We were elated to welcome our first child into the world last month. After a long journey to become pregnant, which I have documented on this blog, it was wonderful to finally meet our baby and transition into the next phase of our lives as a family. Of course, the transition itself wasn’t without issue (seems to be the way of things in my family – rarely do things go smoothly or to plan). I could not have had a more opposite birth experience than what I wanted. We fell victim to the “your baby must be out at 42 weeks” dogma that rules in our state and I had to be induced. This led to every intervention under the sun and in the end I had a pretty harrowing and traumatic birth experience. I include the hospital setting in this. Hospitals are such toxic places, full of both material and psychological stressors. Aside from the constant interruptions, one can expect garbage food and noxious supplies at every turn. I’ll need a year just to detox from the vinyl blood pressure cuffs and IV tubes. I left exhausted and feeling like a pin cushion. Thankfully our baby is healthy and we are both recovering well.

baby feet

If there is a silver lining from the experience, it’s that I learned a lot and can now share with all of you, particularly how childbirth and breastfeeding can affect or be affected by MTHFR mutations. In particular I want to discuss two major areas where your MTHFR mutations can come into play and affect your childbirth and breastfeeding experience, both of which are interrelated.

The first issue is toxins. While I wanted a completely drug-free, natural childbirth, this was not possible for me with what I had to have for an induction. I received Pitocin, which led to an epidural. Prepared as I was for dealing with labor pain, Pitocin contractions are not “natural” and I struggled with them, especially after the 36 hours I had gone through with Cervidil prior to starting the Pitocin. I had little sleep and no food. It wasn’t happening. So here are several drugs you may encounter should you end up in the hospital for your birth. I would never choose an induction but as I have learned sometimes these things are inevitable despite our best intentions. I have often felt sorry for us in our postpartum days, thinking how did I of all people end up with all this? But I’m not special. And I also realize that many women choose these interventions every day. For those who have this choice, I want to be sure to point out some things to consider, especially if you have MTHFR mutations.

All drugs have to be detoxed by the body. As we know, MTHFR mutations make it more difficult for the body to process substances and eliminate them from the body. This includes not only any pain medications received for labor or C-section, but also the Pitocin. Pitocin is now routinely used in hospitals for preventing hemorrhage as the placenta is removed, so you can expect to receive some even if you weren’t induced. This synthetic form of the “cuddle hormone” oxytocin tends to hang around in your system for a while. For those of us with MTHFR mutations, that’s a problem as it’s even harder to detox. C-sections often require postpartum pain medications, like hydrocodone, which contains Tylenol (another MTHFR no-no because it depletes glutathione). Aside from putting extra stress on your system, these drugs (or having a C-section) can also cause problems with breastfeeding.

As aware as I was about the problems I would have with the interventions discussed so far, I had no idea what a challenge my experience would present to breastfeeding. Despite having a labor that progressed beautifully once it got going, I still ended up with a C-section after two hours of pushing. That’s another story. A C-section is what I most wanted to avoid but I had no idea that one of my reasons should have been the challenges it presents to breastfeeding. Women who have C-sections can experience delays in milk production. Having a lot of Pitocin in your system can also delay your milk coming in. We did not learn about this until the day we were discharged from the hospital when we finally were seen by a good lactation consultant (LC). Luckily this LC was also versed in MTHFR and I ended up learning quite a lot from her.

For milk supply, the first two weeks are crucial. If you have interventions such as Pitocin and/or a C-section, you’ll want to get additional support from a LC and may need to start pumping very soon after the birth. C-section moms can have a delay in their milk coming in of 10 days or more. This happened to me and I needed a lot of help to get back on track. We had to supplement with donor milk the first weekend home and had I not gotten immediate help from my doula and a LC, I don’t know where we would be right now. I think having MTHFR mutations may exacerbate this problem because you have a harder time detoxing substances like Pitocin. And if you had a stressful birth as I did, this can further impair milk production.

The LC at the hospital also talked to us about teas and supplements containing fenugreek that are commonly used to increase milk supply. She mentioned that using fenugreek while breastfeeding can potentially cause peanut allergies in babies when there is a history of food allergy in the family. I had never heard of this before so I want to mention it here for your further research and exploration.

Finally we got onto the subject of tongue and lip ties, which is now an issue I have personal experience with.

