HPN 8: Mindful Fertility, TTC, and Managing MTHFR and Folate Intake

July 26, 2019

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Intro Banter

• Julie shares about her sciatica, and despite the setback focusing on what she can do.
• Wonderland trail around Mt. Rainer.
• Can’t get down about injuries, there are lessons to be learned!
• Today’s topic on pregnancy:
  • Pregnancy is a sensitive and emotionally-charged topic.
  • The goal of this show is to help you decide what is best for you, know the right questions to ask, and help you do your best.
  • Pregnancy is mysterious in many ways, and so much of it is out of our control.

 

Casey Asks

Trying To Conceive

I am a longtime listener and have learned a lot from you guys throughout my ultra-endurance career. This question has nothing to do with any of that. I listen to all the usual health and fitness podcasts but have had a difficult time getting any real information.

My wife and I have been trying to get pregnant for about 8 months unsuccessfully. Its crazy how much we have learned about the reproductive system over that time and I am somewhat embarrassed to admit I was (am) completely clueless how to have a baby. There is so much more to it than the obvious.

My question for you ladies is what type of diet/supplements/vitamins or other protocols should we be eating/doing to put our bodies in the most fertile, primed for reproduction, state?

Our diets are not bad, not perfect but generally we eat a lot of veggies and meats from a local farm.

I am an endurance athlete, my wife not so much. Actually I’m concerned that my training is partially to blame. I have run multiple ultramarathons and tons of marathons and Spartan races over the past few years. I do feel as though my testosterone had taken a hit due to all the miles on the road. I’ve actually taken the past year off and recently feel like it’s starting to rebound. I bought a Peloton (spin bike) and started to run a little again lately as I’ve committed to an ultra Ragnar (32 miles over a day and a half, race is not until October) so my plan is to maintain fitness without compromising my health. 

What the Coaches Say:

• Truths:
  • Getting pregnant is often harder than many of us expect it will be.
  • Sex cannot be a chore! Keep it fun! Sex can be destroyed when it’s all about ovulation and pregnancy.
  • Timing your ovulation to conceive can mess with your head and it’s important to not get overly obsessed with data.
  • Don’t just point fingers at the woman, a man’s health needs to be checked too.
• Get male sperm tested
  • Volume
  • Count
  • Motility
  • Form
• Male infertility causes and signs
  • Dietary deficiency, environmental toxicity, and so on.
  • Considered if there is low sperm count, high abnormal sperm levels, or low sperm motility due to testicular causes such as chromosomal abnormalities or testosterone deficiency.
  • Stemming from the HPG or more localized (most common) resulting from testicular inflammation.
  • Note your stress response and HPA axis function.
  • Up your antioxidants
  • Vitamins A,B,C,E
  • Zinc
  • Selenium
  • Sperm more vulnerable than eggs so keep them safe!
  • Avoid fried food, too much alcohol, etc.
• Tips
  • 72 days for sperm to mature
  • 90 days for egg to mature
  • Avoid extreme training during this time (i.e. do a mellow 10k instead of ultra)
  • Avoid high heat exposure, such as no sauna or spas
  • Bring exercise down to normal people standards
  • If not active enough, get in more exercise to increase circulation and
  • Tawnee switched from heavy running to more mellow activities such as SUP, taking her intensity down a notch
  • There is no magic pill to get pregnant, you have to look at your lifestyle.
  • Bond together as a couple and keep the romance alive.
• Supplements (for both guy & gal other than prenatal)
  • For woman: Prenatal (Thorne Research’s Basic Prenatal)
  • For man: Mutli (Thorne Research’s Multivitamin Elite)
  • For both:
    • CoQ10 (Designs For Health Q-Evail)
      • Both male and female fertility; egg health, increased fertilization
    • L-carnitine (Designs For Health Carniclear)
      • Improves sperm health and overall female fertility
      • Several studies found that both LC and ALC supplementation improves disorders such as polycystic ovary syndrome [12], endometriosis [19] and amenorrhea [17]. Carnitines are reported to increase gonadotropins and sex hormone levels as well as improve oocyte health [17].
    • Fish oil high in DHA (Nordic Naturals ProOmega)
    • High dose Liposomal Vitamin C (Empirical labs)
    • NAC or Liposomal Glutathione (Empirical labs)
    • Vitamin D 2,000-8,000 IU depending on status (Thorne Research)
• Diet
  • Stabilize blood sugar
  • Low glycemic foods
  • High antioxidants to boost egg & sperm health
  • Whole food plant-based diet + high quality meats, poultry, fish protein
  • Don’t oversupplement
  • Nothing will replace a quality whole food diet so don’t just rely on supplements
• Health testing
  • DUTCH test – cycle mapping option for females
  • Know the state of your adrenal and endocrine system
  • Morning cocktail – high quality salt with lemon and water in the AM to help adrenals, increasing circulation, staying hydrated
• Mental side
  • There are beautiful lessons to be learned from even the hardest of times.
  • If you’re a Type A try to loosen the reigns a bit. Don’t overanalyze every little thing.
  • Don’t ever say to a couple trying to get pregnant “just relax!”
  • You can learn a lot about yourself in your fertility and pregnancy journey.

