Some individuals with Hashimoto’s may have a gene variation that prevents them from properly activating folic acid. This gene variation is present in up to 55% of the European populations, and some have been saying that this variation seems to be more common in those with hypothyroidism.
The gene involved is the MTHFR (Methylenetetrahydrofolate Reductase) gene, and genetic testing is available to show if someone has this gene variation. The MTHFR gene codes for the MTHFR enzyme, the enzyme that converts the amino acid homocysteine to methionine, a building block for proteins.
Individuals with low activity of the MTHFR enzyme may present with elevated homocysteine levels, which have been associated with inflammation and heart disease, birth defects, difficult pregnancies, and potentially an impaired ability to detoxify.
Nutrient deficiencies in Folate, B6 and B12 have been associated with elevated homocysteine.
Folate is present in the activated form in real foods such as asparagus, spinach and beef liver. B6 and B12 are mostly found in meats.
Betaine, (sometimes known as trimethylglycine), also helps with metabolizing homocysteine. This is known as the alternate pathway for homocysteine metabolism. Betaine can be found in whole grains like quinoa (which some individuals may not be able to eat), beets and spinach.
In addition to lifestyle changes, individuals with the MTHFR gene variation and high homocysteine levels may benefit from an activated version of folate, B6 and B12 , such as methylfolate (also known as L-5-MTHF Folate), Pyridoxyl-5-Phosphate (P5P), and methylcobalamin, respectively. This is because we may not be able to get enough of the needed nutrients from food alone.
Testing for homocysteine and the MTHFR gene variation is available through many labs. 23andme.com offers a test for the MTHFR gene and many individuals can get the tests from their physicians covered by insurance.
However, some may be concerned with this genetic information getting reported on insurance or to employers. A MTHFR variation or elevated homocysteine levels can potentially interfere with future insurance coverage that limits pre-existing conditions.
Patients can order their own confidential tests that will not be reported to insurance through testing through http://www.mylabsforlife.com/BloodTests/mthrf for MTHFR and through http://www.mylabsforlife.com/BloodTests/alllabsalpha for Homocysteine.
Many of the lifestyle interventions helpful for Hashimoto’s are also helpful for the MTHFR variation. Additional information about lifestyle interventions for Hashimoto’s can be found in my book, Hashimoto's: The Root Cause.
Does everyone with Hashimoto's have this variation, and does it make Hashimoto's worse?
Please note, not everyone with Hashimoto's has this variation. A recent study by Arakawa and colleagues of thyroid patients with Hashimoto's and Graves found that polymorphisms were as common in autoimmune thyroid disease as they were in the normal population.
Additionally, the authors concluded that the disease severity did not correlate with whether one had this gene variation or not.
Direct quote from the study:
Genotype and allele frequencies of the MTHFR +677C/T and +1298A/C polymorphisms showed no significant differences between healthy controls and patients with AITD; these genotype and allele frequencies did not influence prognosis of AITD.
I wish you all the best in your healing journey!
Your Thyroid Pharmacist,
Dr. Izabella Wentz, Pharm D.
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- Dell'edera, Domenico (08/2013). "Effect of multivitamins on plasma homocysteine in patients with the 5,10 methylenetetrahydrofolate reductase C677T homozygous state". Molecular medicine reports (1791-2997), 8 (2), 609.
- McNulty, Helene (10/2012). "Nutrition throughout life: folate". International journal for vitamin and nutrition research (0300-9831), 82 (5), 348.
- www.mthfr.net accessed 6/1/2013
- Zappacosta, Bruno, et. al. "Homocysteine lowering by folate-rich diet or pharmacological supplementations in subjects with moderate hyperhomocysteinemia". Nutrients (2072-6643), 5 (5), 1531.
- Prinz-Langenohl, R.; Brämswig, S.; Tobolski, O.; Smulders, Y.M.; Smith, D.E.C.; Finglas, P.M.; Pietrzik, K. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wildtype 677C→T polymorphism of methylenetetrahydrofolate reductase. Br. J. Pharmacol. 2009, 158, 2014–2021
- Prinz-Langenohl, R et.al. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C-->T polymorphism of methylenetetrahydrofolate reductase. British journal of pharmacology (0007-1188), 158 (8), 2014.
- http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ accessed 6/3/13
- http://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/ accessed 6/3/13
- www.mylabsforlife.com accessed 6/3/13
- www.zrtlabs.com accessed 6/3/13
- Walsh, Nancy Folic acid caner debate continues, accessed 6/3/13 at http://www.medpagetoday.com/HematologyOncology/ColonCancer/37008
- http://mthfr.net accessed 6/3/13
- Arakawa, Y. Association of polymorphisms in DNMT1, DNMT3A, DNMT3B, MTHFR and MTRR genes with global DNA methylation levels and prognosis of autoimmune thyroid disease. Clinical and Experimental Immunology, 170: 194–201