Tongue-Tie and Lip-Tie

As a MTHFR-aware person, of course I had heard of tongue-tie. What I didn’t realize is how much they affect my family. I was surprised to learn that I have one, though it is quite flexible and I am able to touch the roof of my mouth with my tongue. I was also breastfed as a baby and didn’t have any issues with that. My husband, on the other hand, has a more significant tie that doesn’t allow him to touch the roof of his mouth, and he did have breastfeeding problems as a baby. During our meeting with the hospital LC, she identified a posterior tongue-tie in our baby as well as a lip-tie. We later met with another LC who referred us to a pediatric dentist to further evaluate the ties.

tongue tie

My very elastic tongue tie

Tongue-tie, also known as ankyloglossia, is a midline defect that seems to be associated with MTHFR mutations. The tongue-tie is actually a short frenulum that restricts tongue movement. There are four types depending on placement in the mouth. Tongue tie can cause a variety of problems with breastfeeding, including nipple and breast pain, low milk supply, plugged ducts, mastitis, poor latch and suck, poor milk transfer, falling asleep at the breast and early weaning.

Although I thought I was well-supplemented with the right forms of folate and vitamin B12 during pregnancy, our child still had this defect. Knowing exactly how much to supplement is, of course, a common dilemma for those of us with MTHFR. Tongue-tie is also hereditary, which we have noticed within our family. Of course, breastfeeding is a priority for us, so we were anxious to correct this problem as soon as possible – the earlier you address tongue and lip ties the better because the first two weeks are really critical to breastfeeding progress. So we went ahead with water laser surgery, which was a success.

Of course, nothing is a quick fix. In fact, going ahead with the surgery sent us down a bit of a rabbit hole. We had to do some exercises to massage the open cuts created by the laser. This kept the frenum from reattaching but also caused some distress to the baby. Our major issues were gas and baby falling asleep after a very short time on the breast and failing to transfer much milk. These didn’t resolve right away for us, though apparently some people do experience instant dramatic improvements after the frenotomy procedure. We were told that it would likely be four weeks before our child’s sucking improved. Because the baby has been motility impaired since being in the womb, there is muscle memory and a need to relearn how to use the facial muscles to create an optimal suck. Muscles beyond the tongue and lips would have been involved in helping compensate for the prior movement restrictions. It’s like trying to throw a ball when your arm has been in a cast your entire life. The entire fascia must be relaxed and regrouped.

We read about CranioSacral Therapy (CST) as an effective complementary treatment to the frenotomy and began those sessions last week. So far we have noticed quite a bit of improvement as a result but we are still not completely on track with our feedings. I do a lot of pumping and supplementing breast milk by bottle. Of course this is not at all what I thought our breastfeeding experience would be like but we are doing the best we can and I feel fortunate that we received so much fast help with all of these challenges from the local holistic birth and breastfeeding community. My milk supply is ample.

Unfortunately sometimes our plans just don’t work out. That was certainly my experience with birth. But mentally I have been working hard to accept what happened and move on – the health of our child going forward is the top priority. I look forward to sharing our experiences as a family with MTHFR, particularly as these related issues arise.

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MTHFR supplements

One of the most frequently asked questions on this site is what dosage of vitamin supplements should one take to address MTHFR mutations. The answer to that is as individual as each of us but there are some guidelines put forth by notable practitioners in the field. In today’s guest post Kiki Kish* explores some of these approaches to give you a starting point. Remember that we are not doctors and the information contained in this post is for informational purposes only – you should always check with a doctor or licensed medical practitioner before beginning any sort of supplement regimen.

Supplementing for MTHFR defects requires some research as to approaches as well as some trial and error. One size does not fit all. I liken the right protocol to a favorite family recipe – everyone seems to have their own version that’s the best because they tweaked it over time. It’s the same way with various approaches to supplementing for MTHFR. Learn about them, tweak them to suit you and then perhaps tweak them again as your metabolism changes, conditions improve or as you learn more about other contributing deficiencies. I’m providing an overview of some approaches for supplementing MTHFR and some comments on common nutritional deficiencies that may have a bearing on your MTHFR protocol.

Dr. Ben Lynch’s Approach

MTHFR.net is a good and well-recognized resource of information for MTHFR defects based on Dr. Ben Lynch’s extensive experience. Dr. Lynch provides a protocol for the MTHFR defect C677T here and while he doesn’t also indicate an approach for 1298C, you can assume the protocol is the same. His general recommendation for starting out is to start with B12 for several days at low dosages, and start adding MTHF folate at a ratio that is half the amount of B12, increasing every several days until you feel better or reach the point of overmethylation symptoms. He also notes that MTHFR is not just about folate and suggests a number of other supplements (some of which you can buy on his site) as well as lifestyle recommendations that would benefit anyone. Dr. Lynch is not a fan of large doses of MTHF folate and certainly not a fan of any dose without the accompaniment of B12 among other nutrients and minerals. Like many families including mine, Dr. Lynch’s family of five all have different MTHFR defects, but he says none of them take more than 400mcg of folate per day. Accompanied by double the amount of B12, that is probably a good base recommendation for people without many health concerns who have MTHFR defects. This is similar to the basic recommendation that my local center for integrative medicine recommends of 500mcg of folate and 1mg of B12 daily for anyone with the defects.