 

Calesse

Prenatals When You Have MTHFR

Quick question, do you have any recommendations as to what type/ brand of prenatal vitamins I can take as my husband and I look towards beginning to start a family? I have the MTHFR defect so I don’t process folate well (especially the non methylated kind). I want to protect my future child from neural tube defects despite this mutation I have. Much appreciated.

What the Coaches Say:

• Try not to go down the Dr. Google rabbit hole of fear.
• Work with your doctor!
• Basics
  • Folate is water-soluble natural form (B9); folic acid is synthetic form.
  • Both folic acid and folate are converted to active form 5-MTHF in the intestines and liver, but with folic acid the ability for the liver to convert this is limited.
  • If eating foods fortified with folic acid, you may be getting excess amount which is linked to health risks (see below). There are no risks for eating fresh foods with naturally occurring folate.
  • Need to be careful of eating processed foods fortified with folic acid (e.g. cereals, breads, etc.), this is not a good solution. Instead, look to natural foods with naturally occurring folate (list below of top foods).
  • Organic foods will not be fortified with synthetic vitamins.
  • What about blood testing to check levels?
    • Blood levels may be normal but this doesn’t mean you’re ok, blood levels may reflect unmetabolized folic acid in the bloodstream, and there could be deficiency because body not converting the supplement form to the active form, 5-MTHF.
    • Serum levels do not reflect total body saturation levels. No prospective studies have evaluated whether routinely monitoring folate/folic acid levels during pregnancy improves outcomes.
  • Pregnancy
    • Folate and folic acid can help prevent birth defects like neural tube defects.
    • Also, folate aids the complete development of red blood cells, reduces levels of homocysteine in the blood, and supports nervous system function.
  • MTHFR
    • An important enzyme in the metabolism of folic acid and dietary folate, to turn it into active form of l-methylfolate for body to use.
    • Crucial for methylation and reproductive function.
    • 23 and me data – extract raw data and find out if you have a MTHFR polymorphism
    • When an MTHFR mutation is present, the external supply of synthetic folic acid is unable to be fully processed, so it accumulates and can potentially cause complications for fetal health and otherwise.
• MTHFR polymorphisms
  • In the United States:
    • Approximately 30% of the population is heterozygous (C677T)
    • Approximately 10% is homozygous, TT or CC alleles
    • Other numbers have shown that 3 out of 5 Americans have some form of MTHFR
  • Heterozygous for MTHFR-CT – about a 30% reduction in activity over the “normal” state.
  • Homozygous (TT or CC) – about a 70% reduction in activity over the normal state.
    • The TT genotype is associated with elevated plasma homocysteine levels more than CC genotype, in conjunction with low serum folate levels. At any given level of folate intake, TT homozygotes have lower plasma folate levels than non-homozygotes.
• MTHFR in pregnancy
  • Lowers ability to convert and use active form of folate. Folate needed for fetal development and health, prevention of neural tube defects and other aspects of fetal health.
  • Just because you have MTHFR does not mean your baby is at risk!!! Especially if you’re heterozygous.
  • Eg: this study showed no association between MTHFR and repeated pregnancy loss.
  • This 2006 meta-analysis of 26 studies of 2120 women with unexplained recurrent pregnancy loss and 2949 controls did not find that the MTHFR C677T genotype was a risk factor for this outcome, except in a Chinese population.
  • That said, folic acid supplementation has been recommended for decades now, and over time we have seen that this has helped lower the rate of neural tube defects.
  • Food started getting fortified with folic acid in 1998.
  • More and more people showing up with MTHFR mutation. What’s that about? A link to the current state of today’s food, environment, etc.?
  • Tawnee mentions a study that recommended women be cautious of low carb and organic because those diets do not have foods fortified in folic acid, yet it did not recommend the obvious: eating natural whole foods rich in folate.
  • Whole foods naturally high in folate may lose folate content once cooked, thus why many doctors will recommend eating fortified food.
  • Dr. Ben Lynch says to stay away from folic acid because it can block receptors and cause a deficiency or malabsorption. Even if you’re eating foods with folate, if having too much synthetic folic acid this will block receptors and could be problematic.
  • Foods to eat:
    • Raw & Partially cooked greens
    • Liver
    • Lentils, beans
  • Prenatals: Don’t freak out if you’re taking one with folic acid, just consider switching to one with folate.
  • MTHFR deficits can be overcome with a healthy lifestyle.
