Dr Ben Lynch: MTHFR C677T Mutation: Basic Protocol - MTHFR.Net

one might want to avoid just trying supplements before you get a handle on a few other primary mutations commonly in the mix, by ordering a $99 DNA report, the only hurdle is that you'd have to wait 6-8 weeks for the raw file from your DNA autosomal testing.  

for most of us that is too much of a wait, we need more energy now and less pain/anomalies!   so this guideline of shortcut protocols by Dr Lynch might provide a thoughtful gradual trial/error bypass to the DIY'ers among us to hold us over for now.  

when we get our full mutation results, we can then book a visit with a doctor of choice either locally or via skype armed with all the data you have gathered (or keep going it alone).  

a functional test to get an idea of your methlyation status i.e. Hcy, MMA, SAM makes sense.

but no matter what, you first have to get the gut optimized to be able/ready to process all the toxins out of system before optimizing your methylation cycles - or you'll be sorry your body started dumping toxins into your blood when your liver/kidneys etc weren't ready to work.

"Once you respond well to the probiotics, krill oil, turmeric and vitamin E, then you may proceed to slowly adding the following..."

MTHFR C677T Mutation: Basic Protocol - MTHFR.Net
http://mthfr.net/mthfr-c677t-mutation-basic-protocol/2012/02/24/

Have one or two copies of the MTHFR C677T mutation?

Don't know what to do?

After working with 1000's of individuals with this defect, I've developed a protocol which may help a significant number of people.

UPDATE 3/16/2015:
Having written this article years ago now, I must let you know that if ANYONE – with or without MTHFR C677T or A1298C snps/variants/polymorphisms/mutations – whatever you want to to call them – should follow the lifestyle, dietary and environmental recommendations.

Regardless of MTHFR or not, the recommendations for diet, lifestyle and environment need to be considered by all!

Now – the supplement recommendations need to be tailored to the individual – again – regardless of which genetic variants you have. Working with a physician trained in this area of medicine is key.

The recommendations of supplements are merely suggestions and ones that I may recommend to a patient or physician. They are not flat out must-haves nor must one take all of them.

—

I want to make it absolutely clear that while the MTHFR C677T mutation may be common across a number of individuals, the outcome of supplementing with various nutrients can vary tremendously due to other genetic defects, dietary and lifestyle choices and environmental exposures.

Some of these recommendations require a full explanation. Due to the nature of this article, it is not possible to do so. If the recommendation is listed, it is critically important.

Let it be known that the information presented below is for your information only and is not intended to treat, diagnose or prescribe in any way. Use the information at your own risk.

Always seek the advice from your physician.

Here is a list of physicians that have training in MTHFR, methylation and nutrigenomics.

Part I pertains to supporting both heterozygous (1 copy of C677T) and homozygous (2 copies of C677T) MTHFR mutations. Part II pertains to mainly homozygous individuals but may also be tried by heterozygous individuals if desired.

PART 1

The biggest differences in recommendations between these two types of mutations are:

1. folic acid needs to be avoided more seriously by homozygous individuals
2. the amount of methylfolate required for homozygous mutations is greater
3. the blood thinning requirement is greater for homozygous individuals

Here are the common recommendations for supporting those with C677T MTHFR mutations:

1. Limit ingestion of folic acid in fortified foods as you cannot process folic acid well.
2. Limit or cease taking supplements or drugs with folic acid in them. Talk with your doctor before stopping.
3. Avoid folic acid blocking drugs such as birth control or Methotrexate.
4. Avoid drugs which increase homocysteine such as Nitrous Oxide (most used in dentistry)
5. Avoid antacids as they block absorption of vitamin B12 and other nutrients
6. Begin understanding which of your symptoms may be related to the C677T MTHFR mutation.
7. Measure homocysteine levels – properly!
8. Inform your family members so they can also test for the MTHFR mutation
9. Find a doctor who is knowledgeable about MTHFR or is willing to learn
10. If you are pregnant, find an OB/GYN or midwife who is knowledgeable about MTHFR.
11. Eliminate Gluten from your diet – especially wheat.
12. Eliminate or reduce Dairy from your diet. If you must have dairy, use Goat milk.
13. Sauna or sweat somehow (epsom salt baths, sports, yoga..) at least once to three times a week.
14. Limit intake of processed foods
15. Increase intake of whole foods and home-prepared meals
16. Eat the Rainbow of colors from fruits and vegetables – daily
17. Castor Oil Packs over your abdomen daily during times of pain, soreness, cramps
18. Vegetable/Fruit Juice Diet with Chia Seeds during times of pain, soreness, cramps
19. Limit intake of high methionine-containing foods if homocysteine elevated
20. Coffee Enemas during times of detoxification or pain
21. Filter chlorine from your drinking water, shower and bath.
22. Drink at least two liters of filtered water daily mixed with vitamin C and electrolytes.
23. Eat smaller, but more frequent meals, throughout the day with some form of protein.
24. Limit protein intake to approximately 0.7 grams protein per kilogram of body weight.
25. Remove mercury amalgams and root canals with a trained biological dentist.
26. Avoid cooking, drinking, storing and heating in any type of plastic container.
27. Use an air purifier in your home and office
28. Eliminate carpets from your home and install low VOC wood or tile flooring.
29. Eat grass-fed beef, free range, hormone free and antibiotic meats and eggs
30. Cook with electric stove and oven and remove gas stove and oven.

