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MTHFR Variants (or single nucleotide polymorphisms =SNP) There are two relatively common SNP’s: A1298C – clinically irrelevant – will not effect homocysteine levels – does not require any specific supplementation C677T – can effect homocysteine levels – patient may need more folate or 5-methyl-folate Utilizing the methionine pathway by adding methyl donors like trimethyglycine and choline can bypass the problem of MTHFR variants Manifestations of Elevated Homocysteine Sources of Methyl Groups B vitamins – folate, B-6, B-12 Trimethylglycine (betaine) Choline Methionine SAMe Metabolically Directed Approach to Elevated Homocysteine Look for root causes of homocysteine elevation – chronic inflammation, hypothyroidism, poor diet, MTHFR variants When replacing needed B vitamins, take into account the patient’s individual metabolic needs For example, a Dysaerobic patient will benefit from folate, but may suffer from increased Dysaerobic imbalance from B-6 and B-12