Lab Results Matter

How To Calculate Your Folate Levels and Why This Is Important

What is Folate? Also known as Folic Acid this is perhaps the most important of all the nutrients. It is also known as Vitamin B9. When you read about Folate, think: turning off bad genes and detoxify your body.

So, you have the results of your MTHFR (a gene that processes Folate or Folic Acid) test in your hands, and you would like to know how much Methylfolate (the usable form of Folate or Folic Acid) to take.  I wish there was a simple answer to this question, but the reality is that the answer is complex and based upon a number of factors that I will cover here. There are also a number of factors that need to be individually accounted for by your doctor based upon your unique genetic make-up and health.

One simple answer is that the more MTHFR mutations you have, the more Methylfolate your body will require. With that said, it is always a good idea to find out how much Folate is already in your body.

It is important to check your Folate levels every time you run a blood chemistry report, the same way that you check your Vitamin D or cholesterol levels. Folate is the most important nutrient your body needs for proper Methylation. You require Folate to detoxify your body from everything that you are exposed to in your daily lives. Methylation controls intra-cellular detoxification.

You need Folate to regulate gene expression because Methylation is the process that can turn genes on and off. No matter how healthy you are, and how nutritious your diet is, I guarantee that in your family there is at least one of the four most common genetic diseases (heart disease, cancer, diabetes or mental illness). With a few exceptions, most diseases including most cancers are controlled by multiple genes, and its expression can be controlled by methylation.

For example: If you have a double mutation on the MTHFR gene and you do not address it then you may be at risk for not having enough Folate to fuel the methylation engine. This can place you at a higher risk for having these disease genes to get expressed.

So let’s say you ask your doctor to order Folate levels. The results come back and your doctor looks at you and says, “Your levels are normal. Despite this MTHFR mutation you have, your body is doing just fine and you don’t need to spend your money on any supplement.” If your doctor is not familiar with genetics and MTHFR he/she will likely misread the results. Despite your lab results showing “normal”, when accounting for an MTHFR mutation your lab results might in reality be below “normal”.

Always consider these two things:

  1. Most laboratories test serum Folate, which is highly affected by diet. Just like when you fast before measuring cholesterol levels, always make sure to fast before measuring Folate levels or the results may not be accurate.
  2. When laboratories test for Folate they are measuring all types of Folate, including Folic Acid and any crude form that still needs to be processed (metabolized). Depending on the MTHFR mutation, you may have reduced ability to metabolize Folates. See chart (updated on 6/21/2017):

MTHFR A1298C – 1 mutation (may lose up to 20% of Folate)

MTHFR A1298C – 2 mutations (may lose up to 40% of Folate)

MTHFR C677T – 1 mutation (may lose up to 40% of Folate)

MTHFR C677T – 2 mutations (may lose up to 70% of Folate)

1 mutation of C677T and 1 mutation of A1298C (may lose up to 60% of Folate)

The following percentages are only hypothetical as I have not seen any research on them yet:

1 mutation of C677T and 2 mutations of A1298C (may lose up to 80% of Folate)

2 mutations of C677T and 1 mutation of A1298C (may lose up to 90% of Folate)

2 mutations of C677T and 2 mutations of A1298C (may lose up to 100% of Folate)

I have yet to see someone with four mutations. I have spoken with different researchers and lab directors who agree with my theory that four mutations may not be compatible with life. If you have three or four mutations (between these two alleles; C677T and A1298C) do not panic, but bring this to your doctor’s attention immediately; and please send me an email as I am currently doing a study on the subject.

Now that you have this data, let’s take a look at what the labs are likely going to show. Although I have not yet found a consensus of what a “functional level” or an “optimal level” should be, I believe that it should be higher than laboratory “normal” levels.

So, how do you calculate Folate levels? For example: Your lab results may show the levels 12 and laboratory normal levels if higher than 5. Your doctor may say that 12 is way above the normal. However, if you have two mutations on MTHFR C677T then you may lose up to 70% of Folate. Your actual levels of usable Folates may be only 30% of what shows in your lab results. In this case that would be 3.6 which is below lab normal. To be on the safe side, always calculate your Folate levels based on your MTHFR mutation. This is one of the reasons why everyone, without exception, should get tested for MTHFR mutations. Otherwise, you will never know if your body has enough levels of Folate to support methylation.

Considering that functional levels or optimal levels are higher than lab ranges, you need to discuss with your doctor what the ideal levels for you should be. My opinion based in part on World Health Organization recommendations is 14 to 59ng/ml.

You may have noticed that I have left out dosage recommendations for Methylfolate based on each mutation. I have purposely left this out because there are several factors, including other gene mutations that can affect the individual’s ability to process Methylfolate. I have to leave the dosage to be determined by your doctor based on your uniqueness. A non-individualized approach is a major biological stressor.

Oder a home test kit for MTHFR mutation.

On a side note, in addition to Folate levels, I always request Vitamin B12, Vitamin D and Homocysteine to be measured.

Feel free to list your lab levels, your MTHFR mutations and what you think is the correct interpretation in the comment section below. I will be happy to guide you.

*For those seeking a more comprehensive analysis and coaching, Ricardo provides long distance consultations. You may contact his clinic directly at 310 914-1624.

About the Author :

172 Comments

  1. Trevor

    recently done seminar with metagenics on methylation , reseach showed deficiency of folic acid was common in all cases of cardiovascular disease. thankyou for additional info.

  2. Kelly

    Hi
    I recently received the below lab results back. I was concerned they were too high and was reassured they were fine. Since then I was diagnosed with 1 mutation on C677T and 1 mutation of A1298C. Is it possible my body just isn’t processing my folate/vit B properly? What additional tests could be recommended? Thank you.
    Component Your Value Standard Range
    FOLIC ACID >20.0 ng/mL >3.0 ng/mL
    Component Your Value Standard Range
    VITAMIN B12 1020 pg/mL >250 pg/mL

    1. Kelly,

      You have what is called a compound heterozygous mutation and you may lose up to 50% of your ability to metabolize folates. Unfortunately some labs don’t give the exact amount of folate/folic acid if they are above certain number, such as in this case. Your lab only states >20.0 ng/ml. We don’t know if it is 20.5 or 100.

      Since we don’t have the exact amounts of folate for you, the best thing to do is to ask your doctor to call the lab and see if they have the actual numbers for your folate results. Sometimes the lab has the numbers but they just don’t report it. If that is not possible then get retested using a lab that will give the exact amounts measured.
      Make sure to be fasting when giving blood. Your B12 levels are good. Another helpful test is homocysteine.

      Good luck to you.

        1. You are welcome.
          Keep in mind that although your lab established “normal” levels >3.0 ng/ml, most labs I see place that number at >5.4 and I believe optimal levels should be equal or greater than 10ng/ml. You must discuss with your doctor what the ideal Folate levels should be for you taking in consideration your entire health history.

    1. Dear Kerry,

      Thanks for sharing with us. The amount of folate one may lose if they have your mutations is unknown but it would likely be roughly 70%. Since I am doing a research on the subject and you have at least 3 mutations I would like to offer to look into your case and give my recommendations free of charges. I would like to see the results of your tests. Would you be kind to email any lab work you have done in the past year to wellness@acupuncture.cc? If you have any health concerns please list them for me and I will give you my professional opinion once I analyze your case. This offer is valid only through March 31, 2017.

  3. Dear Jan,

    The simple answer is: Ignorance. It is easy to discredit what you don’t understand, especially if it challenges the conventional thinking.
    If you look in the “Researches” page on this website you will see that there are over 12 thousand researches on MTHFR from major universities in the US and abroad. You will find that more and more medical doctors are endorsing the MTHFR factor within their field as they look closer to research.

  4. jan bednarik

    After reading all the information online, why do so many medical doctors say this is not true, just
    all made up, so people can waste there money on foolish supplements.

  5. Jeanene Overholt

    Results of lab work done on 10/9/2015. “This patient has the normal or wild-type genotype for the MTHFR C677T (C/C) polymorphism and is heterozygous for MTHFR A1298C (A/C)”. Lab work done 10/28/2016 listed “RBC Folate (ng/mL) as >1619”. I had been taking Optimized Folate (L-Methylfolate), 1000 mcg. per day. Is that dose too high?

  6. Shannon

    My 18 month old carries 2 copies of the gene. I am at a loss as to what to give him. I just found a dr thru this site I will take him to, but until then what?

  7. Jennifer

    I just got tested for the mthfr gene. It came back that I have a1298c 2 copies. What does this mean and how muck should I be supplementing. My homosistine levels are on the low in of the normal range.

  8. Bonnie Temple

    Hello
    my 16 year old daughter was tested with a saliva test and she has homozygous for the T allele of the C677T polymorphiam in the MTHFR gene. She suffers from depression and anxiety. she was taking in pure emcapsulation B complex plus with l5 mthf 800 mcg methylcbalamin 800 and a few more things in it. She stopped taking it for 2 days and had blood tests done.
    Her results are Folate serum 16.4 ng/ml standard 7.0-31.4 ng/ml. Vitamin B12 1269 pg/ml standard 213-816. Homodysteine 4 uMol/L stabdard 5-15 uMol/L.

    1. If her serum folate is 16.4 ng/ml and she is homozygous at position C677T, then she could possibly have only 4.92 mg/ml of usable folate. I consider optimal levels to be equal or greater than 10ng/ml. Her B12 levels are more than enough. On paper she could triple the amount of L-Methylfolate and stop the B12 (temporarily), however because of the depression/anxiety I recommend you do any changes under the guidance of a practitioner as there are multiple other factors that could play a role. There are also different approaches a practitioner could take, this is just one example.

  9. Lindsay

    My last blood test was in June.

    I am homozygous for C677T.

    Serum Folate 17.1 ng/ml
    Vitamin B12 296 (200-1100 pg/ml)

    At the time of my lab we did not know my MTHFR status.

    I am currently taking Thrive Le-vel and Adren-all (for down regulation of my adrenals/adrenal fatigue 3rd stage), as well as Cytomel and Synthroid since I’ve had half my thyroid removed. I’m also quite anemic, despite a good diet.

