate can be added if and when the body is strong and stable.

Read Part 1 Now!

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.

MTHFR Support