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Evidence Based

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What’s Really Causing Your MTHFR Gene Mutation Symptoms

Written by Dr. Michael Ruscio, DC on March 16, 2021

Written by Dr. Michael Ruscio, DC on March 16, 2021 — Reviewed by Hilary Watts

Understanding the Role of Your Gut in Common Symptoms

• About MTHFR|
• MTHFR Gene Mutations|
• Symptoms|
• Why MTHFR Research is Misleading|
• Testing|
• Gut Health and Treatment|

An MTHFR gene mutation might seem to explain your symptoms, from chronic fatigue and pain to brain fog, anxiety, major depression, and hormonal imbalances. But a closer look at the research shows that the health impacts of these common gene variants may actually be quite minimal.

The symptoms that have been associated with MTHFR gene variations are more likely to be caused by gut imbalances and inflammation. This is good news because these imbalances and their treatments are better understood. 

In this article, we’ll explain the more likely causes of symptoms like fatigue, pain, brain fog, digestive symptoms, mood disorders, and hormonal imbalances, and how to treat them.

We’ll also break down why MTHFR research can be so misleading, what the evidence says about the folic acid/folate deficiency debate, and why gene testing in general is likely more trouble than it’s worth.

What Is MTHFR?

MTHFR (short for methylenetetrahydrofolate reductase) is both a gene and an enzyme. When people talk about MTHFR, they are generally referring to the gene that tells the body how to make the enzyme. The MTHFR enzyme plays a role in various functions in the body, which we’ll cover in more detail below.

Common alterations in the MTHFR gene have been tenuously linked to several different health conditions and problems, including bipolar disorder, schizophrenia, chronic pain, heart disease (heart attack), and autism.

Common variants of the MTHFR gene are often referred to as “genetic mutations,” but experts have clarified that the term “polymorphism” is more accurate 1. In other words, rather than viewing these variants as bad, which is most people’s connotation of the word “mutation,” it’s more accurate (and more helpful) to see these variants as simple differences—brown eyes vs hazel eyes, or tall vs short. This might not seem very important, but it’s worth acknowledging that variants in the MTHFR gene are probably not harmful. 

True mutations of the MTHFR gene are extremely rare. True mutations can lead to known and established health problems including seizures and intellectual disabilities in the carrier. Mothers with a verified mutation (and the usual low folate levels that accompany it) may have offspring with birth defects like spina bifida and neural tube defects like anencephaly or be more prone to miscarriage 2. 

In contrast, MTHFR gene polymorphisms affect 30-60% of the population 3. This includes a few common variants, including MTHFR c677t and a1298c polymorphisms. Some MTHFR gene polymorphisms are inherited from one parent (heterozygous), and others are inherited from both parents (homozygous).Despite all the attention the MTHFR gene mutation symptoms get on the internet, research suggests that having “abnormalities” in your MTHFR gene might actually be pretty common and normal. A 2019 review found that only 15% of the population had a genetic profile of MTHFR completely free of any variants 4. So “variants” are paradoxically the norm.

Should You Test for MTHFR or Other Genes?

With the advances in genetic understanding in recent years, the popularity of testing for variants in genes (like MTHFR) for health optimization purposes is booming. But research suggests that the results are generally not useful.

• A review paper found that there was, at best, minimal clinical utility to testing for MTHFR gene variants 5. 
• The American Heart Association also concluded that there was no valid reason to routinely test for MTHFR polymorphisms in any patient group 3.
• Review papers have concluded that in most cases, consumer-based genetic test results do not correlate with a person’s actual risk of developing a disease 6 7. 

Genetic testing results can be a distraction from what’s really causing your symptoms and the types of treatment that can help you. 

Gene testing can also be very disempowering for patients. Why focus on one small thing you can’t control when there are clear and proven approaches for taking charge of your health?

What Do Variations in the MTHFR Gene Mean?

The MTHFR gene tells the body how to make the MTHFR enzyme, which is responsible for converting folic acid (obtained from food and/or supplements) into methyl-folate (the form of folate used by your body).