    I’m concerned about the Thrive – It lists Folate (folic acid) on the vitamins. I started it because I had deficiencies and micro-malnutrition.

    1. Lindsay,
      Being homozygous for C677T you could be losing up to 70% of your serum folate. which means you might have only 5.13.
      I consider optimal levels to be equal or greater than 10ng/ml. Your B12 are also very low, I consider optimal levels to be at least 600.
      You should definitely avoid supplements containing folic acid and replace them with ones containing Methylfolate (5-L or 6S)

    1. Julie,

      You are definitely very low. Your usable folate could be as low as 3. Your B12 should be at least 600. You need help on both.
      Regular dosage recommended on a case like this is usually methylfolate 2500mcg and methylcobalamin 1000mcg daily for 2 to 3 months and test your levels again. However I don’t know any other information on your health or other genes. Please have your practitioner guide you on this. If they need guidance they can always contact me.

      1. Julie

        Many thanks, i have m.e and ibs and wondered whether there may be a link?will tell my gp as i am on folic acid 5mg twice a week and b12 injections every 3 months,

  10. Eric Hooper

    Hi,
    I really appreciate your site. Great info.
    I am a TT MTHFR which I think is the C677 double mutation?
    Anyway, here is my latest blood work:
    Homocysteine 9
    Vitamin b12 907
    RBC Folate 824.
    What are your thoughts?
    thanks,
    Eirc

    1. Eric, based on your MTHFR mutation you could be as low as 247. I need to see the normal range from your lab on folate, it looks as if they use a different measurement from most labs. Please reply and I will give you my thoughts on the folate. My gut feeling is 247 is probably way below that range. Your B12 levels are good.

  11. Danielle

    First of all, THANK YOU THANK YOU THANK YOU. I am a military wife and so far my insurance has not yet agreed to the MTHFR test, but I just received these labs: (homocysteine was also ordered but the result is not back yet)
    I’ve suffered from depression my entire life, was sent to an infertility clinic to get pregnant, suffered a miscarriage, didn’t get my period for YEARS, I have relentless toenail nail fungus (which I have tried everything from medicinal to natural to cure), heart attacks in late 40s&50s run rampant in my family, my father has dangerously high cholesterol despite looking like he belongs on the cover of men’s health, had a horrific reaction to the copper IUD and removed it myself when the doctor’s wouldn’t, my mother’s alcoholism has progressed to the point where she is in a LTC facility, and the list goes on. I can provide more information when I have it but ANYTHING you can advise would provide extreme relief.
    Directly from my PCM:
    Here are you labs results . Looks like they are on with normal limits.

    Vitamin B12 (Cyanocobalamin)+Folate Site/Specimen 24 Aug 2017 0841 Units Ref Rng
    Vitamin B12 (Cobalamins) SERUM 770 pg/mL (239-931)
    Folate SERUM 17.70 ng/mL (2.76)

    Thyroid Panel (T4 Free+TSH) Site/Specimen 24 Aug 2017 0841 Units Ref Rng
    Thyroxine Free SERUM 0.80 ng/dL (0.79-2.35)
    Thyrotropin Sensitive SERUM 2.270 mIU/L (0.465-4.680)

    Basic Metabolic Panel W/Glomerular Filtration Rate Site/Specimen 24 Aug 2017 0841 Units Ref Rng
    Glucose PLASMA 81 mg/dL (70-99)
    Urea Nitrogen PLASMA 10 mg/dL (7-17)
    Creatinine PLASMA 0.70 mg/dL (0.5-1.0)
    Urea Nitrogen/Creatinine PLASMA 14.9 ratio (NOT-ESTABLSH)
    Sodium PLASMA 139 mmol/L (137-145)
    Potassium PLASMA 4.4 mmol/L (3.3-4.6)
    Chloride PLASMA 101 mmol/L (98-107)
    Carbon Dioxide PLASMA 27 mmol/L (22-30)
    Anion Gap PLASMA 11.8 No Units (REF UN-DEFINED)
    Calcium PLASMA 9.3 mg/dL (8.4-10.2)
    Hemolysis Index PLASMA <15 Index (15-1000)
    Icteric Index PLASMA <2 Index (2-25)
    Lipemia Index PLASMA <20 Index (20-800)
    GFR Non-Black PLASMA 114.2 mL/min (SEE IN-TERPRET)
    GFR Black PLASMA 131.6 mL/min (SEE IN-TERPRET)

    1. Dear Danielle,

      You have quite a complex case that requires in-depth evaluation, however I will give you some points to consider to bring to a practitioner to help you. Optimize your methylation should be a priority.

      B12 levels are fine but we do not know if your folate levels are fine because we don’t know your MTHFR results. It is imperative you get tested.
      TSH is fine but your Free T4 is below optimum. We would need to see all the other thyroid markers to analyze.
      Glucose is below optimum indicating some sugar metabolism imbalance (possible hypoglycemia)
      Urea Nitrogen is below optimum – likely insufficient protein and/or HCL

  12. Anna

    Hi there,

    Thanks for this info… very useful!
    I am hetero C677T.
    My Serum Folate is 13 nmol/L (It says Healthy Range is anything >6)
    My B12 is 297 pmol/L (Healthy Range 200-700) – Note: I get hydroxy-cobalamin injections every 3 months so not sure what I’d be without supplementation – I think pretty low as I used to be deficient often times when younger.

    Not sure if relevant, but my TSH is 2.11mU/L (Healthy is 0.5-5). I have Hypothyroidism symptoms and an Autoimmune disease called scleroderma.
    Does this mean I’d be getting 60% of 13 nmol/L (ie. 7.8nmol/L) Folate? Is that ok or should I take a methyl-folate supplement? I am about to ask my Dr for a homocysteine test next week.

    1. Anna,

      You are right, you could be metabolizing only about 60% of your folate. 7.8 is below what I consider optimum, which is equal or greater than 10ng/ml. B12 optimal levels should be at least 600 and I like 800 better. Perhaps you should change the hydroxo-cobalamin for methyl-cobalamin but I don’t know your COMT situation. Methylfolate + B12 needed.

      Your TSH is good but if you still have hypothyroid symptoms you should get a full thyroid panel done (TSH, T3, T4, FT3, FT4, RT3, T3U, TBG, TPO and THYROGLOBULIN AB).
      In addition to homocysteine you should also get vitamin D levels tested.

      1. Anna

        I should mention I am pretty sure I have the COMT and MAOA mutations as well. I have the symptoms and temperament I understand is common for that genetic profile. It runs in my family too.

  13. Georgia

    Hi there,

    I am compound heterozygous for MTHFR and my current results are:

    S Folate = 18.1 mol/L (Reference – >6.0)
    S Active B12 = 44 pmol/L (Reference – 23-100)
    S Total B12 = 207 pmol/L (Reference – 200 – 700)

    S TSH = .01 mU/L (Reference 0.5-5.0)
    S FT4 = 23.4 pmol/L (Reference 11.0-22.0)
    S FT3 = 6.3 pmol/L (Reference 3.1 – 6.4)

    I have just started trying to conceive and wondering what exactly I should be supplementing with. I am currently just making sure I get heaps of natural folate in my diet.

    Your advice would be much appreciated!

    Thanks,
    Georgia

    1. Georgia,

      Based on your MTHFR status you could have only 7.2mol/L of usable folate. Although the lab reference is >6.0 I consider ideal range to be equal or greater than 10ng/ml. I recommend some methylfolate for you. Ideal B12 values are >600 you should have some extra B12 also.

      Your FT3 and FT4 are high, functional ranges are: FT3 = 0.05 – 0.06 pmol/L, FT4 = 12.9 – 19.3 pmol/L Therefore your TSH is extremely low. You must ask your doctor to test all thyroid markers (TSH, T3, T4, FT3, FT4, T3U, RT3, TBG, TPO andThyroglobulin AB).

      You should definitely replace folic acid by methylfolate. A more in-depth look into your case is awarded due to your thyroid numbers. I recommend you consult with a functional medicine specialist that understands MTHFR to guide you on your supplements.

      A safe recommendation is that you take CoQ10 with PQQ which has been shown to improve egg quality for fertility patients.

  14. Allison

    hi! I am with a new Internist (because my Integrative physician just started requiring his patients have a primary care physician). I know I am homozygous for A1298c. I just got my blood work back and My b12 is 951 pg/mL and my folate is >20 ng/mL (not specified). I’ve been on the Neurobiologix Supplement called “Methylation Complete” for almost 2 years. I’ve also been on a high quality prenatal because I’ve been pregnant/nursing. Can you suggest if this is a good place to be? Unfortunately, my integrative physician can’t see me for a few months and I don’t think my Primary Care has any idea what she’s talking about! I look forward to hearing your opinion.

  15. Murray Duffin

    Hello Dr. Miranda, – Based on may hours of research, my understanding is that heterozygous for MTHFR C677T/A1298C means that your methylation of folic acid to methylfolate is upwards of 70% impaired. People who supplement with folic acid and have the MTHFR impairment can have extremely high levels of serum folic acid, which can be dangerous. The lab our MD uses reports “folic acid” but on inquiry have told me that they are really measuring total serum folate, including methyl folate, folic acid and a few other lower level variants. Someone supplementing with 5-MTHF will not be affected by the methylation impairment, so the 70% adjustment cannot be applied to their lab result. For someone not supplementing with folic acid, methylfolate will be about 85-90% of total serum folate. There are 3 large cohort studies by CDC from the NHANES data giving info on folate status, the most recent being here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804191/ . It shows a 95% of population range for total serum folate of 14 to 115 nmol/l or 6 to 51 ng/ml, (serum methylfolate is 11 to 100 nmol/l or 5.2 – 44 ng/ml) and says that the highest levels in the adult population are for non Hispanic white women over 70 years old with low BMI and using a folate supplement. Regrettably there is no breakout by MTHFR carriers, or health conditions. I am trying to find out if there is an upper limit for healthy subjects that is less than the 51 ng/ml . The 75th percentile is 25 ng/ml. My wife is non Hispanic white with low BMI who supplements and is compound heterozygous C677T/A1298C, and has total serum folate of 57 ng/ml (98th percentile for the total population). Is this too high, or nothing to worry about?

