Part 4: Supplementing MTHFR: It’s About More than Folate

Managing MTHFR is complex as every individual is unique. The type and number of MTHFR mutations greatly affects the approach to care and the outcome of care.  Treatment should optimize the production of methyl groups while decreasing the overall depletion.

Genetics cannot be changed, but how genes behave can be altered with a comprehensive diet and lifestyle approach designed to support proper and efficient methylation. Supplementation is also a factor to consider, but is again, complex. It is not a one-size-fits-all approach.

Here is an overview of common approaches to supplementation for MTHFR:

Dr. Ben Lynch’s Approach — Begin with low doses of B12 for several days, then add MTHF folate at a ratio that is ½ the amount of B12, increasing every several days until you feel better or experience symptoms of overmethylation (irritability, insomnia, sore muscles, achy joints, acne, rash, anxiety, palpitations, nausea, headaches, migraines). A good base recommendation is 400mcg of folate per day and double that amount of B12.

Dr. Amy Yasko’s Approach — Dr. Yasko’s supplement protocol is a six-step process. 1. Balance supplements, including a multi and B complex. 2. Detox. 3. Balance lithium levels. 4. Determine ideal form of B12 (see below). Implement long-term support including titrating MTHF folate via drops. 6. Additional support based on nutrigenomic profile.

A B12 deficiency can cause other health problems, so it’s important to get the right type of B12. What type of B12 should you take? Here’s a table that shows the best type based on the COMT and VDR Taq genes.

COMT V158M VDR Taq B12 types that should be tolerated
– – ++ (TT) All three types of B12
+- (Tt) All three types with less methyl B12
— (tt) Hydroxy B12 and Adenosyl B12
+- ++ All three types with less methyl B12
+- +- Hydroxy B12 and Adenosyl B12
+- Hydroxy B12 and Adenosyl B12
++ ++ Hydroxy B12 and Adenosyl B12
++ +- Hydroxy B12 and Adenosyl B12
++ Mostly Hydroxy B12


Dr. James Braly’s Approach — MTHFR defects often cause high levels of homocysteine, a naturally-occurring amino acid produced during the methylation cycle and an indicator of efficient methylation. Dr. Braly believes homocysteine (Hcy) levels is the best indication of how well B vitamins are working. Your homocysteine levels should determine your daily nutrient needs as shown in the chart below. (As your health improves, the amounts of these nutrients you need may change.)

Nutrient No Risk


Low Risk


High Risk


Very High Risk

Above 15

Folate 200mcg 400mcg 1,200mcg 2,000mcg
B12 10mcg 500mcg 1,000mcg 1,500mcg
B6 25mg 50mg 75mg 100mg
B2 10mg 15mg 20mg 50mg
Zinc 5mg 10mg 15mg 20mg
Magnesium 100mg 200mg 300mg 400mg
TMG 500mg 750mg 1.5-3g 3-6g


Dr. Linus Pauling’s Approach — Dr. Pauling believes every sickness and disease can be traced to a mineral deficiency. Treating MTHFR requires a full combination of nutrients. In 2015, simply eating the daily-recommended servings of fruits and vegetables may not be enough. Some of the common nutrient deficiencies include: B vitamins (particularly folate, B12, B6, and B2, calcium, magnesium, iron, D3, K2, selenium, vitamin A, iodine, lithium, and essential fatty acids. Most of these are covered in a good multivitamin, but not all. Most multivitamins do not contain lithium, iodine, and essential fatty acids.

Lithium is found in spring or mineral waters. Lithium helps mood and studies have shown that communities with sufficient lithium in the drinking water have lower crime rates, fewer homicides, less mental illness, fewer suicides, and higher rates of longevity.

Iodine is important for thyroid function, a healthy immune system, mental health, breast health, and bone marrow. An iron deficiency can cause weight gain, decreased energy, depression, cardiovascular disease, poor cognition, and even some cancers. Selenium is an important nutrient that helps the body absorb iodine.

A healthy ratio of essential fatty acids can reduce risk of breast cancer and symptoms of arthritis, allergies, heart disease, and depression. Elevated omega 6 levels contributes to inflammatory diseases, and in the U.S., elevated omega 6 is common. To bring your ratio of fatty acids back into balance, avoid processed foods and vegetable oils. Increase your intake of omega 3 foods like oily fish, certified fish oil supplements, flax, walnuts, cauliflower, Brussel sprouts, broccoli, squash, and collard greens.

Before adding supplements to your diet, talk to your doctor. It’s best to add supplements one at a time to manage tolerance and watch for adverse effects.

Betty Murray, CN, IFMCP, CHC is a Certified Nutritionist & Certified Functional Medicine Practitioner with the Institute for Functional Medicine, founder of the Dallas-based functional medicine clinic Living Well Dallas and Executive Director of the the Functional Medicine Association of North Texas. A master of the biochemistry of the body, Betty teaches her clients how to utilize nutrition for autoimmune diseases, digestive disorders, MTHFR and weight loss.

You can find her book “Cleanse: Detox Your Body, Mind & Spirit” on Amazon here.

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