In its most basic sense, methylation is the process of moving a methyl group (C-H3) from here to there (think of it as a tag or a switch). In doing so, this causes an effect or a change.
So for example, methylating your estrogen (using an enzyme COMT - the “MT” meaning “methyl transferase”) will cause that form of estrogen (OHE1) to become far less toxic as it is being metabolized to MeE1 - conversely, NOT methylating the estrogen (OHE1) properly will cause a buildup of that form of estrogen (OHE1) that can damage DNA and lead to cancer. THIS is why we FOCUS on minimizing risk when treating our patients with hormone replacement (sadly this is rarely done by most hormone treatment practices) using such practices as monitoring the metabolism of estrogen (ie with DUTCH Hormone testing) AND understanding how to respond to the lab data as it is received.
Generally speaking, methylation physiologically is responsible for turning genes on or off, repair of DNA, keeping inflammation in check, detoxification, neurotransmitter balance and associated mood issues, synthesis and metabolism of neurotransmitters such as serotonin, dopamine, norepinephrine, and epinephrine, supporting myelin (the protective coating along nerves, and forming creatine (for energy reserve in muscle and brain).
But what does this all mean?
Well - if you are under-methylating OR over-methylating, you will have serious issues either short term, long term, or both. These issues can include cancer, chronic disease, mood disorders, general states of energy and fatigue, insomnia, and others. You can also see increased miscarriage rate and infertility.
And just to make things more complicated, there are certainly other issues that can contribute to most or all of the symptoms and problems associated with methylation issues, including gut issues such as SIBO, leaky gut and the associated immune activation, micronutrient deficiencies, toxin influences, hormone imbalance, inappropriate supplementation initiating unwanted feedback regulation, and more.
So - how do we approach this whole issue? Well - as usual, it is important to consider the entire patient. Evaluation of the nutritional status, the gut status, toxin and intercurrent infections, and sleep/anxiety management all are important aspects affecting disturbed physiology as well as methylation. We always start from the bottom up - maximizing nutrition, toxin minimization, assessing imbalances and epigenetic influences (paying attention to the "5 boxes").
FoundationMED will also begin with an evaluation of multiple genes associated with methylation. These will include MTHFR, COMT, VDRTaq, CBS, PEMT, NOS3, BCO1 and many others. From this information, an initial therapeutic approach can be initiated. Further information from the expression of the methylation cycle (i.e. the products of those methylation genes) can help better understand where the methylation cycle is impaired (ie via the Plasma Methylation Profile blood test and others).
Finally it must be understood that one should never treat based on genetic information alone.
Often you will see treatment recommendations from well meaning but uninformed practitioners or internet information providers. Other important factors affecting methylation certainly include diet, toxin exposure (processed foods, pesticides, plastics, phthalates and others), stress and lack of sleep, inflammation, nutrients (including impairment to nutrient absorption as seen with SIBO, low stomach acid, leaky gut), magnesium and other methylation cofactors have to taken into account.
As you can see, the methylation system is a complex yet very fundamental system that impacts on many areas of human health and well-being. As we learn more about methylation we become better equipped to both evaluate and treat methylation issues.