Methyl-folate is one of the components that’s necessary for the body’s methylation process, which helps to regulate things like energy production, detoxification, nutrient metabolism, brain and neurotransmitter function, digestion, and hormonal balance. 

Some people have concluded that MTHFR gene polymorphisms inhibit folic acid conversion and slow the methylation process to the point that it disrupts those functions, eventually leading to symptoms and serious health issues. 

But does scientific evidence back up these conclusions?

We’ve had a close look at the research and found very little scientific evidence that having a common MTHFR gene polymorphism leads to any meaningful health changes or risks. While it’s true that MTHFR enzyme production may be somewhat reduced, it does not appear to be a significant reduction that leads to poor health. We’ll dive deeper into this concept below.

Why MTHFR Research Can Be Misleading

The confusion with MTHFR research often comes down to what we call the “effect size.” 

Let’s break that down. When a research paper is published and states that there is an increased risk of a disease or symptom as a result of a specific factor (like the MTHFR gene), it can be understandably alarming. But how great is that increased risk, or the actual impact on your health? That’s where things get a little bit more complicated. 

To understand the importance of effect size in research, consider the example of weight loss. Imagine that a paper is published with the conclusion that a particular supplement has been linked to weight loss. If your weight is a concern, you might want to rush out and buy that supplement. 

But what if, when the research is analyzed more thoroughly, it turns out that the average weight loss associated with the supplement is 2 pounds (roughly equivalent to 1% of body weight) over a period of several months or even years? Is the impact – or the effect size – great enough for you to spend your healthcare dollars on this supplement? 

Keeping this in mind, one of the most commonly cited risks associated with MTHFR gene polymorphisms is higher homocysteine levels.

Technically, the research data supports this link between MTHFR and homocysteine, but on closer scrutiny, we see the effect size is very small. A 2019 analysis of the data showed that the impact of the MTHFR gene on homocysteine levels is at most 1% 4. Your homocysteine levels are actually more likely to be high as a result of improper lab processing than as a result of an MTHFR gene variant.

All of this means that you probably don’t need to make drastic changes to your diet, lifestyle, or supplement routine based on your MTHFR gene variants, which is good news.

Untangling the Folic Acid Controversy

Another common misconception is that people with the MTHFR gene variant should avoid folic acid supplementation and opt for a more costly form of folate supplement or a vitamin B complex instead. 

However, the effects and benefits of folic acid and folate supplements are similar, and there don’t seem to be any risks associated with taking the more cost-effective folic acid even for those who have MTHFR polymorphisms 8. 

• A large study on a Chinese population with common MTHFR polymorphisms found a 30% reduction in the risk of stroke with folic acid supplementation. This demonstrates that folic acid is effective (and not harmful) for those with MTHFR polymorphisms 9.
• Folic acid supplementation is often recommended for women of reproductive age in order to help prevent possible neural tube defects in their children. The available research shows a protective benefit when using prenatal folic acid supplements for mothers with and without MTHFR polymorphisms 8.

MTHFR, Homocysteine, and Heart Disease

Many proponents of the MTHFR theory have warned of an increased risk of cardiovascular disease and related conditions, including blood clots, stroke, high blood pressure, and thrombosis (blood clotting within a blood vessel). 

This is largely based on the concern that MTHFR gene variants may contribute to lower levels of folate (vitamin B9) and vitamin B12, and higher levels of homocysteine, all of which have been linked to a greater risk of heart disease.

One study on a Chinese population did find that individuals with one common MTHFR polymorphism had higher levels of homocysteine and lower levels of folate and B12. However, other factors affecting the prevalence of heart disease in this population are also likely to have contributed 9.

The Bigger Picture of Heart Disease

There are a number of risk factors that can contribute to elevated homocysteine levels. More broadly, factors related to diet, lifestyle, and gut health are known to be essential for heart health and for the prevention of cardiovascular disease. These include eating an anti-inflammatory diet of healthy fats, proteins, and nutrient-dense vegetables, getting enough sleep, and engaging in regular exercise. 

