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Maternal and Pediatric Implications due to MTHFR and Methylation Dysfunction Presenter: Benjamin Lynch, ND ICA Pediatrics Conference October 2014 Las Vegas,

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Presentation on theme: "Maternal and Pediatric Implications due to MTHFR and Methylation Dysfunction Presenter: Benjamin Lynch, ND ICA Pediatrics Conference October 2014 Las Vegas,"— Presentation transcript:

1 Maternal and Pediatric Implications due to MTHFR and Methylation Dysfunction Presenter: Benjamin Lynch, ND ICA Pediatrics Conference October 2014 Las Vegas, NV 1 (c) 2014: Benjamin Lynch, ND

2 Disclaimer & Disclosures The information presented here is for informational and educational purposes only. Docere, Inc and Benjamin Lynch will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the use or misuse of any materials or information published. President and CEO of, and founder of MTHFR.Net 2 (c) 2014: Benjamin Lynch, ND

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4 Why? 4(c) 2014: Benjamin Lynch, ND

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7 Folate 7 (c) 2014: Benjamin Lynch, ND

8 8Source: Big Stock Photo

9 Functions of Folate “The functions of folate in human physiology are relatively simple, but the implications of their activity (and dysfunction) can be profound and far reaching.” Source: Herb, Nutrient and Drug Interactions by Stargrove et al Functions: synthesis of nucleic acids (for DNA production/repair and tRNA) single carbon metabolism (methylation) interconversion of amino acids (for neurotransmitter production and detoxification) formation and maturation of RBC, WBC and platelet production 9 (c) 2013: Benjamin Lynch, ND

10 Does Folic Acid = Folate? Folic acid does NOT equal Folate. Folic Acid is only ONE type of Folate. Folic acid is not found in nature. Folate is. Folic acid must undergo numerous biochemical transformations prior to utilization. Must be specific when discussing folate. Use the appropriate term and form. Folic acid (unmetabolized folic acid) Folinic acid (5-FormylTHF) Methylfolate (5-MTHF) 10 (c) 2013: Benjamin Lynch, ND

11 Comparing Folic Acid to 5-Methyltetrahydrofolate CH 3 FOLIC ACID  METHYLFOLATE  11 (c) 2013: Benjamin Lynch, ND

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14 MTHFR: Why now? 14 (c) 2014: Benjamin Lynch, ND

15 Folic Acid MTHFR increasing in the population. Folic acid fortification, artificial insemination, steroids, hormones ↑ Full-Term Pregnancies ↑ Folate SNPs ↑ Methylation SNPs ↑ Inferior SNPs ↑ Metabolic Issues. 15 (c) 2014: Benjamin Lynch, ND ↑ Susceptibility to Environmental Exposures UnNatural DeSelection: Survival of the ‘Unfittest’

16 “Has enhanced folate status during pregnancy altered natural selection and possibly Autism prevalence? A closer look at a possible link.” “It is hypothesized here that the enhancement of maternal folate status before and during pregnancy in the last 15 years has altered natural selection by increasing survival rates during pregnancy of infants possessing the MTHFR C677T polymorphism, via reduction in hyperhomocysteinemia associated with this genotype and thereby miscarriage rates. This also points directly to an increased rate of births of infants with higher postnatal requirements for folic acid needed for normal methylation during this critical neurodevelopmental period. If these numbers have increased then so have the absolute number of infants that after birth fail to maintain the higher folate status experienced in utero thus leading to an increased number of cases of developmental disorders such as Autism. Detection of the C677T polymorphism as well as other methionine cycle enzymes related to folate metabolism and methylation at birth as part of newborn screening programs could determine which newborns need be monitored and maintained on diets or supplements that ensure adequate folate status during this critical postnatal neurodevelopment period.” 16 (c) 2014: Benjamin Lynch, ND

17 “Is folic acid good for everyone?” “In Spain, the prevalence of the MTHFR 677TT genotype has reportedly approximately doubled in the population since the introduction in 1982 of folic acid supplements for women in early pregnancy”… “Folic acid fortification and supplement use might be “a genetic time bomb.” The first premise of this dramatic claim, that folic acid use increases the proportion of children born with the T allele of MTHFR, is as yet poorly documented and is clearly in urgent need of further study. Studies of the MTHFR genotype frequencies in children before and after fortification should be carried out in countries planning fortification of food with folic acid. Thus, saving fetuses that have a genetic constitution that favors abortion or nonsurvival could lead to children being born with genotypes that favor increased disease during life”" 17 (c) 2014: Benjamin Lynch, ND