    1. Murray,

      Great comment. As you pointed out, the research mentioned does not show the percentages based on MTHFR mutations or health conditions which would likely affect the results. In fact there is one research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811356/ which they have excluded MTHFR homozygous because of the change in results: “Where indicated, individuals homozygous for the C677T MTHFR allele were removed from the analysis because it is known that these individuals accumulate non-methyl folate forms”.

      To answer your question, although I have not to seen a maximum recommended amount of folate for adults I have found information for pregnant women. The World Health Organization has stablished that 13.5 and 45.3 nanomoles per liter is an adequate amount of folate for a woman in her first trimester of pregnancy, however I don’t think they factored in MTHFR mutations. Some researchers consider that more than 59 nanomoles per liter of folate to be an excess, again without factoring in MTHFR. They mention that a “very high amount of B12 may be potentially harmful” and “If both levels are extremely high (they do not quantify what would be extremely high), the risk that a child develops the disorder increases 17.6 times. https://www.jhsph.edu/news/news-releases/2016/too-much-folate-in-pregnant-women-increases-risk-for-autism-study-suggests.html However all of that must take into consideration MTHFR mutations.

      Another factor to consider is over-methylation which can silence tumor suppressor genes. https://www.mdanderson.org/newsroom/2010/12/red-blood-folate-linked-to-tumor-suppressors.html

      That is why I recommend using a lab that shows folate levels of any amount and not just the “>20″ often reported, which could be 21 or 100”. Like with everything in life, too much of a good thing could also be bad.

      It makes sense that a C677T homozygous or a compound heterozygous would yield different amounts of 5-methylTHF than a wild type, when numerous researches show upwards of 70% loss in folate metabolization. Further more, virtually all lab directors agree that a compound homozygous is not comparable with life, that’s why we have never seen one. The loss of 5-methylTHF is so great that a fetus cannot survive.

      Keep up the good work…

  16. Denise

    I am A1298C homo.

    Results:
    Homocysteine: 11.5 UMOL/L
    VIT B-12: 1155 PG/ML
    FOLIC ACID: 5.6 UG/L

    I requested a folate test with my B-12 but it came back as folic? Not sure how to order the folate. I’m no doctor and doing this all on my own so any advice is greatly appreciated!

    1. Denise,
      Some labs report the results for folate as folic acid but it is essentially the same thing they are testing: all types of folate combined.
      I consider ideal levels of “usable” folate to be equal or greater than 10 ng/ml therefore you are in need of folate. Because you are homozygous I suggest you take methylfolate and not folic acid. B12 levels are fine.
      I strongly suggest you get some help from a trained physician to properly guide you on how much and for how long to take the supplements based on your entire medical history.

  17. Robin

    Good Morning,
    I had my genetics tested through the 23andme website and it seems that I have mthfr 1572151 CT +/- and mthfr C677T AG +/-
    I had my folate tested through my doctor awhile ago and my numbers were
    Folic Acid 11.2 ng/ml reference range :
    normal >5.4 ng/ml
    borderline: 3.4 – 5.4 ng/ml
    low: <3.4 ng/ml

    B12 levels: 601 pg/ml
    reference range: 211-911

    I tried taking methylfolate and a more absorbable form of b12 for awhile, but as a stand alone the methylfolate made my brain fog worse.. I noticed that the b12 supplement helped with energy and gave me clearer thinking, without the methylfolate of course.

    I have a few issues that I've been fighting with for quite a few years… ADHD-PI, anxiety, depression, low energy.
    Thank you and I hope you have a good day ?

    1. Robin,

      I am not sure what you mean by “MTHFR 1572151”? I assume your results are for MTHFR A1298C and C677T, which would make you a compound heterozygous losing roughly 60% of the ability to metabolize folate. Provided your tests show 11.2 you could have only 4.48 of usable folate which is way below what I consider optimal: = or > 10ng/ml.

      Although your B12 levels are fine around 800 would be even better. Since you did not respond well to the methylfolate it would be a good idea you have your entire methylation panel looked at by an expert to determine why and coach you accordingly.

      I hope that helps…

  18. my MAPP test says
    C/T (C677T); A/A (A1298C) I really don’t know what this means as far as homozygous or compound heterozygous …
    F Folate Serum test 18.6 (ng/mL)
    – Low: 5.4

    CMP all normal; CBC all normal;
    VITAMIN D, 25-OH, TOTAL 29 30-100 (ng/mL) I have osteoporosis and take a weekly medication plus D supplements
    TSH 4.61 (mIU/L) I have only one thyroid, and do not believe the other functions at all. On medication.
    I am a breast cancer survivor 45 years old, stage 2, I have osteoporosis, with no obvious reason for it, have dealt with depression/anxiety on & off all my life. Now at 52, I am taking an antidepressant, but don’t want to. I am hoping this information I have learned about the MTHFR mutation can be treated and other symptoms will go away.
    Your thoughts?

    1. Suzanne,
      Based on your information you have a heterozygous mutation on allele C677T which makes you lose roughly 30% of function. Despite this your folate levels are good.
      CMP and CNC lab “normal” doesn’t mean much. Labs determine “normal” levels for most markers by considering 90% of their population but 90% of the population is not really healthy so these ranges are usually very wide. You must find a functional medicine practitioner to interpret your lab results based on optimal levels and not “normal”.
      Your Vitamin D is very low, optimal range is 60-80. You can use extra D and possibly Magnesium. If you are already taken plenty of Vit. D you probably need to optimize your gut through acupuncture and herbs to enhance absorption. Acupuncture should also help you with depression.

  19. Dave

    I am compound heterozygous and have been supplementing with folate b12 and b complex. How do you know when you have reached optimum folate levels? I really am not feeling very different. Is there a come to Jesus moment when you know you are complete? Or just keep bumping up the dose until you get adverse reaction and back off? This is all pretty confusing with all of the info out there. I am seeing a practioner but not sure he is an expert on mthfr and these issues. Thanks

    1. Dave,
      The best way is to get a blood test for folate and vitamin B12. First thing in the morning fasting because folate is easily affected by food and do not take any folate or B12 supplements 2 days prior to blood test. Calculate your folate levels as per my article above to see how your levels are according to your MTHFR mutations. I consider optimum levels 10ng/ml or above. If your actual levels are above this and you still don’t feel well it is probably due to something else.

  20. Mary

    Hi Mr. Miranda,

    I’m hoping you can help me. Until a few months ago, I had been on phenelzine (Nardil) for about 14 years and it worked well for depression and anxiety. I’m having problems with both again since being off the medication. Since the medication worked for me and for so long, does that mean that the issues weren’t from the MTHFR mutations? Below are my recent test results for tests I asked doctors for. Any thoughts? Thank you, Mary

    This patient has two copies of the MTHFR A1298C mutation,
    while C677T was not detected.

    Folate
    >20.0 ng/mL (my result)
    NORMAL RANGES >2.8 ng/mL
    SERUM DEFICIENT 1.0-2.8 NG/ML

    Homocysteine
    8.4 (my result)
    Normal: 5.0-15.0 mcmol/L
    Optimal: 0.0-12.0 mcmol/L

    Vitamin B-12
    275 pg/mL (my result)
    Standard range: 239 – 931 pg/mL

    Thyroid Stimulating Hormone (TSH)
    1.00 u[IU]/mL (my result)
    Standard range: 0.46 – 4.68 u[IU]/mL

    Free T4
    1.1 ng/dL (my result)
    Standard range: 0.8 – 2.2 ng/dL

    1. Mary,
      Folate and homocysteine levels are fine. B12 is low. I like to see B12 between 600 and 800pg/ml. TSH is below optimal (1.8) however FT4 is good. You should have the rest of the thyroid markers done. It is quite possible that issues are not from the MTHFR mutations since your folate levels are fine. You should have this looked at by a functional medicine practitioner.

      1. Mary

        Thank you. I will ask my dr to run a full thyrpid panel. just got a few more tests back, if you wouldn’t mind looking at them in relation to the above post.
        B6 is 10.5 nmol/l, range 20-125 nmol/l
        Whole blood histamine 184 nmol/l, range 180-1800 nmol/l. That’s about 20 ng/ml, I believe.
        My dr had me try 5mg of fluoxetine/Prozac, which I’ve been off of for over a month. It made me worse, just as in the past, I get bad side effects from SSRIs, and was put on phenelzine as mentioned above.

        Thank you for your help.
        Mary

  21. Lars

    Hello,

    The patient is positive for one copy of the C677T variant and one copy of the A1298C variant.

    Vitamin B12: >2000 pg/mL
    Folate: 21.7 ng/mL (normal is > 5.4)
    Homocysteine 7.0 umol/L

    Ferritin 26 ng/mL
    Total Iron: 157 mcg/dL
    TIBC: 299 mcg/dL (calc)
    % Saturation: 53 % (calc)

    Free T3: 2.4 pg/mL
    Free T4: 1.4 ng/dL
    TSH: 1.7 mlU/L

    A couple of questions:
    1) Even if patient loses 60% of the folate due to mutation, would he not still be in normal range (21.7 – 60% = 8.6) without need for supplementation?
    2) With B12 levels > 2000 pg/mL, is there any benefit from B12 (Methylcobalamin) supplementation (regardless of whether the current B12 leveles came from Methylcobalamin or not)?

    Other thoughts & interpretations much welcomed.

      1. Leslie

        Isn’t one of the reasons B12 may be higher than the normal range is because your body isn’t using it properly therefore a deficiency? Both my B12 and Folate levels are higher than the normal range. My doctor said it’s because my body isn’t able to absorb them properly and put me on Thorne Methyl Guard twice a day which equates to 2.4 mgs of methyl folate and 2.4 mgs of methyl b12.
        Since I feel no difference should I have further testing done to see if my dosage is accurate? I also suffer from fatigue and digestive issues.

  22. Angelica

    Hi, I am desperate for help. I live in Sweden and the doctors here have little to no knowledge about MTHFR. Some knows that it exists and might test for it but will then prescribe high doses of folic acid. The only methylfolate you can get are supplements and there are not many to choose from. Now we are about to start trying to concieve and I am all alone and feel a bit scared regarding MTHFR and my folate levels. I am compound heterozygous and I am taking 400mcg of methylfolate. I tried to double the dose but felt awful and had to go back to 400mcg. I am taking mecobalamine injections regularisering because if my ME/CFS. My folate levels are 15nmol/L (ref >7), Homocystein 5,7 (5-15) and my cobalamine >1100 (150-650). What shall I do? I can’t up the methylfolate, should I take folic acid (1mg) as well? Please, help me!