UPDATE November 25, 2014

PREVENT SIDE EFFECTS caused by methylfolate.

Read this article first before taking anything else, unless recommended by a health professional. "Preventing Methylfolate Side Effects."

General Nutrient Recommendations for C677T MTHFR mutations:

• Methylfolate
• Methylcobalamin
• Betaine in the form of TMG
• NAC
• Glutathione
• Pyridoxal-5-phosphate
• Riboflavin
• Curcumin
• Mixed tocopherals (vitamin E)
• Silymarin (Milk Thistle)
• EPA/DHA
• Phosphatidylcholine
• Nattokinase
• Vitamin C
• Vitamin D3
• Comprehensive multivitamin/multimineral
• Probiotics

...

In general, those with C677T mutations have decreased ability to produce methylfolate, increased cardiovascular risk, increased risk of blood clots, increased pain and inflammation and increased chemical sensitivity. Recommendations below support the reduction of these issues by increasing the body's inherent ability to restore function through nutritional biochemistry.

NOTE: If you are not sensitive to supplements in general, then it is recommended to start with a comprehensive multivitamin and multimineral as this supports numerous biochemical functions within your body. It also provides a fast testing ground to see if you respond well to numerous nutrients.

If you do not tolerate a multivitamin well, this is a sign that you must proceed more slowly and work on healing your digestion and dietary intake and lifestyle habits first.

• Optimal Multivitamin line
  • contains methylfolate and methylcobalamin
  • no folic acid
  • comprehensive and well-absorbed minerals
  • all B vitamins in quality forms
  • comes in three forms:
    • Optimal Multivitamin
      • Ages 16 and up: consider 3 capsules with breakfast and 3 capsules with lunch
      • contains 400 mcg of methylfolate
      • iron-free
      • free of magnesium stearate, flavors, titanium dioxides
    • Optimal Multivitamin Chewable
      • Ages 4 and up: consider 1 tablet with breakfast and 1 with lunch
      • contains 400 mcg of methylfolate
      • easy delivery and well-tolerated
      • may give to younger children (2 and above) with doctor's permission
      • 2 mg of iron per chewable tablet
    • Optimal Prenatal
      • useful for preconception, pregnancy and breastfeeding
      • contains 800 mcg of a blend of methylfolate and folinic acid
      • comprehensive B vitamins and chelated minerals
      • iron-free
      • specialty nutrients to support neurological development and ease morning sickness
    • Kid's Optimal Multivitamin
      • Ages 4 and up: consider 3 capsules with breakfast and 3 with lunch
      • smaller capsules easier to swallow
      • iron-free
      • free of magnesium stearate, flavors, titanium dioxides

• Optimal Vitamin E
  • contains 400 IU of mixed tocopherals
  • supports a healthy cardiovascular system
  • learn about mixed tocopherals here
  • consider 1 capsule daily
  • if on blood thinning medication or have bleeding disorders, talk with your doctor before taking vitamin E
• Liver Nutrients
  • supports liver detoxification
  • has NAC, Methionine, TMG, Cysteine, Alpha Lipoic Acid
  • has 80% of 200 mg of active silymarin per serving
  • consider starting with 1 capsule per day WITH DINNER
  • always take WITH A MEAL – not a snack
• Optimal Turmeric
  • supports reduction in inflammation
  • liposomal form of curcumin providing higher absorption and effect
  • consider starting with 1 capsule with a snack before bed
  • increase to 2 capsules three times daily during times of high inflammation or pain
  • protect your nerves, brain and blood vessels by decreasing inflammation
• Flow Fx
  • supports reduction in fibrin which is material found in blood clots
  • useful for supporting healthy blood flow and circulation
  • do not use if using other blood thinners such as Lovenox or baby aspirin
  • consider taking 1 capsule every 12 hours
  • this is likely not needed for heterozygous individuals unless other clotting disorders are present.
  • NOTE: nattokinase has not been proven to be more effective than baby aspirin, coumadin, warfarin or other clot-prevention drugs. Caution is advised.
  • if you are high-risk for blood clots, then pharmaceutical drugs are recommended over nattokinase.
• ProBiota 12
  • supports healthy bacteria in digestive tract
  • provides 25 billion bacteria in 12 strains per capsule
  • necessary to strengthen immune system which is weakened in MTHFR mutations
  • consider taking 1 capsule after dinner nightly
• Liquid Vitamin D360
  • supports healthy immune function
  • provides support for healthy bones and hormone formation
  • supports healthy mood and neurotransmitter production
  • each drop provides 2,000 IU of vitamin D3
  • in a base of extra virgin olive oil
• Optimal Krill Oil
  • provides potent antioxidant support which is needed in toxic individuals
  • supports a healthy brain and nerves as krill oil penetrates the nerves and brain better than fish oil due to the natural phospholipid structure
  • consider taking 2 capsules daily with a meal anytime of day
  • naturally more pure than fish oil
• Neutralize
  • provides buffering agents to neutralize side effects from environmental exposures
  • consider taking 1 capsule upon the onset of undesired symptoms from an environmental exposure
  • contains 125 mg of potassium per capsule so take caution if on potassium medications or having arrythmias
  • assists in reducing stomach acid/reflux symptoms

