Scientifically/medically sound nutrition-related sites?

Those who have MTHFR genetic mutations have a difficult time ‘being themselves’ due to neurotransmitter imbalance, increased toxicity and fatigue.

Your husband may appear to be present yet he is unable to completely function due to the MTHFR mutation.

As the initial test, ruling out cobalamin deficiency is very important because deficiency of folic acid and vitamin B-12 produce overlapping neurologic manifestations, and both cause megaloblastic anemia, but folate treatment will not improve neurologic abnormalities due to cobalamin deficiency. [39] The reference range for serum cobalamin is 200-900 pg/mL

The reference range of serum folate is 2.5-20 ng/mL. By statistical definition, 2%-5% of healthy individuals will have a serum folate level of less than 2.5 ng/mL; hence, the serum folate level cannot be used alone to establish the diagnosis of folate deficiency. Therefore, the serum folate test is definitive only when the level is greater than 5.0 ng/mL, which rules out folate deficiency. Otherwise, additional follow-up tests include serum homocysteine (reference range 5-16 mmol/L), which is elevated in vitamin B-12 and folate deficiency, and serum methylmalonic acid (reference range 70-270 mmol/L), which is elevated in vitamin B-12 deficiency only.

Red blood cell folate levels (reference range >140 ng/mL) tend to reflect long-term folate status rather than acute changes in folate that are reflected in serum folate levels, although many confounding factors, such as transfused red cells, can make this unreliable as a test for folate deficiency states.

When the FDA mandated the fortification of grain products with folic acid in 1996, it resulted in a dramatic 40 to 50 percent decrease in the number of babies born with neural tube defects, one of the most common birth defects. But the protection of our children may have come at the expense of our elderly. High folic acid intake may be harming older adults in ways that the FDA didn’t predict.

Twenty-five percent of people over age 65 don’t get enough vitamin B12, which is critical for brain and neurological system function as well as the production of red blood cells. The folic acid in their daily bread and dietary supplements may exacerbate some of the symptoms of B12 deficiency, including dementia and anemia.

Our bodies don’t produce B12, and so we have to get it from what we eat, including meat, eggs and milk. Older adults have more difficulty metabolizing the vitamin because they produce less stomach acid, which separates B12 from the proteins in food to make it available to the body.

“Although causation cannot be shown, there is a high correlation between [vitamin B12] deficiency and cognitive decline,” says Jacob Selhub, director of the Vitamin Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts and a professor at the Friedman School.

But Morris says there is a good chance that even patients with mild B12 deficiency experience some cognitive problems, which health-care providers may have difficulty distinguishing from the memory loss that sometimes occurs with age.

“The elderly take a lot of supplements, and they consume a lot of ready-to-eat breakfast cereals, which are fortified with folic acid,” Morris says. “The interaction between high folate status and low vitamin B12 status may have negative consequences.”

A new UC Davis study found that elevated levels of folic acid may aggravate metabolic complications associated with vitamin B-12 deficiency — a serious health concern that can lead to anemia and neurological damage. The results, which were published in the December issue of the American Journal of Clinical Nutrition, suggest that it is wise to avoid taking folic-acid supplements unless specifically advised by a physician.

"There have been concerns that some people may be getting too much folic acid through a combination of sources, and we wanted to determine if there were reasons for those concerns," said Ralph Green, UC Davis professor of pathology and laboratory medicine and senior author of the study. "Our results show that higher levels of folic acid could set in motion a metabolic imbalance that leads to more serious B-12 deficiency."

Green has had a long-standing interest in folic acid and vitamin B-12, particularly since the mid-1990s, when the government began discussing fortifying grain products with folic acid to reduce the incidence of certain birth defects of the brain and spine. He participated in several expert and advisory committees for the National Institutes of Health, Centers for Disease Control and Prevention and Food and Drug Administration. Today, in addition to mandated fortification of cereals and grains, many foods like breakfast cereals can be further enriched with folic acid. In some instances, those foods contain 100 percent of the recommended daily allowance. Knowing that many people also take vitamin supplements, especially as they get older, he thought it might be possible for some elderly to get too much folic acid.

Green and his colleagues conducted the study, in part, to determine if folic-acid fortification could increase cognitive impairment or depression, as a previous study had suggested. To find out, they evaluated folic-acid and B-12 levels in blood samples from 1,535 participants in the Sacramento Area Latino Study on Aging (SALSA), an ongoing, community-based study of health behaviors and outcomes for Latinos aged 60 and older living in the Sacramento region. Those results were compared with evaluations of the participants' cognitive functions and depressive symptoms.

Dr. Green © UC Regents"We do have to worry about folic-acid supplementation. The fact is that a lot of people are getting more of it than is good for them."
— Ralph Green
The researchers did not find brain or mental-health changes for study participants with low B-12 and higher levels of folic acid. That same group, however, was more likely to take vitamin supplements and had the highest blood levels of methylmalonic acid and homocysteine — two metabolites that are early and highly sensitive indicators of B-12 deficiency.

Green thinks higher levels of these metabolites could indicate adverse shifts in metabolic health due to too much folic acid, and that a larger-scale, longitudinal study that includes participants from additional racial and ethnic groups is warranted.

"We are at an early stage in determining the effects of this biochemical change," said Green. "But we're well on our way now to establishing the facts about how these vitamins can interact and alter body systems."

In the meantime, since fortification of the food supply has almost eliminated folic acid deficiency in the United States, Green suggests avoiding supplements that contain folic acid, especially since the most significant and potentially irreversible outcome of B-12 deficiency — neurological damage — can be difficult to detect before it is very serious.

"We do have to worry about folic-acid supplementation," said Green. "The fact is that a lot of people are getting more of it than is good for them. If they happen to be B-12 deficient, more folic acid may actually harm them."