Up until now, having a gene SNP in methylation enzymes (such as MTHFR), elevated homocysteine, or before and during pregnancy, has typically prompted the use of supplemental methylation cofactors such as B12, folate, B6 and betaine. Often at higher level doses. Yes, it’s right to correct or avoid too little methylation activity in the body, but it’s time to expand our thinking when it comes to this fundamental cellular process.
Not only are there many more ways that we can support healthy methylation, but research also points to a very strong need for caution when it comes to bluntly forcing methylation reactions forward with supplements. Excessive methylation states can also be detrimental; our goal, first and foremost, should be balance.
In this brief podcast, catch Dr. Fitzgerald and Romilly Hodges as they discuss their new eBook Methylation Diet and Lifestyle. Find out:
- The reason why we need to take a more sophisticated and holistic approach to methylation support
- What other factors should we consider when looking to support healthy methylation status
- How to use supplements more judiciously in the context of these other factors
- How to start to think about methylation balance
- What you can expect to find in the eBook
Romilly Hodges: Hello, everyone. This is Romilly Hodges, the staff nutritionist with Dr. Kara Fitzgerald. Life is very busy here at the clinic, but I just wanted to grab 5 minutes with Dr. Fitzgerald to tell you a little bit about the premise for and also the content of our new eBook which is called The Methylation Diet and Lifestyle. Dr. Fitzgerald, why don’t you stat by giving us a view into how a dietary lifestyle approach to methylation support came about?
Kara Fitzgerald: Absolutely, Romilly. We are thrilled to announce the launch of our new eBook program The Methylation Diet and Lifestyle, hoping support for healthy methylation and epigenetic expression. We know that methylation is an extremely important biochemical process, always happening in the body and involves in loads of activities from central nervous system development to cell division, production and metabolism of neurotransmitters, detoxification of toxins, biotransformation of hormones, cellular energy metabolism, genetic regulation, and more.
Additionally, we know that research now suggests that healthy methylation actually exists in an active homeodynamic balance. This appears to be particularly true with regard for the epigenome, or healthy epigenetic expressions. We also know that genetic lesions, as single nucleotide polymorphisms, in methylation enzymes are extremely common, such as the well known MTHR polymorphism and many others. This can be associated with hypomethylation or insufficient methylation activity. The issues associated with hypomethylation are also very far reaching. Neural tube defects, ADD, ADHD, Down’s Syndrome, Alzheimer, addiction, hypertension, insomnia, cancer, fertility issues, and so much more.
Given what a fundamental process methylation is and how far reaching in balance the impact of imbalance is, we really want to support methylation in our patients, healthy methylation in our patients.
Romilly Hodges: Perfect. Perfect. Obviously supplementation with methylation nutrients such as folate and B12, that has been a key strategy for methylation support up until now and it’s definitely a strategy we still continue to use in the clinic, but it’s slightly framed a little differently, in a slightly different context and perhaps used more judiciously. Can you explain why you felt there was more that we needed to do for our patients when it comes to methylation support?
Kara Fitzgerald: Yeah. Absolutely. Ne research is coming down the pike with regard to methylation and especially with regard to the epigenome and this homeodynamic balance of methylation activity. Our thinking needs to expand accordingly. We need to be looking at this research and really sifting through it and filtering it out and refining and interpreting how this might impact our clinical practice.
If we go back in history, we know that folic acid has been extremely useful in the food fortification program for reducing the incidence of various birth defects, such as neural tube defects. We also know that using the natural methylation cofactors has been beneficial. Actually very beneficial for some folks. We also know that there’s new research coming out regarding folic acid, because these fortification programs have been around long enough that suggest maybe we are pushing methylation reactions too far in some.
We see that there’s a possible U curve distribution where folic acid deficiency or folate deficiency is an issue but also excess folate can be an issue as well. Most of that data are around folic acid, but we have to ask ourselves logically, using high dose methyl donors in natural folates, B12 and all the various cofactors and coenzymes and so forth, are we at risk of pushing methylation too far?
I think that there are some data that suggest this can be true. Particularly with regard to the epigenome and hypermethylating in the epigenome. We know hypermethylation is associated with diseases such as cancer, allergy, autoimmunity. I think we need to back up, take a breath, look at the data, and maybe go for a more nuanced or upstream approach. Furthermore, we also have a host of patients in our practice, anybody practicing integrated or functional medicine has a subset of patients who just simply don’t respond to methyl donors and need a more upstream approach or sometimes we call it back door methylation approach to support.
Romilly Hodges: Great. What we need is more tools in our tool box basically when it comes to methylation support. That’s how you and I came to start using the methylation diet and lifestyle with patients. It’s been a natural evolution of our research or evidence based practice.