    1. Angelica,
      You might want to eat more broccoli and spinach which are rich in folate. Here in the US we can find multivitamins that contain folate from vegetables and not folic acid or methylfolate, this is also an option to help you get more folate without making you feel bad.

  23. Luis

    Hi Doctor! great article.

    I have many problems but for the sake of this subject will limit myself to the following:
    C677T +/-
    COMT +/-
    VDR +/-
    CBS +/-
    MAO-A R297R +
    Homocysteine: 11
    Folate: 12 ug/L (4.6 – 18.70)
    B12: Active 60 pmol/L (25 – 165)
    B6: 33 pmol/L (8.7 – 27)

    I’ve been thinking about starting with:
    400mcg Folinic acid + 400mcg Metafolin
    300mcg Methyl B12 + 300mcg Adeno B12
    45mg B6 P5P
    100mg Niacin
    as well as others Vit+Minerals to complete.

    What would you think of this approach? (COMT/MAO hetero so being caution with Methul
    donors)

    best
    Luis

    1. Luis,

      Just based on your SNPs and numbers above I think this regimen is fine without the Niacin, unless you have a specific reason to take it that I am unware off. Retest your folate levels in couple months to see if it is inside optimal levels.

  24. Al

    Thanks for sharing your expertise.

    MTHFR C677T —
    MTHFR A1298C +-
    COMT V158M ++
    COMT H62H ++
    MAO-A R297R ++

    B12 646
    Folate >24
    Homosysteine 15

    In this case MTHFR mutations appear to be minimal, and folate and B12 levels appear to reflect this, yet homocysteine levels remain elevated. Supplementing B12 and folate are typically recommended to lower Homocysteine. Should folate levels need supplementing beyond 24? Would raising B12 levels higher be useful? Based on the COMT status, should methyl forms of both B12 and folate be avoided? Your thought on this would be greatly appreciated! Thanks in advance.

    1. Al,
      I really need to write an article on how to appropriately correct an elevated homocysteine problem as I see even functional medicine doctors make the mistake of just prescribe folate and B12.
      There are several reasons homocysteine can get elevated and one of them is MTHFR mutations. The others are CBS I278T / T833C, cardiovascular disease, chronic kidney disease or malfunction and thyroid imbalance. You need to identify which one of the above is the causative factor for your elevated homocysteine.
      You don’t need to supplement with folate at the moment. Your B12 could be higher but it is not necessary at the moment.
      Based on your COMT status methylB12 should be used with caution, if you experience any unwanted symptoms you should switch to hydroxoB12.on

  25. Georgia

    Hi Ricardo,

    Just wondering if there is any danger supplementing with iron for someone who is compound heterozygous for mthfr?

    Thank you!

    Georgia

  26. Josefin Karlsson

    Hi, my boyfriend is really ill, probably inMCAS. He is homozygot on c677t and heterocygot in a1298c. So 3 of them, do you have any suggestions? He seem to tolerate a bit of adenosylcobalamin and methylfolate. He also have COMT and others that also is homozygotes. Would appreciate any input!

  27. Hi. I just got back results and it says I have one 677 mutation so losing about 30-40 percent folate. Do I just buy a folate supplement and start taking it or do I need to do addition tests ? Thank you in advance.

    1. Fatimah,

      I recommend you do a blood test to check your folate, B12, Vit. D and homocysteine levels. Draw the blood first thing in the morning before any food. Do not take any vitamins or supplements 2 days prior to the blood draw. Let me know the results.

  28. Jenny M.

    Hi Doctor!
    I am a 33 year old female and I just found out a couple weeks ago that I’m heterozygous for MTHFR C677T. I have been struggling with fatigue, depression, anxiety, brain fog, dizziness, body aches, and other symptoms for at least 15 years. I have Hashimoto’s (currently treating with Thyro-Gold but was taking Armour) and also am probably Vitamin D deficient (a few years ago I was at 8), along with iron deficiency anemia. I am also autistic and have ADHD. I got my levels tested and this is what I have:

    Folate: 7.3 (normal >5)
    B12: 361 (200-1100)

    Should I be supplementing with methylfolate? I am taking 5000 B12 Methylcobalamin 2x a day, but should I add anything? I’m going to be seeing a functional doctor as soon as my insurance kicks in, but I’m pretty miserable and want to start feeling better before then.

    1. Jenny,

      Being heterozygous for MTHFR C677T make you lose roughly 40% of your ability to metabolize folates. To be on the safe side you should factor this on your lab results which would place your folate levels at 4.4 which is way below what I consider optimal: >10. I would recommend supplementing with 5-L-Methylfolate about 2500mcg per day.
      Your B12 are also below what I consider optimal: >600 therefore your supplementation is adequate.

      I do not know other key factors on your health therefore these recommendations should be checked with a functional doctor that knows your medical history.

  29. Nermeen

    My son is 10 years old Mthfr c677t , he is GFDF, I give him b12 I haven’t started methyfolate yet, we just run some tests on him , his vit b12 and folate are high b12 is 1533 , ( should range from 211-946) folate is >20 ( should be >3) , can it be ? How come he has c 677t and folate b12 are high ? I though he should be low in folate and b12.
    Another question , his Cholesterol is high and hemoglobin a1c 5.4 ( 5.7 considered prediabetes ) , MCV , MCH are low , does this related to his Mthfr c677t? Does Mthfr is causing all these problems?
    Please help

    1. Nermeen,

      You need to get tested by a lab that shows exactly levels of folate when they are above 20 because it could be 21 or 100 and we do not know where he is. There are other factors that will influence folate levels in the body therefore even with a MTHFR C677T mutation his folate could be high and a blood test is always recommended.

      You really need to have his case evaluated thoroughly by a functional medicine practitioner. Although is likely that his MTHFR mutation is a factor in his health it is likely not the only factor and you need to look at all factors to properly help him.

  30. Judy

    I am homogygeous c677t. I have been reading that i should not be taking ANY folic acid. My multivitamin has folic acid in it. I have asked my doctor about it and she keeps telling me that she has not found any reliable sources that indicate I should not take folic acid. She warned me about reading information found on the internet. Not sure what I should do. She seemed to be fairly familiar with MTHFR. Any advise would be appreciated!!

  31. Satish

    Hello dr, my daughter is recently diagnosed with autism. IWe had done her lab test in October 2017 and her B12 level was normal,375 ( normal range around 200 to 800) and homocysteine was also normal. The doc suggested to supplement with methyl b12 sublingual. which we started however as she is too young 2 year old hence not sure drug was absorbed. After around 20 days we reordered b12 along with mthfr from another reputated lab. Her b12 level comes out high around 900 and she was found to be compound hetetegenous. Now we have stopped giving methyl b12. Is there any possibility that she has ASD feature due to mthfr mutations. Could you please suggest what other test should be done. I am thinking to get her tested for folic acid and homocysteine ( repeat as I am not sure if it was done correctly) and methymalonomic acid. Please provide your recommendation

    1. Satish,

      When reading blood chemistry labs please follow the guidelines below for optimal range:
      B12 600 to 1000
      Homocysteine 5 to 9
      Folate >10 You must calculate folate levels based the MTHFR mutations
      Have you tested her for MTHFR and COMT? If not order from the link below:
      https://www.mthfrdoctors.com/product/mthfr-comt-cheek-swab-test/

      With the results in hand you must calculate the folate levels in order to give the right dosage of methylfolate considering also the results of COMT. Chances are you have to work on her gut too.

  32. Jennyrn

    Hello!
    Last year I was diagnosed with anxiety and depression And did some
    Genetic testing. It was brought to my attention that I am homozygous mthfr t667t and homozygous TCN2 gene, and comt v158m – – It was recommended that I take Deplin along with my antidepressant medication. I ran out of the Deplin and did it Refill it because of the cost.

    I recently had my physical with my medical doctor and she Gave me the results of
    Vit d 28

    B-12 238

    Folate >24

    She recommended vitamin b12 injections.

    She doesn’t know anything about MTHFR and when I inquired about what form of B12 injection she has at the office, I didn’t get a response …

    1. Jennyrn,
      Optimal levels of Vit. D are 60 – 80 so it looks like you need more Vit. D.
      Optimal levels of B12 are around 800 and that’s why she recommended it for you. Ask her to inquire with the supplier of what kind of cobalamin is the B12. Cyanocobalamin, Hydroxocobalamin or Adenosylcobalamin are best for you since you are homozygous for COMT V158M. Another issue that you may have is reduced ability to transport B12 into the cells because your TCN2 homozygous. I would like to see your B12 levels between 800 and 1,000.

      You should get tested for folate at a different lab because your results only show >24, and you just don’t know if it is 25 or 100. That would determine if you need to supplement with methylfolate. If she doesn’t know anything about MTHFR I strongly recommend you consult with a practitioner that specializes in MTHFR.

  33. Sue S

    I have the marker rs1801131(A;C) on promethease. I believe this means I have one mutation, but I’m not 100% sure if that’s correct. Do you need more info? My folate level was 16.0 a few days ago, but I was not fasting and had taken 800mcg of folinic acid on the day of the test and once the day before (so only 2 days total). Unfortunately, I didn’t find your site until after the test so I can’t realistically go back and get fasting levels. Thanks!

    1. Sue,
      According to your information you have a heterozygous mutation on MTHFR A1298C which makes you lose roughly 20% of metabolization of folate.

      You must refrain from taking any supplements couple days prior to drawing blood otherwise the results are inaccurate. I suggest you re-test folate levels

  34. Ewa

    I have homozygotus mutation on mthfr T/t c677t. After four-months supplementation with folate 800mcg, b12 and other supplements that support absorption, all my parameters improved (in fact, homocysteine ​​is at level 6 from the previous 12), however, the level of folic acid in the blood remains too high (31ng / ml). I have done this test in November – currently im 5 weeks pregnant. Should I be worry? Is it possible that the blood test shows both folate and folic acid? I had previously measured folic acid levels in blood in August and the result was lower – 29 ng / ml (When I did not know about mutation I took normal folic Acid for over a test). Thanks !