18 18(c) 2014: Benjamin Lynch, ND

19 Epigenetics “As an organism grows and develops, carefully orchestrated chemical reactions activate and deactivate parts of the genome at strategic times and in specific locations. Epigenetics is the study of these chemical reactions and the factors that influence them.” 19 (c) 2014: Benjamin Lynch, ND and Epigenetics and the developmental origins of inflammatory bowel diseases. “Epigenetic changes are environmentally responsive mechanisms that can modify gene expression independently of the genetic code.”

20 20(c) 2014: Benjamin Lynch, ND

21 Methylation 21 (c) 2014: Benjamin Lynch, ND

22 Functions of Methylation Several Functions of Methylation: 1.Turn on and off genes (gene regulation) 2.Process chemicals, endogenous and xenobiotic compounds (biotransformation) 3.Build neurotransmitters (norepinephrine  epinephrine, serotonin  melatonin) 4.Metabolize neurotransmitters (dopamine, epinephrine) 5.Process hormones (estrogen) 6.Build immune cells (T cells, NK cells) 7.DNA and Histone Synthesis (Thymine aka 5-methyluracil) 8.Produce energy (CoQ10, carnitine, creatine, ATP) 9.Produce protective coating on nerves (myelination) 10.Build and maintain cell membranes (phosphatidylcholine) 22 (c) 2013: Benjamin Lynch, ND

23 How is Methylation Disturbed? Methylation is often disturbed by various mechanisms 1.Lack of cofactors driving methylation forward (Zinc, B2, Mg, Choline, B6, B12) 2.Lack of substrate driving methylation forward (Methionine, Hcy) 3.Medications (antacids, methotrexate, metformin, nitrous oxide) 4.Specific nutrients depleting methyl groups (high dose Niacin) 5.Environmental toxicity, heavy metals, chemicals (acetylaldehyde, mercury, high copper) 6.Excessive end product (feedback inhibition – DMG, SAM, SAH, Hcy) 7.Genetic mutations/polymorphisms (MTHFR, GSTM1, PEMT, MAT, GAMT, SOD) 8.Mental state (stress, anxiety, lack of sleep, ‘can’t do it’, pessimist, optimist) 9.Receptor site blocking (folic acid, antibodies) 10.Carrier protein deficiency (transcobalamin, folate binding proteins) 23 (c) 2013: Benjamin Lynch, ND


25 (c) 2014: Benjamin Lynch, ND25 Arsenic. Big Deal.

26 Pregnancy 26 (c) 2014: Benjamin Lynch, ND

27 Issues (some) 27 (c) 2014: Benjamin Lynch, ND Mother: Infertility Miscarriage / Recurrent Pregnancy Loss Preeclampsia Gestational diabetes Postpartum depression Newborn: Autism NTD Midline defects Down syndrome

28 Patient Evaluation 28 (c) 2014: Benjamin Lynch, ND

29 Screening 29 (c) 2014: Benjamin Lynch, ND Team Care – Request Charts Prior to Treatment One Page Summary History - thorough Current Medications and Supplements (including OTC) Diagnoses Recent Lab Findings Status of Children (autistic? DS? NTD?) Labs (some) 23andMe  / Genetic Genie CBC Full thyroid CDSA (Doctors Data) Urinary OAT (Great Plains) Serum ferritin, vitamin D RBC Fatty Acids and Plasma Amino Acids (Doctors Data) Methylation Profile (Doctors Data) ION Panel (Genova)

30 Pregnancy Risk due to Methylation Dysfunction 30 (c) 2014: Benjamin Lynch, ND Conditions/History (some) Bile stagnation IBD, Constipation Diabetes Obesity Allergies / Asthma Mental dysfunction Cancer Hispanic, Chinese, Italian descent Reflux Dental issues / Amalgams / Root Canals Lyme, H pylori, Candida, EBV, Hep, Strep Autoimmune Eating disorders Neurological disorders Cardiovascular disorders Lifestyle Type A Vegan Vegetarian Addictions Hobbies Commuter Couch Potato Premier Athlete Occupational Exposures