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Dr. Amy Yasko’s Approach

My previous post provided direction on how to get a number of useful reports from your 23andMe genetic data including Dr. Yasko’s Methylation Pathway Analysis (MPA). The MPA provides a good discussion of methylation, the impact of various SNPs as well as a suggested supplement protocol based on your individual genetics. If you haven’t had your genome mapped yet, you can still access Dr. Yasko’s Simplified Protocol right on the knowyourgenetics home page. Her protocol addresses methylation by first laying groundwork before starting B12 and folate supplementation. The six steps of the protocol include 1) balancing certain supplements including a multi and B complex, 2) providing other shortcut support that supports detox as toxic loads can interfere with methylation protocols 3) balancing lithium levels, 4) determining your ideal form of B12, 5) Implementing the remainder of long route support which includes titrating the amount of MTHF folate you need via drops and 6) additional support based on your particular nutrigenomic profile.

One part of her recommendations that is very important is the type of B12 that is best for you based on two particular genes, COMT and VDR Taq. This table is duplicated below.

Best Type of B12 based on COMT V158M and VDR Taq SNPs

COMT V158M VDR Taq B12 types that should be tolerated
– – ++ (TT) All three types of B12
+- (Tt) All three types with less methyl B12
— (tt) Hydroxy B12 and Adenosyl B12
+- ++ All three types with less methyl B12
+- +- Hydroxy B12 and Adenosyl B12
+- Hydroxy B12 and Adenosyl B12
++ ++ Hydroxy B12 and Adenosyl B12
++ +- Hydroxy B12 and Adenosyl B12
++ Mostly Hydroxy B12

When I first started supplementing for MTHFR, I did not pay much attention to the type of B12. Once I found this table, I tried the recommended combination and it made a big difference for me and also for my husband (COMT – -, VDR Taq ++). His recommended type of B12 is the top line of the table. I further tweaked his B12 as he seemed to do best with adenosyl and methyl. So while I’ve seen sites that have recommended that people try different types of B12 to see which works best, I’m a proponent of this table as a starting point and really appreciate the work that Dr. Yasko and colleagues put in to develop it.

The right type B12 is as important as folate. In fact, a B12 deficiency alone can cause a variety of conditions and ailments that can be as serious as the conditions attributed to MTHFR defects. For this reason, many feel the supplementation of pharmaceuticals (medical foods) like Deplin and others in high amounts without recommending associated B12 or other cofactors is a real mistake that can make many symptoms worse rather than helping.

Just a bit more about B12. There are four forms, the three mentioned in the table above as well as cyanocobalamin. Cyano has to convert to hydroxyl before it can be converted to the methyl and adenosyl forms that the body can use (these forms are sometimes referred to as B12 coenzymes). Hydroxy is supposed to have a longer half life than any other form and adenosyl is the only form stored by the liver.

Recommended Approach Based on Homocysteine Level

One of the generally understood problems of MTHFR defects is that they cause high homocysteine. Homocysteine (Hcy) is a naturally occurring amino acid that is produced as part of the methylation cycle and is an important indicator of how efficiently you are methylating. High Hcy is implicated as a factor that can cause many serious problems from heart disease to Alzheimers. Dr. Brady, author of The H Factor Solution recommends a number of supplements that work synergistically with dosages based on Hcy values shown in the table below. He believes that your Hcy level is the best indication of whether the B vitamins are doing their job as opposed to checking B12 or B6 levels for example.

Daily Nutrient Needs Based on Homocysteine Score



No Risk

H < 6

Low Risk


High Risk


Very High Risk

Above 15

Folate 200mcg 400mcg 1,200mcg 2,000mcg
B12 10mcg 500mcg 1,000mcg 1,500mcg
B6 25mg 50mg 75mg 100mg
B2 10mg 15mg 20mg 50mg
Zinc 5mg 10mg 15mg 20mg
Magnesium 100mg 200mg 300mg 400mg
TMG 500mg 750mg 1.5-3g 3-6g

When I first had my husband’s Hcy measured, it was in the very high risk category at 17.4 (and that was after supplementing him for several months with folate and B12). Four months later, after following a combination of these three approaches, it’s at 11.1. And while there is conflicting research as to whether lowering homocysteine correspondingly lower the risk of heart disease, Alzheimers, etc, he feels a lot better and I anticipate continuing improvement.