    1. Ewa,
      31ng/ml may not be that high considering your homozygous MTHFR mutation on C677T because you may loose up to 70% of metabolization of folate, in fact I would try to keep the levels around that number. Blood test shows all types of folate including folic acid. Nothing to worry about.

  35. JA

    Thank you for your article, it has made some things very clear to me. Reading through the comments, I felt that I needed to comment because my Folate levels seem so much higher than everyone who has shared. I don’t think I need folate supplementation but I do need B12. I
    These numbers are without any kind of supplementation in place.
    Folate 34.2 ng/mL
    B12 (cyanocobalamin) is 758
    I am Homo C677T
    My doctor has prescribed a fairly high dose of methylfolate, but I don’t think that is warranted at this time, correct?
    Thank you!

  36. JA,
    Being homozygous for C677T your levels are about right. I would scale down the methylfoate to about 800mcg and retest your folate levels in three months. B12 levels are OK but if you want them a little higher that is fine too.

  37. Stephanie

    First, thank you for having an easy to understand site. I have found yours the most helpful.

    I have Celiac Disease and have trouble maintaining my vitamin levels as is. After running my raw data from a genetic test, it turns out that I have homozygous mthfr a1298c. My most recent labs are:

    Folic Acid 11 ng/ml. Standard range >=4 ng/ml
    B12 433 pg/ml. Standard range 232-946 pg/ml

    I was taking B12 supplements at the time of the last test and from what I understand, you must abstain from supplements for 4 months before testing in order for tests to be accurate. Is it correct, that if I am supplementing, my levels should be upwards of 1000?

    I am not taking the right forms of B vitamins and my multi has folic acid, I will correct this, but in the meantime, should I be requesting that my doctor test my Homocysteine? After a year of strict gluten free I still feel horrendous (many of the symptoms can be attributed to Celiac and/or B deficiencies), but in all fairness it took 20+ years to get diagnosed so healing might be slow.

  38. Stephanie,
    You don’t need to stop taking supplements 4 months prior to blood test, I believe a few days should be enough.
    Test for homocysteine is helpful if you have never done that but not crucial in correcting your folate levels, in any way I do recommend to include homocysteine along with Vitamin D when you re-test your folate and B12.
    You are right that your B12 should have been much higher. Consider acupuncture and Chinese herbs to fix gut absorption as well. You may have a problem with it.
    I recommend your serum folate levels to be >= 17 because of your mutation and your B12 to be >= 800.

  39. Marita

    Hi,
    My 10 year-old son has two heterzygous mutations (C677T & A1298C). His labs:
    Vit B6-26
    Vit B12-923
    Folate>20
    Vit D-40.
    His practitioner recommends taking Thorne Reasearch Methyl- guard plus starting with 1cap. That would be 1mg of methylfolate + vit B6,B12. Is that a good starting dose for him? I’m afraid it can be too high too fast. Please let me know your opinion. Thank you

    1. Marita,
      It should be a good starting dose, however I recommend you get his folate levels tested by a different lab that shows exactly how much folate he has. The results of >20 could mean 20.1 or 40 and we don’t really know if he needs to supplement or not.
      I recommend giving him more vitamin D to get his levels above 60.

  40. Anne

    I just recently received my results after some blood work and I’m very confused about my B12 and Folate levels as they seem pretty high. Does that mean I’m taking too much methylfolate and methyl b12 supplements? Ever since I changed my diet to avoid folic acid and taking the “right” supplements, I have not been able to get pregnant after having 3 miscarriages. I take a bunch of other supplements but not sure if i’m Missing anything. I take Thorne Stress B Complex (not every day though), CoQ10, fish oil, vitamin D3, and was taking baby aspirin but recently stopped. My homocysteine is 5.2 umol/L.

    Folate ng/ml = 39.3 (standard range 3.1 – 17.5)
    B-12 pg/ml = >1500 (standard range 211- 911)

    Any advice would be greatly appreciated!

    1. From your numbers I think you can safely stop taking everything except CoQ10, fish oil and vitamin D (unless your vitamin D is above 60) for about a month and retest. I also need to know your MTHFR status in order to calculate your actual levels of folate. Have you tested for MTHFR mutation?

  41. Jolene

    Hello to you, my b12 is 1286 (213-816) and folate 15.1 (7.0-31.4) My TSH 1.27 (0.35-4.94) FT4 1.1 (0.7-1.5) T3uptake 30 (24-35) TPO <3 (0-6) thyroglobulin 4 (0-5) I also have the mthfr gene. Don't know if this will help but am including these. I also have thyroid nodules all over and an elongated thyroid. Thanks for any input you can give.
    FUT2 rs492602 GG ++
    FUT2 rs602662 AA ++
    MTHFR C677T rs1801133 AA++
    MTHFR A1298C rs1801131 TT–
    MIR4761 (COMT V158M) rs4680 AG+-
    NBPF3 rs4654748 TT++
    MTR rs10925257 AG+/-
    rs10925263 TT-/-
    rs2275565 GT +/
    rs3768142 TT -/-
    rs883396. AG+/-
    MTR A2756G. rs1805087 AG+/-

  42. Peggy

    Hello,
    Thanks for your reply. I know all this is time-consuming. I am homo for MTHFR A1298C. My last test for folate serum was at 14 which from what you say may actually be functioning lower–around 8 because of the mutation. I am also homo for VDR Bsm, and my vitamin D was at 25. I see you recommend testing for D so I assume a connection. Does low D also affect functioning folate? I’ve tried a fairly low dose of L5 MTHF on four different occasions (100mcg) along with the b vitamins that are in the same supplement. I always start out a little dizzy, then that goes away after an hour, and I have a lot more energy than usual for the rest of the day. Also slept well those nights. That’s encouraging, but I’m so afraid to take it. Does it sound to you like I’m on the right track, or are there other things I need to take into consideration before taking L5 MTHF regularly? Some real horror stories out there.

    1. Vitamin D is not directly related to folate function but it does so indirectly and is also vital for so many other functions. Optimal levels are 60-80.
      As far as continuing with the methylfolate I would need to see complete blood work and medical history, it gets much more complex than just folate, since you have some reactions at first. Do you know your COMT V158M mutation? If not, you can order one from the site at: https://www.mthfrdoctors.com/product/comt-gene-cheek-swab-test/

  43. Carlos Manriquez

    Hello doctor, I am homozygous in the T allele C677T polymorphism in the MTHFR gene. My Folate >40 ng/mL and my B12 levels 2000 pg/mL. I am so confused as what this all means, as it appears that both numbers are high, but perhaps they need to be due to the genetic situation? If it matters vitamin D is
    VITAMIN D, 25-HYDROXY 50.0 ng/mL
    Your help is highly appreciated!

    1. Carlos,
      You do not need methylfolate or B12 supplementation at the moment, however a good look at your entire biochemistry labs are necessary to put the pieces together. Your vitamin D is almost at the optimal level (60), I recommend a little more supplementation.
      You need a full assessment to determine what is going on.

  44. Nicole

    Hi Doctor Ricardo
    I am located in Canberra Australia and found out a few months ago I have the homozygous C677T mutation. I got tested because I had two miscarriages before conceiving the baby I am currently carrying and wanted to see if this could be the cause. Now i am scared that I am not doing everything right for this baby that is now 19 weeks and i cant find a single practitioner in Canberra. I had been taking folic acid supplement (very high – 800mcg!) before finding out I had the mutation. I switched to Seeking Health and then Thorne prenatal (with active folate) when the baby was around 10 weeks along (so had already passed the crucial period). However I have been eating very well – lots of folate rich foods – for the last six months or so.
    I had my bloods done this week and they came back as follows:
    Folate: 45
    Homocysteine: 3.5
    B12: 370

    Is there anything I need to be doing to help protect this baby? My folate seems ok? I have been taking the active folate supplements for the last 10 weeks or so but my doctor doesnt approve because they contain vitamin A and would like me to stop them. Should I? Should I be doing something to get my B12 up?
    Also, from my reading online, all pregnant mothers with my mutation are on blood thinners but my doctor will not let me take them. I am afraid my mutation means I should be on blood thinners too but i’m also reluctant to go against my doctor’s advice. Any advice would be so greatly appreciated!

    1. Nicole,
      Your folate is fine, but your B12 is low and your homocysteine is below optimal which could indicate over-methylation. I recommend taking B12 by itself instead of the vitamins that contain the A since your doctor doesn’t want you to take vitamin A. Try to bring your B12 to about 600.
      As for blood thinners I also advise you to follow your doctor’s recommendation as they know your entire health condition.