31 Take Caution with MTHFR (you already know to avoid Folic Acid) Antacids (deplete B12) Cholestyramine (deplete cobalamin and folate absorption) Colestipol (decrease cobalamin and folate absorption) Methotrexate (inhibits DHFR) Nitrous Oxide (inactivates MS) High Dose Niacin (depletes SAMe and limits pyridoxal kinase = active B6) Theophylline (limits pyridoxal kinase = active B6) Cyclosporin A (decreases renal function and increases Hcy) Metformin (decreases cobalamin absorption) Phenytoin / Valproic acid (folate antagonist) Carbamazepine (folate antagonist) Oral Contraceptives (deplete folate) Antimalarials JPC-2056, Pyrimethamine, Proguanil (inhibits DHFR) Antibiotic Trimethoprim (inhibits DHFR) Ethanol Bactrim (inhibits DHFR) Sulfasalazine (inhibits DHFR) Triamterene (inhibits DHFR) Source: Fischbach, Laboratory Diagnosis and BMJ and Herb, Nutrient and Drug Interactions by Stargrove 31 (c) 2014: Benjamin Lynch, ND

32 At-Risk Populations for Methylation Dysfunction 32 (c) 2014: Benjamin Lynch, ND Environment Zipcode ( New construction Remodeling Office/Employment Mold Gas/Propane/Exhaust Cleaning supplies Gardening supplies Food Water Bedroom location House orientation

33 Pregnancy Risks 33 (c) 2014: Benjamin Lynch, ND

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36 Spontaneous Abortion / RPL – Genetic Association 36 (c) 2014: Benjamin Lynch, ND What genes are most evaluated in PubMed for Spontaneous Abortion? 1.F5  94 papers  2 Meta Analysis Factor 5 Leiden 2.MTHFR  90 papers  5 Meta Analysis How many genes are associated with Spontaneous Abortion in PubMed? 289

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38 38(c) 2014: Benjamin Lynch, ND Genetics of recurrent miscarriage: challenges, current knowledge, future directions

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41 Neural Tube Defect – Genetic Association 41 (c) 2014: Benjamin Lynch, ND What genes are most evaluated in PubMed for NTD’s? 1.MTHFR  119 papers  7 Meta Analysis 2.MTR  23 papers  4 Meta Analysis 3.MTRR  21 papers  4 Meta Analysis 4.CBS 5.MTHFD1 6.RFC1 7.BHMT 8.SLC19A1 9.DHFR 10.SHMT1 11.TCN2 12.TYMS 13.FOLH1 14.FOLR2 15.BHMT2 How many genes are associated with NTD’s in PubMed? 166

42 42(c) 2014: Benjamin Lynch, ND

43 Down Syndrome – Genetic Association 43 (c) 2014: Benjamin Lynch, ND What genes are most evaluated in PubMed for DS? 1.MTHFR  50 papers  6 Meta Analysis 2.MTRR  21 papers  5 Meta Analysis 3.APOE  19 papers  1 Meta Analysis 4.MTR 5.RFC1 6.CBS How many genes are associated with Down Syndrome in PubMed? 116

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45 45(c) 2014: Benjamin Lynch, ND

46 Infertility – Genetic Association 46 (c) 2014: Benjamin Lynch, ND What genes are most evaluated in PubMed for Infertility? 1.AR  57 papers  3 Meta Analysis 2.CFTR  53 papers  1 Meta Analysis 3.MTHFR  49 papers  7 Meta Analysis 4.ESR1 5.GSTM1 6.GSTT1 How many genes are associated with Infertility in PubMed? 450

47 Autism – Genetic Association 47 (c) 2014: Benjamin Lynch, ND What genes are most evaluated in PubMed for Autism? 1.SL6A4  27 papers  3 Meta Analysis 11. MTHFR  8 papers  0 Meta Analysis How many genes are associated with Autism in PubMed? 463

48 Autism – Prenatal Associated Risks 48 (c) 2014: Benjamin Lynch, ND Methylation and detoxification systems are poorer in mothers of Autistic children SAH > 30 umol/L = 7.3 fold increased risk SAM:SAH ratio < 2.5 = 10.7 fold increased risk GSH:GSSG ratio < 20 = 15.2 fold increased risk Both SAM:SAH and GSH:GSSG ratios off = 46 fold increased risk