  • MTHFR aids in methylation, which is is helpful for regeneration and regulation of cells, imprinting genes, epigenetics, processing amino acids for neurotransmitters, detoxification of compounds like Homocysteine (Hcy), and DNA repair.
• How much folic acid is safe?
  • Many resources say that up to 1mg/day range (plus dietary folate) is safe. But still, why not just take folate given the data we have on this topic.
  • Folic acid becomes unsafe at levels of 4-5mg/day.
  • Some OBs may recommend a high dose of folic acid for women in first trimester if they are high risk for NTD and DO NOT have MTHFR. (But why not take folate instead to be safe?)
  • Even folate should not be over-supplemented, more is not better.
  • There is no consensus about what blood concentrations of unmetabolized folic acid might cause harm (this form is due to the inability of the body to convert synthetic folic acid to a natural form). According to research, the upper limit of safety appears to be around 59 nmol/L.
• Why is it better to supplements with folate (5-MTHF) especially if you have an MTHFR mutation
  • Thorne basic prenatal has 1,000 mcg of 5-MTHF(1.7mgDFE)
    • Other brands: Designs for Health Prenatal Pro, Pure Encapsulations Prenatal Nutrients, Seeking Health Optimal Prenatal
  • By supplementing with the active form of folate that is ready to use by cells, aka 5-methyltetrahydrofolate (5-MTHF), the mutated MTHFR is bypassed and cells can still get the active enzymes needed for crucial biological processes.
  • Also by eating naturally active folate through leafy greens, etc., it will not build up and cause clots in the blood responsible for miscarriages and stillbirths.
  • Studies show at least 600-800 mcg of active 5-MTHF has beneficial results, especially in women with previous infertility or pregnancy loss.
  • Chris Kresser recommends 800-1200 mcg folate for preconception and 600-800 mcg during pregnancy.
  • The conventional use of large doses of folic acid (5 mg/day) has become obsolete. Regular doses of folic acid (100-200 mcg) can be tolerated in the general population but should be abandoned in the presence of MTHFR mutations, as the biochemical/genetic background of the patient precludes a correct supply of 5-MTHF, the active compound. A physiological dose of 5-MTHF (800 mcg) bypasses the MTHFR block and is suggested to be an effective treatment for these couples. 
• Best dietary folate sources & MTHFR foods:
  • If having nausea, make the most of smoothies and soups to get in foods that otherwise taste gross.
  • Avocado, spinach, asparagus, beets, romaine lettuce, lentils, brussels sprouts, broccoli, green peas, turnip greens, mustard greens, parsley, collard greens, cauliflower, beef liver and chicken liver, turkey, papaya.
  • Eden organics—brand of beans that are already soaked and sprouted!
  • Foods high in K2, along with supplementing—Thorne Vitamin D3/K2 drops have you covered if you’re not getting K2 in prenatal or foods.
  • Drink your spinach or broccoli water!
  • Also a diet abundant in antioxidant-rich foods helps with an MTHFR mutation. Phil Maffetone recommends apples with the skin, for example. Also high quality omega 3 fish oil, B complex and magnesium for MTHFR (Bs and Mg in prenatal are ok).
  • Choline is crucial for MTHFR too. Helps to lower Homocysteine. Get from egg yolks.
  • Foods with B vitamins, B complex supplement if needed.
• Get your homocysteine level checked too!
  • With MTHFR mutations, there may also be a build up of homocysteine, which not only has the ability to damage blood vessels via accelerated atherosclerosis, but creates a hypercoaguable state that can form clots leading to early fetal loss and repeated first trimester miscarriages.
  • In normal pregnancy, homocysteine concentrations fall. Disturbance of maternal and fetal homocysteine metabolism has been associated with fetal neural tube defects, with various conditions characterized by placental vasculopathy, such as pre-eclampsia and abruption, and with recurrent pregnancy loss.
• Some hope if you have had pregnancy problems & MTHFR:
  • “In our Georgia centre, 22 patients with recurrent miscarriages, failed IUI and/or IVF attempts were noted and tested for MTHFR mutations. They tested positive, either homozygous or heterozygous for the MTHFR mutations, and were started on 800mcg QD of 5-methyl THF. Upon follow up, 100% of these patients conceived successfully, many within only 2-3 months of starting the supplement. Another study out of France looked at 30 couples with infertility lasting 3-5 years, where at least one member was a carrier of one main isoforms (C677T and A1298C), who were treated with 500-800mcg QD of 5-methyl THF for 2-4 months. Of this group, 12 conceived spontaneously and 15 others with the help of assisted reproductive therapy, with the remaining still under treatment [8].”
• Signs of folate deficiency
  • Paleness
  • Sore, red tongue
  • Bleeding gums, although this can happen during pregnancy with increased blood volume
  • Diarrhea
  • Irritability
  • Insomnia
  • Fatigue

 

 

 

 

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