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Lippincott Williams & Wilkins

American Academy of Orthopaedic Surgeons

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Why you need both for MTHFR: Taking only methylfolate without B12: May improve methylation initially Can deplete B12 stores over time May not fully lower homocysteine Neurological symptoms may persist Taking only B12 without methylfolate: Wont bypass MTHFR enzyme bottleneck Methylation remains impaired Homocysteine may stay elevated Less effective for MTHFR mutations Taking both together: Synergistic effect on methylation More effective homocysteine reduction Better symptom improvement Supports complete methylation cycle Other B vitamins that support the partnership: B6 (as P5P): Cofactor for homocysteine conversion to cysteine Supports transsulfuration pathway Helps prevent homocysteine buildup B2 (riboflavin): Required for MTHFR enzyme function Particularly important for C677T homozygous mutations Can improve MTHFR enzyme efficiency by up to 50% Choline or TMG (betaine): Alternative methylation pathway Provides methyl groups independently of folate Helpful backup when folate pathway is impaired Food sources to support both: B12-rich foods: Meat, fish, eggs, dairy Shellfish (especially clams, oysters) Liver and organ meats Fortified plant milks (for vegans) Folate-rich foods: Dark leafy greens (spinach, kale) Asparagus, Brussels sprouts, broccoli Legumes (lentils, chickpeas, black beans) Avocado Avoid synthetic folic acid (fortified breads, cereals) Signs youre taking the right amounts: Homocysteine normalizing (below 10 mol/L, ideally 6-9) Energy improving Brain fog clearing Mood stabilizing Sleep improving No adverse reactions MTHFR B Vitamin Checklist Use this quick reference guide to ensure youre supporting your MTHFR mutation with the right B vitamins in the optimal forms and doses