How much methylfolate to take?
This is the big question that is asked all the time.

Experience demonstrates that those with 1 copy of the C677T MTHFR mutation do not need much methylfolate beyond what is found in the Optimal Multivitamin line.

The MTHFR enzyme is working at nearly 70% or so effectiveness in heterozygous individuals while in homozygous individuals, it is working at only 30% effectiveness (The effectiveness percentage varies from paper to paper. Currently evaluating the research).

Individuals who are homozygous for the C677T MTHFR mutation do need more methylfolate than what is in the Optimal Multivitamin line.

To determine how much more methylfolate you need, it is best to start low and work up. This allows you to safely identify how much you tolerate without triggering very undesirable side effects.

If you are heterozygous for the C677T MTHFR mutation, the recommendations below are likely not needed. You are welcome to try them but it is highly encouraged that you proceed cautiously in order to prevent side effects from excessive methylfolate.

NOTE: If you begin supplementing with methylfolate and you have inflammation unchecked, your symptoms may worsen. This is why it is critical that you are tolerating and taking probiotics, krill oil, turmeric along with improving your diet and lifestyle first.

PART II

Methylfolate Recommendations for those homozygous for the C677T MTHFR Mutation: 
Once you have determined you respond well to the probiotics, krill oil, turmeric and vitamin E, then you may proceed to slowly adding the following.

Methylfolate is best absorbed on an empty stomach or sublingually.

• Active B12 5000
  • provides 5,000 mcg of methylcobalamin per sublingual tablet
  • important to supply methylcobalamin first before methylfolate to prevent methyl trapping
  • break the tablet into fifths and place 1/5th under the tongue upon waking
  • do this for 1 week to see how you feel
  • if you feel well, proceed to switching to 1/4 tablet of Active B12 with Methylfolate
  • if you do not feel well, stop taking it and switch to taking 1/2 capsule of L-5-MTHF
  • if you do not feel well taking 1/2 capsule of L-5-MTHF, stop taking it. You are either receiving sufficient methylfolate at this time or you are not yet prepared to take it due to other mutations present or other health issues worsen from methylfolate.
•  Active B12 with Methylfolate
  • provides 1,000 mcg of methylcobalamin
  • provides 800 mcg of methylfolate
  • sublingual tablet provides effective absorption of both nutrients
  • break the tablet into quarters and take 1/4 tablet upon waking for a few days.
  • if not well tolerated, cease the use. You have to back up and heal your digestion further and identify other issues before addressing the MTHFR mutation
  • if well tolerated, increase to 1/2 tablet upon waking for a few days
  • as you tolerate it and feel improvement, keep increasing by 1/4 tablet every three days.
  • once you reach 1 full tablet in the AM and tolerate it well, stop the use of Active B12 with Methylfolate and switch to HomocysteX.
• HomocysteX
  • provides 800 mcg of methylfolate, 1000 mcg of methylcobalamin and 25 mg of pyridoxal-5-phosphate
  • provides further support in lowering homocysteine and producing glutathione through pyridoxal-5-phosphate
  • upon waking, consider taking 1 capsule of HomocysteX with a glass of water.
  • if not well tolerated, you may have a CBS mutation or COMT/MAO A mutation. Stop the use of HomocysteX and return back to taking 1 tablet of Active B12 with Methylfolate as you were.
  • if well tolerated, stay on 1 capsule of HomocysteX for 1 week.
  • if improving, consider adding in a 1/2 capsule of HomocysteX 30 minutes before lunch for one week.
  • if well tolerated, consider taking a full capsule of HomocysteX upon waking and also before lunch for one week.
  • each week, if well tolerated and feeling improvement, keep increasing by 1/2 capsule.
  • if well tolerated at 2 capsules upon waking and 2 capsules before lunch, cease the use of HomocysteX and switch to HomocysteX Plus
• HomocysteX Plus
  • provides similar nutrients as HomocysteX with the addition of riboflavin-5-phosphate and betaine as TMG.
  • provides further methylation support and homocysteine-lowering nutrients
  • consider taking 1 capsule of HomocysteX Plus upon waking for a week.
  • if not well tolerated, stop the use and return back to HomocysteX.
  • if improving after one week, consider adding in a 1/2 capsule of HomocysteX Plus before lunch for one week.
  • if well tolerated, consider taking a full capsule upon waking and a full capsule before lunch.
  • each week, if well tolerated and feeling improvement, keep increasing by 1/2 capsule.
  • it is not expected to increase beyond 2 to 3 capsules upon waking and 2 to 3 capsules before lunch.
• Active B12 5000
  • Once you discover which methylfolate supplement you tolerate best: Active B12 with Methylfolate, HomocysteX or HomocysteX Plus, then work on adding in additional methylcobalamin via Active B12 5000.
  • Upon waking take 1/2 tablet of Active B12 5000 in addition to your chosen methylfolate supplement.
  • Do this for 1 week.
  • If well tolerated, take a whole tablet sublingually of Active B12 5000 upon waking in addition to your chosen methylfolate supplement.
  • Typically, only 1 tablet of Active B12 5000 is needed by most individuals; however, some autistic children or those with MTR/MTRR genetic defects require additional methylcobalamin.
  • Continue increasing by 1/2 tablet of Active B12 throughout the day – but not past 1 pm as it may inhibit your sleep.
  • Up to 4 tablets may be taken daily – ideally spread throughout the day to increase absorption – but again – not after 1 pm.