  45. Scott

    Hi Doctor Ricardo and thank you for what you do. I recently found out that I am homozygous C677T, heterozygous VDR Taq, VDR Bsm, MTRR A66G, CBS C699T, and BHMT-02. My homocysteine levels came back at 20.4, which I know is way too high. My serum folate is 5.0 and my serum B12 is 544. From my understanding of C677T having close to a 70% reduction in usable folate, would my true folate be closer to 1.5?? What advice could you give based on this? I am a 36 year old, Caucasian male, no serious health problems but chronic inflammation symptoms, low testosterone, and generally feeling “blah”. Any advice is appreciated, thank you sir,
    Scott

      1. Scott,
        Based only on this information I would recommend you take some methylfolate + B12 (if you don’t respond well to methylcobalamin take hydroxocobalamin). Take it for about 2 months and test folate, B12 and homocysteine levels again (fasting, stop taking all vitamins 3 days prior to blood draw)

  46. Tess

    Dear Dr Ricardo
    Could you please help me interpret my folate and B12 results. I have one T allele on C677 and also one mutation on COMT. My Serum B12 is 1931 pool/L; lab ref range is >138. My Serum Folate is 70.1 nmol/l. My red cell folate is 1544; lab red range is >285. I have made extensive diet changes (Whole Foods, pasture raised meats and organs, raw milk kefir etc ) and am supplementing with activated folate and B12 and a B complex. Are my levels way too high or optimal. Thank you, Tess

  47. Mia

    Hi Dr. Miranda,

    This is fascinating! I recently got tested in Nov 2017 for the MTHFR gene mutation after finding out that my mom was heterozygous for the C677T variant. Also, because my Vit B was quite low – 282 pg/mL in Sept 2017 (close to 500 in Jan 2017, though). Turns out I’m homozygous for that variant but normal for the A1298C one. My Dr. requested several tests, so I’ll just list them out below in series:

    11/15/17 –
    Vit D 25-OH – 37 ng/mL (30-100 normal range)
    Ferritin – 38 ng/mL (10-154 normal range)
    Magnesium RBS – 4.6 mg/dL (4-6.4 normal range)
    Iron total – 144 mcg/dL (40-190 normal range)
    Total Iron biding capacity – 381 mcg/dL (250-450 normal range)
    % transferrin – 38% (11-50% normal range)
    MTHFR – C677T homozygous

    My Dr. put me on Xymogen’s B Activ, 2 capsules a day while we continued and tested for folate and homocysteine.
    https://www.xymogen.com/formulas/products/21

    12/1/17 –
    Folate RBS – 706 ng/mL (>280 normal range)
    Homocysteine, total – 7.9umol/L (<10.4 normal range)

    I retested the vitamins with my comprehensive panel in January 2018, and I'll just mention my B12, D. In fact I'll also mention my TSH, because I notice some others mentioned it.

    Jan 16 2018 –
    Vit. B12 – 651 pg/mL (normal range 211-911)
    Vit D – 44.42 and second test was 53.93 nmol/L (normal range 25-250)
    TSH – 4.07 uIU/mL (0.35-5.50 normal range)
    T3 total – 0.40 ng/mL (0.6-1.81 normal range)
    T4 total – 2.80 ug/dL (5.01-12.45 normal range)
    Went back to do TSH Ultrasensitive:
    TSH Ultrasensitive 0 3.402 uIU/mL (0.550-4.780 normal range)
    T3, Free; FT3 – 2.75 pg/mL (2.3-4.20 normal range)
    T4, Free; FT4 – 0.97 ng/dL (0.89-1.76 normal range)

    Now, I noticed that you said I'm probably absorbing 70% of my folate, that would put me at 211.8 ng/mL, which is less than the 280 that's the normal range. My doctor said it's fine, but this has me curious. I'm interested to hear what you think about my results and if there's further testing that you think I should do. I should mention that my husband and I are thinking of a pregnancy soon, so I am curious what kind of prenatal vitamins I should be taking so that I'm getting activated methyl folate and not folic acid.

    Thank you so much for your time, I'm so interested in this it's a total rabbit hole for me!

    1. Mia,
      My recommendation is to supplement with methylfolate to double your levels based on your mutation and the fact you want to get pregnant. I would also get your husband tested and make sure he also has the right amounts of folate and B12. I also recommend getting your B12 to 800-1000. Get some Vit. D as well to get it to 60.

  48. Katie

    Hello Dr. Miranda,

    I had my newborn tested and he is HOMO for 677. I want his pediatrician to test his levels as you’ve mapped out. What are the ideal levels for children under 2? If pediatrician is reluctant to test, do you recommend a type of practitioner we should seek out when dealing with pediatric patient? Are you supportive of supplementing for a baby as young as 3 months (breastfed baby). Lastly, what’s your POV on vaccinations for a baby with HOMO 677?

    1. Katie,
      I have to research the ideal levels for newborns. I will post it here once I get that answer. The best thing you can feed a baby is breast milk. Vaccinations, as long as they have no mercury, etc. have more pros than cons as they will protect your baby from common diseases. I will get back to you on all the questions once I have completed my research.

  49. Ron

    Thank you Mr Miranda for this fabulous information you truly our making a difference in peoples lives, perhaps you could evaluate my situation. I am positive for C677T Heterozygous & COMT g/g Val158Met. My recent blood test show Folate 11.7ml (range 3.4-5.4ml), B12 926ml (200-1100ml), B6 41.4ml (2.1-21.7ml), Histamine 2.8ml (.01-1.8ml), Homocysteine 9.5ml (<11.4.ml), C-Reactive Protein 2.7mg (<8.0mg) & vitamin D 35.0ml (30-100ml). I am using no supplements what would you recommend. This has been a very long journey I have seen multiple doctors over several years only to be disappointed when they don’t have an answer to my headaches, body fatigue and pain as well as anxiety. Your advice would be very much appreciated. Thank you for your time. Ron

    1. Ron,
      My advice pertains only to your mutations and the shared lab values. In order to correct your headaches, body fatigue/pain and anxiety you will need an in-depth analysis and treatment plan. Accounting for your mutations your folate levels could very well be below what I consider optimal (10). anywhere between 1000mcg to 2000mcg of methylfolate for a few months but you may need to increase slowly because of your COMT. I also recommend 5000IU of Vitamin D daily for about 3 months. to get your levels above 60ml.

  50. Deborah Brooks

    Curious if you are still doing the study on the genetic mutations, I have both. Just happened upon your site and very happy to have found it. Thanks!

  51. Nemanja Vujcic

    Hello Dr Miranda,
    My wife and I are planning a second child. She has the MTHFR C677T heterozygous mutation. In early October 2017, she did a blood test and it was found her folic acid was very low at 9.35 nmol/l. She started supplementing with very potent 5,000 mcg pills of L-methylfolate, one per day. On 17th February 2018 her folic acid levels were off the charts, a laboratory wrote: >45.4 nmol/l. I assume their test doesn’t even include the possibility of levels this high. She stopped supplementing immediately, and on 24th March (so that’s 35 days later) she tested her folic acid level again in another lab. Results are still off the charts: >54.2 nmol/l. We are completely confused. I tried to make sense of this and found your website. Any advice is appreciated. She is not taking folic acid now. Should she avoid any folic supplements until her levels go down?

    1. Nemanja,
      According to her lab results she doesn’t need any folate supplementation for the time being, however that might change, so I recommend testing every 3 months without supplementation. She should start adding some when her levels drop to 20, but at that time consult with an MTHFR expert to coach her on the dosage. She should start with a much lower dose than 5000.

  52. Reneice

    Is having a mma serum and mma urine test the best way to test if you have the mthfr mutation? I am heterogeneous c667t one variant. My folate was >20 and b12 1241, urine mma 0.5 , serum mma 58. I have been taking multivitamins but not methylated ones because I just found out about this mutation. I’m afraid the vitamins are giving false readings because I have a lot of symptoms of b12 or folate deficiencies. Thoughts?

    1. Reneice,
      It seams you already know you have a mutation. Whenever you go for blood test to measure your folate levels you should stop taking any supplements for 3 days and draw the blood after 8 hours of fast.

  53. Reneice

    I meant for that to say is testing the urine and serum mma the best way to get an accurate for sure reading on your b12 levels if you have mthfr.

  54. Jennifer

    I have heard things about too much folate and cancer. I take 2 mg methylfolate. I have 2 genes of the C677 mutation. How do I know its not too much? My homocysteine is 8 on the supplement. I am concerned they say overmethylation and cancer??

      1. Jennifer

        I’m confused because my lab tests said greater than 1459 or something, it wasn’t a low number. Am I supposed to convert this?

  55. Justin

    Hello,
    This site has been immensely valuable in trying to solve the myriad of mystery health issues. I recently took a 23&Me test about two months ago and it revealed a chart with a bunch of fun colors on it. These were the ones highlighted yellow and red. Based on what the report showed I have a compound MTHFR, so I ordered a supplement online by the name of BPLEX PRO, which is a Vitamin B complex with 1.5 mg Methlyfolate and 3 mg of B12, along with a bunch of other B vitamins. I had my doctor order some blood work earlier this week and I was not sure if I am taking enough of the supplement or if my body needs to build up its’ levels. Other than that, I am a 30 yr old male with the occasional crippling brain fog and very low testosterone that has been below 200 since my early 20’s. Do these mutations typically coincide with lower testosterone levels? Below are my genetic and blood tests. Thank you again for all that you have shared and provided for the lost mutants of us.

    COMT V158M (+/-)
    COMT H62H (+/-)
    VDR Taq (+/+)
    MTHFR C677T (+/-)
    MTHFR A1298C (+/-)
    MTR A2756G (+/-)
    MTRR A66G (+/-)
    CBS C699T (+/-)
    SHMT1 C1420T (+/+)

    Vitamin D Level 37.5 ng/mL (<10=Deficient; 10-29=Insufficient; 30-96=Sufficient) ng/mL
    Total Testosterone 193 ng/dL 240 – 871 ng/dL
    Folate 18.4 ng/mL 7.0 – 31.4 ng/mL
    Vitamin B12 Level 743 pg/mL 213 – 816 pg/mL

    1. Justin,
      I have not seen strong correlation between MTHFR and low testosterone. I believe you need to have a comprehensive look at your health to determine why.
      Your folate levels are OK for your mutation, for the time being. Recheck every 3 months and make sure it doesn’t fall below 17. Your Vit. D should be above 60 so take some more.
      When testing for folate levels stop all supplements for 3 days prior to blood draw and fast for 8 hours.

  56. shauni farrell

    This is a very interesting article. Wondering if you can advise. I have many health conditions such as postural orthostatic tachycardia syndrome, ehlers danlos syndrome, mast cell activation disorder and gastroparesis to name a few and i take many medications. I saw an alternative specialist a couple years ago and he advised i take biocare nutrisorb liquid methyl b drops with folate and a strong multivitamin called source of life gold that includes 333ug of b12 and 142ug folate along with many other vitamins. he advised this based on me having the following mutaions from 23 and me genetic tests:
    Gene Mutations
    MTHFR A1298C (heterozygous mutation)

    Other heterozygous mutation:
    COMT V158M
    COMT H62H
    VDR Bsm
    VDR Taq
    MTRR A66G
    MTRR K350A
    AHCY-01
    AHCY-19
    CBS C699T
    CBS A360A

    Homozygous mutations
    MAO-A R297R
    BHMT-08

    After reading online that too high levels of b12 and folate can cause anxiety which i suffer from i decided to get mine checked.
    my serum folate level 12.1ug
    serum b12 1039 ng/L
    im wondering should i still continue to take these supplements and could the supplements cause anxiety to worsen at these levels?
    they also tested GFR to be 83mL/min and vit D 109nmol/L, serum urea 3.7mmol/L, serum creatine 75umol/L, potassium 3.9mmol/L and despite taking 500mg supplements my magnesium was only 0.78mmol/L
    Any advise would be massively appreciated! Thank you very much for your time. I am sure you are helping many peole so much!
    Shauni

    1. Shauni,
      Your folate levels could use a little help. I don’t think the folate is causing your anxiety based on your genes, however with so much going on in your health I would need to do a complete evaluation to be comfortable giving you more recommendations.