Inflammation and imbalances in the gut have also been linked to heart disease 10 11 12 13 14, and probiotics have been shown to help reduce homocysteine levels and increase levels of B vitamins by modifying bacteria in the gut 15.

It’s important to keep these health fundamentals in mind, as too much emphasis on a single gene (which is something you can’t control) may end up distracting you from the modifiable diet and lifestyle factors that have been proven to support a healthy heart.

If folate, vitamin B12, or high homocysteine levels are a concern for any reason, simple blood tests can determine your actual status 16 17.

Symptoms Attributed To MTHFR Mutations

Beyond heart disease, several different kinds of symptoms have been attributed to MTHFR gene mutations, including fatigue, chronic pain, brain fog, depression and anxiety, estrogen dominance, and headaches. 

These are common symptoms that we see and treat daily in our clinic. While the symptoms themselves are very real and troubling for patients, chances are, they’re not caused by MTHFR gene polymorphisms. Generally, these symptoms are signs of systemic inflammation and imbalances in the gut.

Let’s take a closer look at some of these symptoms, explore other likely causes, and discuss how to treat them.

Fatigue

The symptoms of gut imbalances often go well beyond digestive distress, and fatigue is a clear example. 

There’s a strong connection between fatigue and several different gut conditions, including irritable bowel syndrome (IBS), intestinal permeability (leaky gut), gut infections, and non-celiac gluten sensitivity 18 19 20 21 22 23 24. 

• Fatigue is one of the most common symptoms of IBS 18. A meta-analysis of 17 studies showed that more than 50% of IBS patients experience fatigue 19. 
• Tiredness is one of the most common symptoms of non-celiac gluten sensitivity, reported by 64% of patients 20.
• Fatigue has been linked to imbalances in the gut microbiome and gut infections 22 24.
• Fatigue is a common symptom of leaky gut 21 23. 

Healing the gut may help to resolve chronic fatigue or low energy. 

• Treating leaky gut has been shown to improve symptoms of fatigue in patients with chronic fatigue syndrome 23. 
• Following a low FODMAP diet, which is a commonly recommended treatment for patients with small intestinal bacterial overgrowth (SIBO) and IBS, has been found to improve fatigue as well as digestive symptoms 25. 
• Probiotics may help to improve symptoms associated with gut imbalances, like fatigue, by balancing bacteria in the gut, reducing inflammation, and improving leaky gut 26 27 28 29 30.

Chronic Pain

Chronic joint and muscle pain are often related to gut imbalances. 

• Leaky gut and other gut imbalances have been linked to joint pain and inflammation in rheumatoid arthritis and related conditions 31 32 33 34 35 36. 
• Joint pain is a common symptom of IBS 37.
• Muscle and joint pain are symptoms of non-celiac gluten sensitivity, reported in 31% of patients 20. 
• One study showed that 48% of fibromyalgia patients also have IBS 37. 
• Gut dysbiosis (an imbalance between beneficial and harmful gut bacteria) has been shown to be a contributing factor to the development of osteoarthritis 38. 

Dietary strategies and therapies that target the gut have been shown to improve joint and muscle pain in both patients with gastrointestinal disorders and patients with chronic pain disorders 39 40 41.

• A 2019 clinical trial found that reducing dietary sugar, which contributes to intestinal inflammation and imbalances, improved muscle and joint pain for patients with IBS 39. 
• In one study, an elemental diet (a therapy that reduced gut dysbiosis) was shown to improve pain and joint stiffness in patients with rheumatoid arthritis 40. 
• Following a low FODMAP diet, which is often used to starve bacterial overgrowth in the gut, has been shown to reduce pain for patients with fibromyalgia 41.

Brain Fog

Brain fog, or difficulty thinking clearly, concentrating, or remembering, is commonly reported among patients with gut imbalances.