Methylfolate Side Effects
These are common despite what physicians may inform you.

Common undesirable side effects of methylfolate must be identified.

• headache
• migraine
• rashes
• irritability
• anxiety
• joint pain
• muscle pain
• insomnia
• depression

If side effects occur, then the amount of methylfolate you are taking needs to be taken under consideration and likely reduced. Talk with your physician before altering any protocol or supplement/pharmaceutical.

Many times one is not yet ready to take methylfolate.

There are other steps that must be taken prior to supplementing with methylfolate if these side effects occur.

If side effects occur, taking Niacin helps bind the excessive methyl groups which are likely causing the issue. Consider taking 100 mg or 1/5th tablet of Niacin if these symptoms occur. It is a good idea to have a bottle of Niacin on hand in case these symptoms occur from taking too much methylfolate. Be sure to swallow the 1/5th tablet of niacin – not chew or place sublingually.

Flushing is common from taking niacin in the most active form, nicotinic acid. This is not harmful and will subside in about 20 to 30 minutes.

Do NOT take a full tablet of Niacin. Begin by taking only 1/4 a tablet.

Cycling Supplements for Methylation BalanceSupplements and pharmaceuticals such as HomocysteX Plus, HomocysteX, Cerelin Forte or Metanx are designed to support methylation.

It is methylation that is severely disrupted in those with C677T MTHFR mutations – especially homozygous individuals.

Methylation requires balance.

If methylation becomes excessive, side effects will occur as noted above. This requires adjustment in your protocol.

There is a need for routine adjustment as our bodies are dynamic.

If you feel the side effects above, it is recommended you notify your physician and have them make adjustments.

For example, these adjustments may range from:

• stopping all methylation-supportive nutrients
• taking these nutrients 4 days on and 3 days off
• taking them every other day
• taking them only in the morning
• decreasing the amount taken every other week

General Side Effects
If you are feeling improvement consistently, then you are on the right track.

If you begin to feel heavy, tired, dry mouth, irritable, 'toxic', or otherwise 'not right', then something in your protocol needs to change.

These are all signs that one must listen to otherwise you are potentially increasing the circulation of toxins and not eliminating them properly.

These side effects can be eliminated quite quickly through a pure vegetable and fruit juice diet for at least one day. This means producing your own juices at home via a quality juicer such as Champion Juicers. Prepare mostly vegetable juices with some fruit juices to increase the taste.

Taking a capsule of Neutralize or some Niacin also helps offset many side effects.

Conclusion
The above recommendations will help a majority of individuals who have heterozygous and homozygous C677T MTHFR mutations.

In the event you are stuck, consider obtaining a copy of the Folate Metabolism and MTHFR Video Presentation.

I highly encourage that you locate a physician with training in this complicated – yet amazing – area of medicine.

Visit the Physician Directory at Seeking Health Educational Institute to find a health professional near you.