Studies on MTHFR and nutrition indicate that common variants (especially C677T) reduce folate metabolism enzyme activity by 30–40% in TT homozygotes, leading to elevated homocysteine. Increasing intake of active folate (5-MTHF) or folic acid can partially normalize homocysteine levels. However, large-scale studies show inconsistent associations with disease outcomes (e.g., cardiovascular risk), and evidence for personalized dietary recommendations based solely on MTHFR status is weak. Most individuals, even with risk variants, achieve adequate folate from a balanced diet. Caution: high-dose folic acid (>1 mg/day) can mask vitamin B12 deficiency. Blood testing is more informative than DNA alone. Consumer DTC tests often overstate the clinical utility of MTHFR. Evidence: human-moderate (observational studies, limited interventional data).
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