The methylation cycle has four key steps that change homocysteine into methionine, methionine into SAMe, and then SAMe back to homocysteine that needs a methyl donor so that it can start the cycle over again. The enzymes that facilitate this metabolic process need the cofactors B6, B12 and folate, the active forms of B vitamins. TMG, also known as betaine, is an important methyl donor and is included in all the protocols discussed here. Many people may be deficient in betaine due to metal toxicity, inflammation and stress. Dr. Brady considers TMG as the best (and most cost-effective) way to generate SAMe in the body, which he calls the “master tuner”. SAMe helps make or activate important neurotransmitters that can help with mood, chronic pain and food cravings. Interestingly, TMG is an FDA-approved treatment for a rare genetic condition (CBS deficiency) that causes high homocysteine because it “methylates” homocysteine, removing it from circulation.

Note that while most other approaches recommend double the amount of B12 in relation to folate, Dr. Brady’s does not. What he does recommend is that as your health improves, you may not need as much of these nutrients as you did initially and can lower your dosage. He also recommends dividing the doses of the B vitamins within the day. B vitamins are water soluble and will leave your body based on your hydration status (yep, that’s the Bs in bright yellow urine). We take sublingual B12 and folate when we wake up and after lunch. That seems to work well for us. I’ve heard some feel well dividing them into three doses. Most people don’t recommend taking them later in the evening because they are energizing and not conducive to sleep.

Why You Need More Than Folate, B12 and B Complex for MTHFR and Health

Dr. Linus Pauling, two-time Nobel Prize winner, said you can trace every sickness, every disease, and every ailment to a mineral deficiency. Without minerals, amino acids and enzymes don`t work and so vitamins and other nutrients don`t get broken down and absorbed properly and we end up with major deficiencies in both vitamins and minerals. In relation to MTHFR, most approaches concur that a full combination of nutrients works much better than any two in isolation. Many are synergistic and don’t work at all without other cofactors. Methylation can’t even take place without a magnesium molecule. B6 is converted to its active form by zinc, so a zinc deficiency would make taking B6 useless. Vitamin B6 has been shown to improve the absorption of magnesium as well as other minerals into cells. Calcium works synergistically with vitamins D and K2 and may actually be harmful if not taken with K2.

People are deficient in many vitamins and minerals due to a number of reasons and it may not simply be diet. The typical advice of eating five servings daily of fruits and vegetables is still the best, but it doesn’t buy you the nutrition that it did in the 1940s due to the nutrient depletion in the soil, the use of chemicals in farming, hormones in livestock and other factors.

Here is a list of the most common critical deficiencies:

  • All the B Vitamins, particularly folate, B12, B6 and B2
  • Calcium
  • Magnesium
  • Iron
  • D3
  • K2
  • Selenium
  • Vitamin A
  • Iodine
  • Lithium
  • Essential Fatty Acids

Most of these can be found in a good multivitamin/mineral supplement, but not all of them. Both Dr. Lynch and Dr. Yasko have multivitamin formulas, and they don’t cover all the bases. There are three particular deficiencies that deserve special mention: lithium, iodine and essential fatty acids. Most multivitamin/mineral supplements do not contain these important nutrients.

Lithium, Iodine, and Essential Fatty Acid Deficiencies

Lithium can only be found in water that comes out of the ground, so that would be spring or mineral water and not bottled water labeled as purified or drinking water. Areas that have sufficient lithium in the drinking water have lower rates of crime, homicides, mental illness and suicides and higher rates of longevity (a good discussion can be found here). I can actually go to a spring that’s about a five minute drive away and get spring water right out of the ground (find a spring near you). Water with sufficient lithium would provide about 2mg/day. A safe daily low dose is considered 3-5mg. Lithium is neuroprotective, can help with mood, inhibits beta-amyloid secretion, and also prevents damage caused by beta-amyloid protein once it’s been formed and enhances nerve cell DNA replication. This is obviously beneficial in preventing Alzheimers. Lithium also helps to chelate or remove aluminum from the body. Hair mineral tests on family members, one 19 and one 75, showed they both had harmfully high levels of aluminum indicating that they were not able to detoxify this metal. As you may recall, one of the problems MTHFR creates is an inability to detoxify things like aluminum and other metals; thus, lithium may be beneficial for those of us with the defect. I found a mineral supplement with 4.5mg and both my daughter and I felt a positive effect on mood after taking it. This is far from the amount used in prescriptions for serious mental illness which is typically 300mg.

