or patients who are concerned with premature hair graying, in addition to assessing gut closely, do you find functional methylation testing to be relevant? Are there any other workups or treatment approaches?

For premature gray hair, I’m going to think about sort of oxidative stress and antioxidant imbalance. Yes, you can look at gut. I don’t do a whole lot of methylation testing at this point. I look at homocysteine as sort of a rough guide. I might look at ​MTHFR,​ the C677T and A1298C, just to see kind of what we’re dealing with, but again, we’re learning more and more about these ​MTHFR,​ single-nucleotide polymorphisms and how they actually impact things like detox. I think it might point you in a direction that you need to look at detox a little bit more, look at methylation, i.e., homocysteine, a little bit more, but I’m not getting too deep into these big methylation protocols at this time.

I would think more about what are big sources of oxidative stress. First, start with lifestyle. We always want to do that. Make sure diet is a low-inflammatory diet. You want a lot of antioxidants or a lot of fruits and vegetables in the diet; you don’t want a lot more of the pro-inflammatory compounds, so not too much in the way of the industrial seed oils, so the person shouldn’t be eating out too much. We’ll get how much this person is sleeping, how much restorative and deep sleep they are getting, and what the cortisol levels are looking like. And then other potential causes that might increase oxidative stress are certainly chronic infections, so you mentioned the gut. Also, think about heavy metals, environmental toxins. But first and foremost, start with diet lifestyle stress management and then start thinking about what are the big sources of oxidative stress, and I would think mostly chronic infections and toxins. There’s also some genetic predisposition, I think, when we start going gray. I would also look at family history. I do still think that there’s sort of an oxidative and antioxidant balance in there, but do look at family history because that will inform it to some extent.