Jacques Courseault, MD, CAQSM, FAAPMR

August 26, 2022 – The area of hypermobility and Ehlers-Danlos research is gaining more traction with the recognition of peculiar clinically presenting patterns in flexible patients. Because of the thorough evaluation performed at the Tulane Hypermobility and Ehlers-Danlos Clinic, we noticed a trend of high folate levels during the screening. To explain the significance levels, we checked for MTHFR polymorphisms and noted an interesting trend. High folate levels correlate with MTHFR polymorphisms. We then teamed up with Dr. Gregory Bix to determine if folate has a relationship with extracellular matrix products. We have reported a connection between low intracellular folate and inactivated decorin (a protein necessary for the “glue that holds collagen together”).

This is very early research, and we are the first to publish this connection. Here is access to our peer-reviewed paper.

Click to access the publication.

Here are the highlights:

  • There is no known gene to explain hypermobility spectrum disorders or hypermobile-type EDS.

  • Hypermobility and hypermobile-type EDS are not primary collagen disorders.

  • Decorin may be a key protein implicated in extracellular matrix health. Decorin is important in holding connective tissue together.

  • Methylated folate is needed to ensure the health of decorin.

  • MTHFR polymorphisms result in a decrease in activated folate availability, resulting in deactivated decorin.

  • A HIGH FOLATE lab test may indicate an MTHFR polymorphism. However, a normal or low folate lab test does not rule out MTHFR polymorphisms that may be relevant.

  • Folate deficiency leads to many hypermobility signs and symptoms.

  • Assessing for an MTHFR polymorphism is essential to make the proposed diagnosis of Folate-Dependent Hypermobility Syndrome.

  • Treating with methylated B-vitamins shows good observational benefits. More studies are needed to determine the benefits and proper dosing and to determine whether other B-vitamins are needed for the methylation cycle to properly run.

    If there is concern regarding a hypermobile child, in our clinic we recommend this pediatric multivitamin. Please check with your child’s pediatrician before any supplementation.

    (The Fascia Institute is an affiliate and dispensary of Thorne products because the supplements are research-grade, and may be used in studies. Thorne has not provided research funding for this project. We can’t stress the importance of using research or pharmaceutical-grade supplements. We have provided a link to Thorne products for convenience and for example.  Please choose whichever supplement company you prefer, just make sure the supplement is of high-quality). 

  • Incorporate a folate-rich diet into your nutritional plan.