• Gut dysbiosis, or imbalances in the gut microbiome, have been shown to affect brain function 42 43 44.
• Patients with IBS report a lower sense of coherence as a common symptom 18.
• Brain fog is a common symptom of celiac disease and non-celiac gluten sensitivity 45 46. 

Diets and treatments that address inflammation and gut imbalances may help improve cognitive function and symptoms like brain fog. 

• A 2019 review showed that an anti-inflammatory diet can help reduce brain inflammation and leaky gut, which may improve brain fog 47.
• Probiotics have been shown to improve cognitive function in patients with fibromyalgia, Alzheimer’s disease, and among healthy older adults 42 48 49 50.

Bipolar, Major Depression, and Anxiety

Anxiety, depression, and other mental health conditions are often connected to inflammation and gut health 18 20 51. 

• Depression and anxiety are common in patients with digestive disorders like IBS and non-celiac gluten sensitivity 18 20.
• Leaky gut has been shown to contribute to depression and anxiety 51. 

Healing the gut with the help of probiotics and diet has been shown to help treat depression and anxiety 52 53 54.

• A systematic review of 21 studies showed that anxiety improved in more than 50% of patients with the use of therapies that support a balanced gut microbiome, including probiotics and diet 52. 
• A meta-analysis of 10 clinical trials concluded that probiotics were an effective treatment for mild to moderate depression 53. 
• A study found that following a low FODMAP diet led to significant improvements in anxiety, depression, and overall happiness among patients with IBS 54. 

That being said, a correlation (not causation) was shown in a 2022 meta-analysis of 66 observational studies between MTHFR gene polymorphisms (C677T and A1298C) and the occurrence of ADHD, bipolar disorder, and schizophrenia 55. While these findings are certainly interesting and do bear repeating to learn more about the relationship, their relevance is limited by 55:

• Many small samples (lack of power to make meaningful conclusions)
• Some unaccounted-for confounding factors (ethnicity, origin of control populations, differences in diagnostic criteria, and socioeconomic status)
• The unknown influences of clinical subtypes of mental disorders, gene interactions, and epigenetics.

Again, with the limited information that we have on the prospects of causation combined with the inability to do much to change your genes, it’s worth leaning into what you can control—your gut health—that’s been shown to have a marked difference in mood and cognition.

Estrogen Dominance 

Hormonal imbalances, especially estrogen dominance, are sometimes attributed to MTHFR gene polymorphisms. However, research does not support this connection. 

Estrogen dominance and its symptoms, including irregular menstruation, mood swings, heavy or painful periods, bloating, and conditions including PCOS, may actually be caused by imbalances in the gut microbiome, which have been shown to disrupt estrogen levels 56 57. 

While research is limited, preliminary evidence suggests that probiotics may help to balance estrogen and other hormones by improving balance in the gut microbiome and reducing inflammation 57.

Migraines and Headaches

Migraines and headaches are common symptoms of gastrointestinal conditions including IBS and non-celiac gluten sensitivity 20 58. One study showed that a diet aimed at reducing inflammation (in this case, a gluten-free diet) improved migraine symptoms among patients with non-celiac gluten sensitivity 59.

Diet, Lifestyle, and Gut Health Should Come First 

When it comes to your health, it’s very important to take a step back from the minutia and focus on the big picture. Research demonstrates, over and over again, the importance of health fundamentals. Diet, lifestyle, and gut health are among the most important factors when it comes to truly improving your health and resolving the symptoms commonly associated with MTHFR mutations. 

Key lifestyle factors, like eating an anti-inflammatory diet and getting enough sleep, lead to clear and meaningful health and wellness benefits, regardless of your genetic profile. 

Treatments that target the gut, including probiotics, can help to resolve many of the imbalances and symptoms associated with MTHFR gene variants.

To learn more about how to heal your gut and resolve your symptoms, check out my book, Healthy Gut, Healthy You. For more personalized help sorting out the true cause of your symptoms, my clinic is accepting new patients both virtually and in person. You can request a consultation here to get medical advice from our healthcare professionals.

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