  57. shauni farrell

    If its relevant i should also add my iron levels have been below the clinical range however i am not taking supplements as they cause me too much stomach pain.
    Many thanks Shauni

  58. Angela

    Thank you for all that you do to help us! I just recently found that I have MTHFR C677T and MTHFR A1298C both heterozygous. I had my folate testing done with it being 29.1 (normal levels 3.1-17.5), B12 being 1,356 (normal levels 250 – 1,100). HOMOCYSTEINE- 8.2 (normal being <10.4) These were done fasting. I have an appt with my Func Med doc later this month and want to be prepared. With having one gene of each MTHFR, how would I compute my "normal"? Thank you for your time 🙂

    1. Angela

      Also wanted to add that I am COMT V158M, H62H, VDR Taq Hemozygous. I tested on the low end for Ferritin 10 (normal 8 – 252). My thyroid levels are all within normal limits except I am 77 on Antibodies being anything >9 is abnormal).

  59. Carol

    Hi Dr. Ricardo, I am still waiting for my genetic tests, but I got by blood analysis and my Folate is VERY low (Folic acid 3.4 ng/ml normal range > 5.4) and B12 326.0 pg/ml normal range 211.0 – 911.0… So even if not having any MTHFR mutation the folate level is so low that I am really worried. What does this low level mean? Can I start any supplement even without having the genetic test yet? Any help would be great… Also, do you do skype sessions? Thanks in advance

    1. Carol,
      You may definitely start supplement with methylfolate. Your are likely undermethylating.
      I do long distance consultations and coaching. The best is for you to contact my office at 310 914-1624 to arrange for one and I will be glad to give you the proper comprehensive analysis and coaching.

  60. Dana

    Hello Dr. Ricardo,

    I just recently found out I am homozygous for the MTHFR C677T variant. The MTHFR A1298C variant was not identified.

    My Folate and B12 levels were:
    Folate, Hemolysate: Not Established
    Folate, RBC: >498 ng/mL
    Vitamin B12: 545 pg/mL

    My doctor recommended Deplin, but after reading a bit from Dr. Ben Lynch, I’m hesitant to jump straight into that. Any advice or guidance would be greatly appreciated.

    Thanks.

  61. waleed

    hi, my 11 y o son has compound heterozygous mutations ( MTHFR_677& MTRR_66& MTR_2756) Homocysteine level is 16.
    Dr gave him folic acid, i have read that folic acid is a mistake in my son case.
    i do not know what to do.

      1. waleed

        Hello Dr. Ricardo,
        Thank you for your reply, may i ask about the suitable kind and dose of methylfolate, he is 11 years and 5 monthes with 40 kg weight .

  62. Jessie

    I am MTHFR homozygous c677t, I do take supplements. 3,000 mcg of methyl b-12 & 1000 mcg of L-methylfolate. Labs are b-12 is at 1500 and folate is 18.3. waiting on the vitamin D labs. Am I taking to much?? I am on a PPI for acid reflux that should reduce my b-12 ? I have been tested for so many things and everything comes up negative. Lupus, Thyroid, Lyme’s, Hemocromotosis, Mono, etc. All have the same symptoms. Only labs that are high are hemocrit, and hemoglobin. Can MTHFR be causing these issues?? Please Help… 🙂

  63. Nancy

    Hello Dr Ricardo,
    I have just found out that have one C677T heterozygous mutation and one A1298C heterozygous mutation.
    My labs are as follows:
    Vitamin D tot =32, D3=32 ,D2=<4
    Homocysteine level =9.4
    Vitamin B12= 549
    Folate = 18.4
    Even though my labs appear within Normal range, I was wondering if you could interpret them for me, and advise me on which vitamins to take ( if any) and the dosage.

    1. Nancy,
      Based on your mutations, your folate levels could be as low as 7.4 and I like it above 10. I like B12 at about 800 and D above 60.
      If you are perfectly healthy and just want to get your levels at optimum you could probable take (methylfolate 2,500mcg, methylcobalamin 1,000mcg and Vit. D3 5,000 IU) per day for about 3 months and recheck your levels.

  64. waleed

    Hello Dr Ricardo
    I just receive the results of B12 and folic acid of my 11 y.o son, who has high homocystin level (16 umol/l ) as i told you before, folic acid ( 6.8 ng/ml ) and Vitamin B12 ( 350 pg/ml ) .He has compound heterozygous mutations ( MTHFR 677, MTRR 66, MTR 2756 ) . you may kindly advice me.
    Thank you.

    1. He definitely needs to take methylfolate and methylcobalamin. Because he is a child I would want to have a good look at his file before giving you recommendations on dosages etc. I suggest you call a practitioner you trust to guide you through this. If you don’t have one I would be glad to take him on, in which case you may call my office at 310 914-1624 to make arrangements.

  65. Diane

    Hi Dr. Miranda…I am positive for one copy of the C677T variant and one copy of the A1298C variant…compound heterozygous….homocysteine was at 13.1 UMOL/L (range <10.4) on 2/6/18; then on 3/29/18 homocysteine 18.9 UMOL/L (range 4.7-12.6)…different lab….serum folate on 3/29/18 was 13.9ng/mL (range 2.8-20.0); methylalonic adic on 3/29/18 was 0.18 UMOL/L (range 0.0-0.40); also folic acid RBC was 407 ng/mL (range 281-999999); copper 124 ug/dL (range 80-155).; serum zince was 88 ug/dL (range 60-120)…I have tried methylfolate and it has caused me more anxiety and shakiness; tried nonmethyl B12 liquid one drop with water and felt like I was going crazy; then tried methyl B 12 liquid one drop in water and got more pain in back and neck, nervous, and wanted to sleep…I don't know what to do anymore…The ND I saw doesn't know either…My body is rejecting everything….I can't even tolerate small doses of probiotics….have tried 4 different kinds….I get more anxiety, cry….

    1. Diane,
      Your homocysteine is much higher than the functional range of 5 to 9. Your folate levels considering the compound heterozygous status could be as low as 5.7 which is below the functional range of 10.

      I am wondering what is your COMT status. That could be a possible cause of you reacting to the methylated B9 and 12.

      If you would like me to take over your case please call my office at 310 914-1624 and I would be glad to take a deeper look into everything to give you proper guidance.

  66. Elise

    Hello Dr Ricardo,
    Months ago I tested positive as homozygous MTHFR T667T, (no other gene mutations) and from then on started supplementing 1000mcg methylfolate 50mcg B12 combo daily. I avoid folic acid in my diet except on weekends where I cheat and might eat some bread and pizza, but that’s it. We are looking to conceive and for the last month and a half also get an extra 400 mcg methylfolate from my Seeking Health prenatal. I just got my blood test results and I’m not sure how to go about it:

    – Folate RBC: >2500 (normal range > 1186)
    – Homocysteine: LOW 3.8 (normal 5.1 – 15.4)

    I was surprised as I was expecting high homo, not low! So I’m overmethylating, but I’m weary of stopping/reducing methylfolate as it’s only 1400mcg and I’m homozygous! Also, if I metabolize only 70% does that mean I should up my intake so I get a reading around 4000, or is my number ok because the majority of that sample is methylfolate and therefore get plenty?

    It’s tough to find infos on low homocysteine and got from Dr. Ben Lynch that those with low homo should supplement liposomal gluthatione. I already take NAC (N-acethyl-cysteine) once a week so I will start taking daily. What’s your take on my situation? Thank you very much!

  67. Hi Elise,
    You should continue with your methylfolate intake as folate levels fluctuate on a daily basis. Let me point out that your lab results is for RBC Folate and not Serum Folate. I would like to see serum folate levels.

    Because you are looking to conceive, I strongly recommend you have a health care practitioner take a look at your entire blood chemistry and health history and guide you throughout the entire process. There are lots of pieces that need to be looked at and since your homocysteine is below optimal we can’t leave any stone unturned and make sure you have the best outcome for you and the baby.

    1. Mary Selix

      I’ve had 2 miscarriages and a still born at 7 1/2 months and 1 full term child. All due to taking prenatal vitamins with mthfr mutations compound homozygous I believe mine is. And had I not taken prenatal vitamins with fic acid may have hadless complications is what my prior hematologist stated but she moved to another state so nobody else in Omaha, NE is educated in mine and are all at a loss how to help me right now.

    2. Elise

      Hello Dr Ricardo,
      I wanted to follow up with you as I got more blood tests done just yesterday (I’m now about 6 weeks pregnant!) and along with the standard blood work I requested my Folate serum and Homocysteine (B12 was included). Here are the results:

      B12: 654 (normal range 138-652 pmol/l)
      Folate: >30.0 (normal range >8.7 nmol/l)
      Homo: 5.9 (normal 5.1-15.4 umol/l)

      I think all of this looks MUCH better than my previous results, and it looks like supplementing a little extra b12 and glutathione really paid off in raising my homocysteine level a good 2.1 points! Considering I’m homozygous MTHFR 667T if I cut down my serum folate by 70% it brings me to just around the normal range, so do you think it’s enough or should I up my dosage a little more? I currently take 1400mg per day. Thank you Dr!

      1. Dear Elise,

        I am glad that your levels look much better now. It is hard to know if you should continue or stop supplementing because we don’t have an exact result for folate from your lab. To merely state >30 could be 31 or 100. You should re-test with a lab that will give you exact numbers. If your results are <50 I would continue supplementing throughout the pregnancy and re-test after delivery. When re-testing remember to stop any supplements for 3 days prior to blood draw and fast before blood draw.

