Boise, Idaho
methylation & genetics in Boise.
Reviewed by Dr. Andrew Rostenberg, DC, DIBAK · Last reviewed
MTHFR, COMT, MAO, CBS. If you've been down the methylation rabbit hole, you've probably been told to take methylfolate and call it a day. Methylation is more nuanced than that, and getting it wrong can make people worse. We've been getting it right as part of our functional medicine practice in Boise since 2011.
What methylation is.
Methylation is a biochemical process that runs roughly a billion times a second in your body. It controls how you make and break down neurotransmitters, how you build DNA, how you detoxify hormones and environmental chemicals, how your immune system regulates itself, and how your cells turn genes on and off.
When methylation is working well, you feel resilient. When it's slow, fast, or dysregulated, the consequences show up everywhere: anxiety, depression, fatigue, hormonal symptoms, cardiovascular markers, poor detox tolerance, miscarriage risk, autoimmune flares, and more.
The genes: MTHFR, COMT, MAO, and friends.
MTHFR is the gene most patients have heard of. It codes for an enzyme that converts dietary folate into the active form your body can use for methylation. Common variants (677T, 1298C) reduce that enzyme's efficiency and have been linked to a long list of conditions.
COMT determines how quickly your body breaks down catecholamines (adrenaline, noradrenaline, dopamine, estrogen). Slow COMT and fast COMT are different clinical pictures and need different support.
MAO handles serotonin and other monoamines. Variants here often present as mood, sleep, and behavioral patterns that don't respond to the obvious interventions.
And there are dozens more (CBS, MTR, MTRR, BHMT, AHCY, TYMS) that interact with methylation in clinically important ways. Looking at one gene in isolation almost always misleads.
How we test and treat.
We use comprehensive genetic testing alongside functional lab markers (homocysteine, methylmalonic acid, organic acids, hormone metabolites, and others) to see not just what your genes can do, but what your body is actually doing right now.
The treatment is rarely just "take this methylated B vitamin." Depending on your pattern we may recommend a specific nutrient form (active or non-active folate, B6 in PLP form vs. pyridoxine, etc.), targeted amino acid support, careful dosing, gut work first if methylation is downstream of malabsorption, or, in over-methylated patterns, strategically slowing things down before adding cofactors.
The wrong methylation protocol given to the right patient can trigger anxiety, headaches, insomnia, or worse. Methylation is a place where careful clinical judgment matters more than enthusiasm.
Author · Educator · Clinician
Dr. Rostenberg literally wrote the book.
Dr. Andrew Rostenberg has been treating methylation and genetic cases since 2011 and has taught the material to other practitioners around the world. His book, Your Genius Body, walks patients and practitioners through the methylation pathway and how to think about it clinically.
If you've been bouncing between providers who don't know what to make of your genetics report, this is the office to land in.
Where methylation matters most
Conditions we treat with this approach
These are the conditions where methylation and genetic patterns most often shape the treatment plan.
- COMT, MAO & Memory CareGenetic methylation pathways behind brain fog, mood, and memory issues.
- Anxiety & DepressionNeurotransmitter balance, methylation and the gut-brain axis behind mood symptoms.
- Estrogen DominancePMS, fibroids, weight gain and mood swings tied to estrogen imbalance and detox pathways.
- InfertilityFunctional preconception care for couples ready to optimize fertility naturally.
- Autoimmune ConditionsWhen the immune system attacks the body — calming inflammation at the root.
- Complex Medical MysteriesWhen every test comes back normal but you still don't feel well — we love these cases.
See the full list of conditions we treat.
Common questions about methylation & genetics
- What is MTHFR, and why does it matter?
- MTHFR is a gene that codes for the enzyme responsible for activating folate into its usable form, methylfolate. Common variants (C677T and A1298C) reduce that enzyme's efficiency, which can affect detoxification, neurotransmitter balance, cardiovascular markers, and pregnancy outcomes. MTHFR rarely acts alone; it's most useful as one input in a fuller methylation, nutrient, and lifestyle assessment.
- Should I take methylfolate if I have an MTHFR variant?
- Not necessarily, and not without context. Methylfolate is helpful for some patients and destabilizing for others, depending on COMT, MAO, MTR/MTRR, and overall methylation status. Pushing methyl donors blindly is one of the most common reasons people feel worse after getting a genetic test. We evaluate the full pattern before recommending dose, form, or whether to supplement at all.
- How does Red Mountain evaluate methylation and genetics?
- We work from raw genetic data (23andMe, Ancestry, or a clinical panel), functional lab markers (homocysteine, organic acids, hormone metabolites), and a careful history. Dr. Rostenberg is the author of Your Genius Body and has taught MTHFR and methylation work to other clinicians internationally. The goal is a personalized plan, not a one-size-fits-all methylation protocol.
Ready to get this evaluated properly?
We see patients in Boise and via telehealth. Contact us for more information about genetic testing options.
Become a Patient