04/09/2021
There is increase incidence of tongue ties in new born. Data is accumulating about the increase. Hopefully future will point out the cause if such increase.
Tongue Ties and Folic Acid
This post is bound to make some people irritated - please understand that isn’t my intent. I’m writing this because I feel there’s a lot of misinformation out there about the topic of folic acid, methylfolate and the role of MTHFR in tongue tie formation. I get the question asked a lot so I wanted to put some thoughts down to allude to later. Hopefully, the discussion can remain civil.
1) There are currently no published studies correlating folic acid consumption in pregnancy to tongue tie. One study attempted to look at a correlation but did not find any statistical significance correlating the two (https://pubmed.ncbi.nlm.nih.gov/31835174/) when folic acid was ever taken or taken on most days. When they asked those who took it regularly, they did find a correlation - the problem is that the methodology of this study is poor. The authors reworded the question several times to try and find some sort of correlation. They didn’t control for any other factor so it’s hard to pin the difference on just the folic acid. Finally, they asked about folic acid consumption months after the fact — we’re talking 6-8 months later. That's a poor study model and doesn’t really prove anything.
2) Many people blame MTHFR gene polymorphisms as an underlying reason WHY folic acid consumption is bad. Without getting into a science lesson about biochemistry, some feel that folic acid itself isn’t used by the body until an enzyme adds a methyl group to the folic acid - a necessary step that ultimately results in converting folic acid to methylfolate. The enzyme responsible for that is abbreviated MTHFR but is chemically called methylenetetrahydrofolate reductase. If you analyze people’s genetics, some estimates are that 40-50% of humans have a SNP (single nucleotide polymorphism) that may affect the activity/efficiency of the enzyme. Currently, no studies document a connection between MTHFR SNPs and the formation of a tongue tie. Some practitioners have erroneously concluded that if you consume activated methylfolate, you can get around the lack of folic acid conversion caused by your dirty genes. There just isn’t any proof that it helps.
3) Here’s the kicker that may cause some gasps and pearl clutching - I do not consider tongue tie or lip tie to be a midline defect. The best studies on the topic come from Nikki Mills, a pediatric ENT from New Zealand who has published several studies done on adult and infant cadavers (https://pubmed.ncbi.nlm.nih.gov/31116462/ and https://pubmed.ncbi.nlm.nih.gov/30701608/) She did not find a discrete structure, like a band under the tongue - what she found was that the frenulum was instead a coming together of the floor of mouth fascia. While a tongue tie is in the midline, it is not a midlife defect (something that is more related to a neural tube defect like spina bifida).
What do I think is the cause of the rise of diagnosis of ties?
1) genetics - I frequently see ties running in families
2) more scientific studies analyzing tongue function provide us with a different way to look for ties
3) more awareness (science, social media)
Many moms read about MTHFR and folic acid at some point and invariably think that the consumption of folic acid CAUSED the tongue tie. This unnecessary and unfounded self-blame is rooted in misinformation about what has actually been demonstrated scientifically. Some day, we may have a study that proves the correlation. But for now, relying on websites that either has a vested interest in forming the connection (they sell supplements, books, genetic analyses, etc) or non-scientific websites/blogs does a disservice to families.
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