  68. Sharyn

    Did not do the mutation test yet.
    Vitamin B12 443 pg/mL
    Folate 11.8 ngML
    Homocysteine 10.2 umol/L
    Mg 5.5 mg/dL

  69. Nikki

    Thank you so much for your commitment to this thread. 38 146lbs 5’10 female no children, and I suffer from digestive issues, depression, acne, fatigue, migraines, memory loss and inability to recall and low lobido. Supplements include krill oil, turmeric, activated vit c and trace minerals.
    1 copy rs1801133(C;T) – C677T
    1 copy rs1801131(A;C) – A1298C

    Folate, Serum : 12.4 ng/mL
    Vitamin B12 : 580 pg/mL
    Homocysteine : 8.5 umol/L

    Should I expect to be only processing 50% of folate with 2 copies? If so, should I attempt to raise it with methyl folate?
    How do we know for sure if our bodies are only processing at a half rate?
    B12 seems to be at the lower end of the acceptable spectrum?
    I am unsure of Homocy levels.
    Any other tests to recommend?

    Thanks again!

  70. Nikki,
    You could lose up to 60% of folate being compound heterozygous. Methylfolate is definitely recommended along with methylcobalamin.
    We don’t know for sure if our bodies are only processing at half rate. I prefer to plan for worst case scenario and be on the safe side.
    Homocysteine levels are OK.
    To address only folate levels you supplement for about 3 months and tested again. Stop all supplements 3 days prior to blood draw and fast for at least 8 hours before blood draw.
    To address all your complaints you need to have an MTHFR expert to look into all your history, complete lab tests, etc.

  71. Hilary

    Hi, newly DX. Homozygous for the T allele of the C677T. Additional testing was done.
    Methylmalonic acid. .10 nmol/mL. Reference. <0.40
    Heavy metals, arsenic, lead, cadmium And mercury….all ok
    Homocysteine. 8mcmol/L. References366.0. Considered deficient when less than 4

    Should I be supplementing or not? Folate was high.
    Dealing with severe anxiety and depression for years. Plus DX with mitochondrial issuein 2016.

  72. Hilary

    Sorry left out my folate test!
    Folate 942.2 ng/mL. Reference. >366.0

    Also how important is fasting for the folate and homocysteine labs. I checked before I went and lab said I didn’t need to be fasting, so I wasn’t when these tests were done.

    1. Hilary,

      You need to be fasting for serum Folate test. Your results may or may not be accurate. I also recommend be off all vitamins for 3 days before blood draw. Regardless your folate is low if you factor in your homozygous mutation.

  73. Adnan

    Hello Dr. Ricardo,
    Thank you for all the great information you provide. I suspect I might be undermethylated. I seem to have most of the symptoms of undermethylation and I am homozygous for A1298C mutation. I am also homozygous for VDR Taq (I don’t know if that is relevant) and for COMT V158M I am – / –

    I recently got my copper, histamine release, histamine plasma, folate serum, and zinc testing done and the results are as follows:
    Copper: 71 mcg/dL
    Histamine release (?): < 16
    Histamine plasma: 24 ng/mL
    Zinc: 71 mcg/dL

    In your assessment, do you think I am undermethylated? Would methyfolate and/or methyl b12 be helpful? I’ve also read that SAMe is better for some people.

    Thank you in advance for your comments!

    1. Dear Adnan,

      The best measure for methylation is folate. I recommend you order serum folate, B12 and vit. D tests (be fasting and refrain from taking supplements for 3 days prior to blood draw).
      SAMe is not indicated based only on your SNPs however your medical history and symptoms would play a role as well.

  74. Mary Selix

    Please I beg for your help. Everyone here is uneducated. I’ve the most complicated mthfr (had a PE in each lung that caused testing) and am not well lately. Did a physical and all cholesterols and triglycerides and thyroid are sky high (doc says walking heart attack waiting to happen) but they are trying to give me a synthroid my body is reacting to (not in a good way either) and he says reactions aren’t normal but keep taking it. I have refused because it felt just like a prior med that almost killed me with a reaction to Avelox. I’ve my labs and mthfr reports from hematology with homocystine levels etc etc. These docs are so uneducated here I can’t find a specialist and all hematologist are lost with my mthfr mutations. I’m also in severe menopause yet I believe it’s my petuitary gland causing such severe sweats every 5 min 24/7 where I literally drench in sweat but can feel it activate in the back of my brain about 2 seconds before the hot flash activates and doctor says it’s impossible. My health is declining FAST and I’m on 45. I was 3 years ago in excellent health…now not so much. Thank you for your time. God Bless.

    1. Dear Mary,

      I am so sorry to hear about your suffering. It looks like you have a complicated situation and to give you suggestions without properly analysis of your case is not a good idea. I would have to analyze all your lab tests thoroughly in order to give you a good advice. I recommend you call my office at 310 914-1624 and schedule a proper consultation.

  75. Elizabeth

    Hello…I recently had some blood work done and I am confused with the results
    Some background…3 years ago I had tests run and I had high methylmalonate (1.9 on the organix urine test so it said adenosylcobalamin insufficiency) and my homocysteine was 8.9
    I don’t have the numbers for my folate or my b12 but I remember that my active folate was low and my serum b12 was “normal” I think around 620
    My SNPs

    MTHFR C677T +/+
    MTRR A66G +/+
    CBS C19150T +/+
    CBS C699T +/+
    COMT V158M +/+
    COMT H62H +/+

    My most recent blood tests and I should mention I have not taken any supplements for the last 8 months (I get different recommendation from different doctors about working on my lithium, or working on my gut first before I add in supplements). I got so confused I stopped everything. Before I stopped I was taking 5000mcg methyl b12 and 800 methylfolate. I did have an IV infusion of methyl b12 on June second with a glutithione booster…not sure if these affected my results: I aslo shsould mention that my doctor took blood during my office visit which was not done until 2pm…she did not think it necessary for me to fast so I realize that my folate is probably way off but I do not know how the other results would be affected
    TSH 0.8 range 0.40-4.50
    T4 Free 1.3 range 0.8-1.8 ng/dL
    MMA 100 range 87-318 mmol/L
    Homocysteine 6.3 range <10.4 umol/L
    B12 360 range 200-1100 (this has decreased from 441 done in March)
    folate 10.6 range 5.4 (in March this was 4.1 a different range, I was flagged as a bit low)

    I don’t take anything with either folate or folic acid nor b12. I am working on digestion and I have been able to digest more greens which is great.
    How is it possible that I can go from high MMA to normal and I have not been taking B12 for 8 months with my MTHFR mutations? Did I build up enough stores? Should I continue supplementing with B12? And how is it possible I am still normal when my serum B12 continues to drop? Same questions for the Homocysteine. It dropped from 8.9 to 6.3 and I feel sure that when I get retested for folate it will NOT be anhywhere near 10 because I eat a big pile of greens now for breakfast.

    I realize that my folate is probably way off becuase these were not fasting tests…

    I may contact you for more thourough guidance because I do have some compounding SNPS but thank you so much taking your time to do this…it is beyond appreciated.

    1. Your homocysteine will not give you a meaningful number because of your MTHFR/CBS. MTHFR will elevate homocysteine and CBS will lower it. Your folate looks low if you take into account your MTHFR mutations.
      There are just too many other factors involved and you really need someone to take a thorough look in your case to give you the right guidance.

  76. Rich

    Hi Dr Miranda,

    Firstly thank you for taking the time to help so many of us. I have just had blood tests which show the followin:

    serum folate 9.3 ug/L (reference range 4-20)
    serum B12 179 ng/L (reference range 130-800)

    I have homozygous mutation on MTHFR 677 and no mutation on MTHFR 1298. I don’t supplement with any folic acid and don’t eat any food that contains folic acid. I’m currently taking a daily multivitamin that contains 400mcg of methylfolate and some methylcobalamin.

    Given that folic acid is not being consumed, should I assume that my serum folate is solely made up of the methylfolate that I supplement and the folate that I take in from food? And therefore is it likely that my usable folate is far greater than 30% of 9.3ug/L? Is the folate from food as usable as methylfolate or does the mutation mean that only a certain percentage of it can be used?

    Thanks.

    1. Dear Rich,

      Your serum folate is not solely made up of methylfolate. The most accurate way of testing is to stop taking any supplements for at least 3 days and test in the morning before breakfast. Your usable folate could be as low as 30% in the worse case scenario, so we should plan for that scenario. The ideal levels for you are: folate 35 and B12 800. You should continue supplementing until you reach that level. 1,000mcg to 2,000mcg of methylfolate would be ideal.
      Folate from food still needs to be transformed into methylfolate as well, however unmetabolized folate from food is not harmful.

  77. Natasha Fourie

    Dear Richard
    Hi from South Africa.
    I have been struggling to find understanding regarding my son’s last blood test, especially his folic acid results. I am trying to find out what the normal range should be for your RBC folate. Also, since his last blood test his folic acid has increased even though he is on a methylation supplement. Both his MTHFR C667T and A1298C was homozygous, with more impact on the C667T, his MTRR was also homozygous. Because of this he was put on a supplement to help with his methylation and homocysteine over a year ago, but after the last blood test his B12 dropped but his RBC folate increased very much (first test: B12 was 1164pmol/l and B9 was 1305nmol/l; last test: B12 was 898pmol/l and B9 was 2859nmol/l).
    The most folic acid is from his multivitamin which is 400mcg (recommended for children over age 4) and the methylate folate of 800mcg from his supplement. The only other folic acid he does get is from bread, he does not eat any leafy greens.
    What is the normal RBC folate level for a child?
    Regards
    Natasha

  78. Tina Uba

    I have compound heterozygous for the
    variants, C677T and A1298C in the MTHFR mutations.
    My test results are:

    HOMOCYSTEINE,S 8.8 umol/L 280 ng/mL RBC
    Vitamin B6 17.1 ng/mL 2.1 – 21.7 ng/mL
    VITAMIN B1 <7 nmol/L 8 – 30 nmol/L
    VIT D,25-OH 12 ng/mL 30 – 100 ng/mL

    So is my folate level normal? I only have d and b1 deficiency although i have MTHFR issue?

    Thank you

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