Kara Fitzgerald: Yeah. Absolutely. I’m just so thrilled for this program, because we’ve logically, using best available evidence and clinical observation, have expanded our reach with regard to how we support healthy methylation in our practice. We’re really looking to do right by our patients. Again, this is an upstream safe nuanced approach that supports healthy methylation balance.
Romilly Hodges: Okay. Shall we give those who are listening to this quick overview, some detail about what they can expect to find in the book?
Kara Fitzgerald: Yeah. Yeah. We are looking to cast a wide net as I’m saying here over and over again. We’re really looking at how can we tweak and support balanced methylation in the body. Of course we’re looking at nutrients and we’re looking at diet. We’re leaning on the diet heavily. We also know that physiologic factors such as inflammation, oxidative stress, microbiome, gut health, hormone balance, methyl donor drain, detoxification, there are myriad ways that we can imbalance methylation and conversely as we correct these imbalances or support the healthy expression of these various areas, we can support healthy balanced methylation. Further, it’s the methylation diet and lifestyle. That lifestyle piece is incredibly important as well with regard to supporting healthy methylation. sufficient sleep, an appropriate exercise program, reducing stress response. All of these things are critical.
Romilly Hodges: Great. You mention, a lot of factors that you just covered there that are at play when it comes to methylation support. One of them being methyl donor drain, which I think is a fascinating concept. Can you just give us a high level explanation of what that is?
Kara Fitzgerald: Yeah, absolutely. There are many ways that we can cause methyl donor drain. There can be many leaks in the ship, as it were. Probably a example we can all relate to is the stress response. When the body’s pumping out a whole lot of adrenaline, we’re in active stress response, we’re using CME, the universal methyl donor to both produce adrenaline as well as metabolize adrenaline. Therefore, we’re taking CME away from all the myriad of other methylation reactions that are so fundamental and important to it. One really basic thing we can do to patch up one of those holes in the methylation boat is simply by reducing our stress response. Actively working at modulating our stress response. Additionally, there are data out in animal and human models demonstrating that stress has impact on the DNA methylation, which is regulating gene expression. This is looking at the epigenome. This mechanism is actually independent of the overuse of CME in adrenaline production and metabolism.
Romilly Hodges: Fantastic. These concepts especially to me on what has been so fascinating to explore and to research and then to implement. Obviously we do see patients responding nicely to these protocols, so we’re effectively lowering their homocysteine levels or reversing folate, B12 deficiencies or other deficiencies. Of course, reducing, and this would be the goal, reducing or eliminating the clinical signs and symptoms that might be problematic. Another thing to say that this includes those who aren’t table to tolerate the supplements as well. That’s very has been very rewarding to see.
Kara Fitzgerald: I know. It is. It’s just been really it’s been a great journey for us both and I think for our patients to be implementing this. You and our nutrition team put endless amount of effort into designing a lovely diet program. Why don’t you give us some background on that.
Romilly Hodges: Great. Yeah, okay. When we’re putting together a methylation diet, clearly we want to pay attention to all of the nutrients that have a role as cofactors or substrates for all those methylation cycle enzymes. There are many of course, and it’s not just folate and B12.
We’re talking about food sources of these nutrients, not just supplements. We pay careful attention to designing and maintaining dietary protocols that optimize nutrient intake. Including periods of higher nutrient intake. Perhaps at the beginning where we’re taking a more therapeutic aggressively approach and then maybe backing off a little bit as folks move into more a maintenance phase.
The interesting thing as well is that a whole foods diet doesn’t automatically guarantee an optimal level of methylation nutrients. We routinely find people coming into our practice who have transitioned away from processed foods, yet they’re not meeting some of those optimal nutrient intake levels. We find we need to use the methylation diet and lifestyle food plan, the menu plan, the recipes, which all are in the book to guide patients in that.
Kara Fitzgerald: Mm-hmm (affirmative) yeah, absolutely. It’s quite amazing. We do have these patients coming to our practice who’ve already done a lot of work and they’ve moved away from, as you pointed out, the enriched grains and a lot of the really poor quality standard American diet foods and they’re eating generally a really good whole foods diet, but when I look at them, analyze them using laboratory testing, we almost always identify nutrient insufficiency. Then your team steps in and does the nutrient intake analysis, another very useful tool, and you identify inadequacies where as well. Of course, digestion and absorption can be a piece of this. There’s many reasons why people might not be nutrient replete but the gut is certainly one place to look at.
Romilly Hodges: Right. Right. Tending to the gut, optimizing digestion and absorption, is definitely a piece of the MDL as well, not only for proper nutrient assimilation. There are also these specific commensal species of our microbiome that are robust folate producers. Research actually shows that you can increase serum folate levels by just adjusting the microbiome using specific probiotics. Even more so when we and certain prebiotics as well. Those studies are independent of any other dietary change. It’s really fascinating. Of course, we can support those as well through diet.