Iodine is important for thyroid function, breast health, bone marrow, the immune system and mental health. A deficiency can cause weight gain, low energy, depression, cardiovascular disease, cognitive decline, and a variety of cancers. Most experts do not believe that the intake of iodine in iodized table salt is sufficient for good health. Selenium is synergistic with iodine helps the body absorb it. The Japanese have an average daily intake of 12.5mg from their high consumption of sea vegetables as well as fish. Consequently, the Japanese have rates of breast cancer that are 1/3 the incidence for US women. They also have a lower incidence of other types of cancer and heart disease. Iodine-deficient breast tissue also shows alterations in DNA and increases in estrogen receptor proteins. Women with fibrocystic breast disease (FBD) were given iodine in doses between 3 and 6mg and it reduced the symptoms of FBD significantly without side effects. Iodine also suppresses tumor growth and causes cancer cell death in breast cancer in cancer-prone rats, reducing tumor rates 2.5 fold. Although my local women’s hospital told me my risk was low for breast cancer about eight years ago, given that my sister was diagnosed with breast cancer at age 40, and I’ve had three stereotactic biopsies, a lumpectomy, a history of FBD along with estrogen exposure from decades of birth control plus being heterogenous C677T, I’m taking iodine. So I’m guessing when my doctor said there is nothing that can be done for FBD, I doubt she was considering possible beneficial integrative medicine approaches.

Regarding essential fatty acids (EFAs) the Omega 6 to omega 3 ratio in the US is one of the most unhealthy in the world. The average ratio in the US is 15:1 but can be as bad as 50:1. The healthy ratio is 1:1 to 5:1. A healthy ratio will reduce the risk of breast cancer, and reduce the symptoms of arthritis, allergies, cardiovascular disease and depression among many other conditions. Elevated omega 6s contribute to all inflammatory diseases. Probably the worst offender food is omega 6 vegetable oils followed by processed foods. You can fix your ratio by decreasing the omega 6 foods and increasing the omega 3 foods like the oily fish in these recipes, certified pure fish oil supplements containing DHA and EPA, or other foods such as flax, walnuts, cauliflower, brussel sprouts, broccoli, squash and collards. In doing some research on this important ratio, I downloaded a not very user friendly tool called Kim. I tried to input my diet in numerous ways but could not get my ratio down even when eating salmon three times a day. But by adding 1 Tbl of flax oil, my ratio was in the optimal range. So 1 Tbl of flaxoil, preferably organic or ground flax seeds (which go great in oatmeal) is going to have a positive effect of your ratio of these essential oils. I think of EFAs as a brain lubricant and just as important to your brain as oil is in your car. Your brain is the fattest organ in your body, comprised of 60% fat, so make sure it gets enough good fats!

For people with MTHFR defects, the minimum supplements recommended by the approaches reviewed here are folate, B12, B6, magnesium, Zinc and TMG. Due to the positive synergistic effect of all the vitamins and minerals on the B vitamins, the best approach would be to make sure you don’t have any deficiencies by taking a good multi, supplementing to improve your ratio of EFAs and consider supplementing iodine and lithium. Like the advice of Linus Pauling, avoiding these deficiencies would go a long way in avoiding most diseases and improving or resolving many adverse health conditions.

Always add supplements one at a time slowly to assess your tolerance and remember that methylation is a critical metabolic process. Always check with your doctor or a qualified practitioner before starting any methylation related protocol.

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About Kiki Kish*

In 1992, my husband, 24 years my senior, was diagnosed with Hepatitis C. Hep C is a serious liver disease without a cure, so I explored alternative medicine. Now at 75, he is the poster child for transplants and health with Hep C, mostly because I became a self-navigating nutritionist, naturopath and now a budding nutrigenomist. In 2001, my son was diagnosed with Autism. Same thing, no cure, but I used supplements and nutrition; he’s in college making As and Bs. These two situations along with a parent with cancer caused me to do two decades of research on alternative therapies. I was often asked if I was in the medical field probably because I did my research to try and make sure that the doctors were doing a good job. I had problems for which I was prescribed medication, but the doctors, as usual, didn’t discuss what might be causing it. I determined I had a histamine intolerance problem, and in researching that for myself, I found that compromised methylation could be a cause. That led to MTHFR (I’m heterozygous for 677C). Once I did the research on it, as an engineer (M.S), I found the statistical prevalence of the defect and the risk of problems and diseases it causes or contributes to astounding. Everyone in my family as well as those in my extended family who have been tested have the defect and have many related conditions. And that’s how I arrived here. 

* Name has been changed to protect privacy.

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