Health Wanted: Alcohol

The Episode

We are smack dab in the middle of the holiday season, which usually comes with enough liquid cheer to kill a horse…or at least get some people to consider wringing themselves out in the new year. This week on Health Wanted, it’s a not-so-happy hour as we take a big old swig of the truth about the health risks of alcohol.

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The Listener Questions

Should people with a MTHFR gene mutation avoid folic acid?

You may have heard that people with a MTHFR gene mutation should take methyl folate instead of folic acid. That is not true—you don’t need to avoid folic acid, and you don’t need to take special methyl folate supplements.

MTHFR mutations impact the way the body processes folate. There are different kinds of folate that we can consume: folic acid, methyl folate, and folinic acid. The MTHFR gene converts these into the active form of folate, which breaks down an amino acid called homocysteine.

If you’re not getting enough folate in your blood, you can experience a build up of homocysteine. That can lead to health effects typical of a vitamin B deficiency like dizziness, heart palpitations, fatigue, skin color change, or sores on your tongue or mouth. It also increases your risk for blood clots.

People with a MTHFR mutation (which is estimated to be more than half of the population) might have a harder time processing the folate they consume. But there is really no evidence that methyl folate is any better at reducing levels of homocysteine compared to folic acid. There are very few studies comparing methyl folate and folic acid in this way, and the ones that exist show the two are about equally as good. One found that folic acid is better than methyl folate when it comes to reducing homocysteine.

Another study showed that people with the MTHFR gene mutation might need slightly more folic acid, but that proper levels are easily attained through diet alone, no expensive supplement needed. When people who were put on a high folic acid diet were compared to people who excluded folic acid in their diets but took methyl folate supplements, their levels of homocysteine were the same.

If people want to take methyl folate supplements, that's fine. Just keep in mind that folic acid is the only form of folate proven to reduce the risk of neural tube defects. So if you are planning to get pregnant and give birth, don’t skip out on folic acid for methyl folate supplements.

Should I be worried about Epstein-Barr virus?

The Epstein-Barr virus (EBV) is a member of the herpes virus family, and it’s estimated to have infected 90% of the population. Most infections are asymptomatic, but some people do get a symptomatic infection known as mononucleosis, also known as mono or the kissing disease.

The first chronic condition we feel very confident is connected to an infection with EBV is multiple sclerosis (MS), which is an autoimmune disease that affects the central nervous system. The very strong evidence tying EBV to MS came in 2022, when a longitudinal study found the risk of MS was minimal in people who had no evidence of an EBV infection, but the risk of developing MS increased 30-fold after an EBV infection.

Now, scientists have linked the virus to another autoimmune disease: lupus.

EBV is part of the family of herpes viruses, like chickenpox and herpes simplex one and two, and once you’re infected it lingers, basically forever. It can deposit some of its genetic material in the nuclei of your cells and just hang out without causing any problems. But for some people, it appears that these infected cells can get switched on. When the cells that are harboring EBV genetics are part of our immune system, those immune cells can turn on the body, causing autoimmune diseases like lupus and MS. And it’s possible that we might find a connection between EBV infection and other autoimmune disorders, like Crohn's disease, in the future.

It’s estimated that 90% of the population has exposure to EBV but less than 1% of the population will develop MS or lupus. So if you've had mono, that's not a guarantee that you will develop an autoimmune disease. There’s still a lot we need to learn about what causes some people to develop these diseases when the majority of people do not.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
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