Dr. Amy Nett: Technically we’re not covering methylation in this course, but I’ll just give you sort of a basic overview, and then if you want to follow up in more detail with Chris, maybe bring it up with him, and then I’m guessing methylation will eventually be a one-off course.
There are a lot of different approaches to treating methylation. For example, if you Ggoogle “methylation,” Amy Yasko comes up. I think she does a lot of the treatment based on genetics. She has found for her personally that she feels that having the genetic information alone is enough to provide treatment, so that is her approach. Again, you can all Ggoogle “Amy Yasko.” I think she has a PDF book that talks about her approach and the different mutations.
The other camp, so to speak, I would say one of the bigger names in that is probably Ben Lynch, and his company is Seeking Health. He actually approaches methylation from a functional perspective. For functional methylation, what you would be looking at is, how is the body actually methylating?
Ashley, if you’re asking if there are other indicators outside of genetic testing that reveal possible methylation problems, absolutely. Number one, look at the homocysteine level. If homocysteine is elevated above 8—or some might argue even above 7—that may indicate impaired methylation.
If you have a high MMA, methylmalonic acid—it’s an inverse marker of B12—or basically if you have markers for low B12 or folate, those could be potential indicators of methylation. You might find those either on a blood panel or on the Genova urine Organix Comprehensive test. Markers for low B vitamins can indicate methylation might not be running effectively.
We’re also going to be talking about the Precision Analytical hormone profile. We’re going to be talking mostly about the adrenals, I believe, in this course, but if you order the Precision Analytical complete hormone profile, you look at all of the estrogen metabolites, and you get a marker for methylation. You look at how the 2-hydroxyestrone is converted into 2-methoxyestrone. If you have slow conversion of that 2-hydroxyestrone, that indicates potentially decreased or low COMT-dependent methylation, so that’s another marker.
If you want to do direct functional methylation testing, we generally use the HDRI, Health Diagnostics and Research Institute, methylation panel. That gives you a look at the S-adenosylmethionine-to-S-adenosylhomocysteine ratio, or it gives you the measure of SAM to SAH, and then if you put that ratio together, that will give you an indication of methylation. You generally want that to be 4.5 or above, so if you see a low SAM-to-SAH ratio, that’s an indication. That test also gives you levels of a number of different folate metabolites, 5-methyltetrahydrofolate, so that can also give you information as to how you’re functionally methylating, because as you’re saying, genes alone are probably not indicative because you have to think, well, what does the exposome look like? What do the epigenetics look like?
Ben Lynch, who is in this camp of you want to treat based on functional methylation, not based on genetics, he has said he has the homozygous MTHFR SNP, and he did methylation support, he felt some benefit, but now it’s at the point where, in general, when he’s managing his stress and his diet well, he doesn’t need that additional methylation support. What he does, and this is what I do also, is I’ll keep active forms of B vitamins around the house and things that I would use for methylation support, whether it’s phosphatidylcholine, maybe some detox support, like Seeking Health has the Liver Nutrients with milk thistle, lipoic acid, that sort of thing. When you have more stress in your life, when you are getting sick or you’re not sleeping well, that would be the time to take methylation support because any additional stress is going to be potentially draining your methylation cycle. That’s sort of the functional approach to treating methylation.
Those are the two major camps right now. One is sort of treating based on genetics alone, and then the other one is treating based on functional methylation and taking into account lifestyle and, to a lesser extent, genetics