Kara Fitzgerald: Yeah. That’s right. Additionally, we know that the gut microbiome influences the epigenome as well and specifically the methylation patterns in the DNA. No doubt, a healthy microbiome is fundamental to healthy methylation.
Romilly Hodges: Yeah. Another dietary concept which we incorporate is methylation adaptogens, which they essentially help to modulate methylation activity. For example, they seem to appear to balance out DNA methylation in the body in a way that allows for healthy gene expression and really provides those checks and balances to make sure that we’re not pushing methylation reactions too far and inadvertently repressing a gene that should be expressed.
Kara Fitzgerald: I know. I know. I really want to underscore what an incredible point that is. The fact that research demonstrates that there are a host of food based nutrients that are not directly involved in the methylation cycle but appear to balance healthy genetic methylation activity. We’re not just pushing methylation reactions forward with high dose cofactors, but we’re actually also engaging, these nutrients engage in the under appreciated role of demethylation in the epigenome as well. Perhaps allowing for as you point out, the healthy expression of a gene, say a tumor suppressor gene that was otherwise turned off by inappropriate hypermethylation. Again, this is a powerful example of the homeodynamic balance of methylation.
Romilly Hodges: Yes. Yes. Continuing with the diet piece, additionally we’re thinking about what tools we have in terms of macronutrient ratios, overall calorie intake and meal timing that have beneficial effects on methylation and we discuss those. We ave used the methylation diet as a stand alone protocol, but it also works well to combine it with other protocols. Obviously as indicated. We have combined it with say for example, a low FODMAP diet for SIBO or a low carb diet or paleo style diet for weight loss, so cardio metabolic support. Autoimmune diets, elimination diets, etc.
Kara Fitzgerald: Mm-hmm (affirmative). Yeah. The methylation diet will fold in nicely. It marries nicely, I think, to any dietary or any therapeutic diet that you want to prescribe. I think it’s readily modifiable. I also want to point out that I do prescribe methyl donors to my patients to demonstrate need, when many patients do demonstrate need. I am using supplements, but now as I really dive in and explore this emerging body of research, I have an active end point in sight with folks. When I combine it with the MDL, I don’t need to go aggressively with the methylation donors anymore. Again, we can use it for the folks who don’t tolerate methyl donors.
Romilly Hodges: Great.
Kara Fitzgerald: I think I would say that this is the methylation diet certainly aspects of it, it’s a good foundational approach for really many, many of our patients.
Romilly Hodges: Okay. Okay. What else should we mention?
Kara Fitzgerald: Why don’t you talk about some of the recipes you love? You’re a pretty expert recipe designer, Romilly. You came up with some great ones. What’s your favorite recipe?
Romilly Hodges: We have a bunch of recipes in the book that are really, really great one that I think is a little bit more unusual that I really like, partly for that reason is the diakon dulse salad, which has sun dried tomatoes and toasted sesame oil for flavoring. That’s just yummy. The other one I like especially is the creamy coconut collard greens, which are a really tasty way to get in lots of folate. We also have a lot of regular recipes that are just tweaked to be really rich in those methylation nutrients. We have some wild salmon recipes, a pesto frittata, we have a bunch of stir frys and more. We’ve got recipes in there enough for one week long gluten free, dairy free, methylation menu plan as well as another one week paleo menu plan. That’s breakfast, lunches, dinners, snacks, smoothies, juices. All that stuff.
Kara Fitzgerald: Right. Right. The diet itself leans a little bit more lower carbohydrate and a little bit higher fat, so I think that’s foundationally it’s very anti-inflammatory.
Romilly Hodges: Absolutely.
Kara Fitzgerald: I personally love the beet recipes. I love beets and I love the betaine that I get from beets.
Romilly Hodges: Perfect. Perfect. I think we’ve gone a little bit over our 5 minutes, but hopefully that’s okay. Do you want to just give us a little few last words
Kara Fitzgerald: Yep. Yep. Thanks for hanging in there with us, folks. We’re excited about it as you can see. We just launched the eBook and it coincided with our presentation over at the Institute for Functional Medicine’s annual international conference and we’ve had really lovely feedback and interest in our book. We’ve just done first of a series of two trainings at the Cleveland Clinic’s Center for Functional Medicine, and we are recording these trainings and we want to make them available to you. Stay tuned. You can access the eBook at our website through www.drkarafitzgerald.com. That’s D-R Kara Fitzgerald dot com. You can join us in the conversation. You can do so on social media, Facebook, Twitter, or reach out to us through our monthly newsletters.
Romilly Hodges: Perfect. Perfect. Thank you Dr. Fitzgerald. That’s it. We’ll say goodbye.
Kara Fitzgerald: Thank you.