49 49(c) 2014: Benjamin Lynch, ND

50 Support Pathways! 50 (c) 2014: Benjamin Lynch, ND “Geez. Now what?”

51 (c) 2014: Benjamin Lynch, ND51 Should we use folic acid?! NTD Associated Genes: 1.MTHFR 2.MTR 3.MTRR 4.CBS 5.MTHFD1 6.RFC1 7.SLC19A1 8.DHFR 9.SHMT1 10.TCN2 11.TYMS 12.FOLH1 13.FOLR2 14.BHMT2 15.FOLR1

52 52 Contribution from Adam Rinde, ND

53 (c) 2014: Benjamin Lynch, ND53 Diet Stress

54 (c) 2014: Benjamin Lynch, ND54 Support Pathways

55 (c) 2014: Benjamin Lynch, ND55 ROS Key Points From mitochondria also

56 (c) 2014: Benjamin Lynch, ND56 Glutathione Key Points

57 Systems Approach 57 (c) 2014: Benjamin Lynch, ND Have to do it ALL. Cannot cherry pick.

58 Interventions 58 (c) 2014: Benjamin Lynch, ND Implement on all patients Breathing Sleep schedule Filtered water Caffeine free or greatly reduce Smaller yet more frequent whole food meals with protein, veggies, few good carbs Gluten and dairy free three week trial then challenge one at a time Chewing Read: The Metabolic MakeoverThe Metabolic Makeover CoQ10 Boswelia AKBA or Liposomal Curcumin Liposomal Glutathione Choline Multi Probiotic D3 Adaptogens Adrenal cortex Exercise – rebounder, weights, resistance, yoga, Zumba Sauna Potassium Magnesium

59 Steps of Treatment 59 (c) 2014: Benjamin Lynch, ND No Protocol – Think Systems – Do NOT Treat the SNP Remove causes and exposures Food, Lifestyle, Environment, Social, Hobby, Employment, Meds, Supplements Basic Foundational Support Food, Sleep, Hydration, Breathing, Exercise, Social, Nutritional Identify all areas of dysfunction GI, adrenals, mitochondria, liver, cell membranes Pathogens CDSA, OAT, Total IgG, IgM, IgE Labs CBC w chem panel, urinary hormones, serum ferritin, TNFa, ION Methylation profile

60 Key Lab Findings 60 (c) 2014: Benjamin Lynch, ND Common findings Lactate Ammonia Urinary MMA TNF alpha / Sed rate SAH SAM Cysteine MCV and MCH Serum ferritin Estrogens RBC magnesium RBC folate RBC zinc RBC manganese Arsenic Glutathione Homocysteine Vitamin D3 Serum folate Serum B12

61 Oxidative Stress & Mitochondrial Screening Glutathione Levels Enzyme Upregulation Ammonia Levels Vitamin Levels 61 (c) 2013: Benjamin Lynch, ND Test available through Doctors Data

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63 63 Test available through Health Diagnostics Lab

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66 What else? 66 (c) 2014: Benjamin Lynch, ND

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69 Key Points to Take to the Clinic 69 (c) 2014: Benjamin Lynch, ND 1.Identify Obstacles and Remove 2.Foundation / Basics 3.Inform 4.Prepare 5.Team care 6.Test – Methylation Profile, 23andMe, MTHFR Support 7.Adrenals 8.Glutathione 9.GI 10.Pathogens 11.Inflammation 12.Mitochondrial support 13.Sulfur 14.Pathways and Systems – NOT Protocols or SNPs

70 Three Points to Take to the Clinic 70 (c) 2014: Benjamin Lynch, ND 1.Balance Methylation by Reducing its workload Eliminating blockages 2.Screen for SNPs 3.Test Methylation and restore balance – after Foundation

71 Key Supplements to Use at the Clinic 71 (c) 2014: Benjamin Lynch, ND 1.Adaptogens 2.Liposomal Glutathione (start low) 3.Phosphatidylcholine 4.Multivitamin/mineral (to start - no folate, B12, Cu, Ca, Fe) 5.Methylfolate w/ methyl/adenosylcobalamin (after foundation) Throw away Folic Acid

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75 Great ways to stay informed: Newsletter Available at Facebook: October 2013 Nutrigenomics Conference March 2014 Nutrigenomics Conference – Pathway Planner Poster and Set – Physician’s Forum for Collaboration – 75 (c) 2014: Benjamin Lynch, ND Thank you

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