Symptom Free Treatment through Methylfolate + Choline + low dose multi+ Exercise

[ThisType]

TLDR: Have treated all symptoms of POIS through:
1) Methylfolate (1000mcg daily - using Thorne)
2) Phosphatidylcholine ( 420 mg daily - using Thorne)
3) Exercise daily (30 minutes daily moderate heart rate)
(Edit: I now also take 1 low dose methly B vitamin and multivitamin gummy (New Chapter kids gummy) daily (this is a half dose. They recommend 2)

I believe the cause is poor folate metabolism and poor choline metabolism due to genetic causes.

The medical blood tests that have flagged this are - fasting morning of and doing the following:
* RBC Folate (this is the long term 120day level of your blood cell methylfolate (methyl B9). I was on the low end of the normal range after a few weeks of supplementation.
* Serum Folic Acid (this is a test for your folic acid levels in your serum and is short term). I was above the normal ranges in spite of not supplementing with folic acid in addition to fasting that morning

This signals that the folate metabolism is not effective at converting folic acid all the way to methylfolate.

Genetics is still an up and coming field, so what I could glean was that I have a number of mutations in the folate and choline enzymes that reduce or impair effectiveness.  Two of the more commonly discussed ones are:
* the second of the MTHFR mutations (A1298C also known as rs1801131)
* PEMT mutation rs7946 that impairs choline metabolism
these are common enough that there are definitely other factors contributing...  Added genetics summary here (https://poiscenter.com/forums/index.php?topic=3694.msg48480#msg48480)

It turns out that b12 can mask b9 (folate) deficiency is known, but it seems that choline can do some of that as well as they're all part of the same cycle.  this is part of why it's challenging to identify the root cause.  The b9 or b12 or choline metabolism may be able to handle low demand times.  In short, you may only trigger it during times of higher stress or need (perhaps replenishing neurotransmitters and sperm, for instance).

Symptoms I had that were related to POIS - turns out many are also indicative of folate deficiency:
* brain fog
* difficulty recalling known words and terms 
* swelling of lips and tongue
* sores on mouth
* irritability
* low energy
* difficulty focusing eyes at times during conversation for instance

I have tested this for over 3 months and it seems pretty bulletproof (mild variability).  It's quite an experience to truly be free of worry.

I wanted to say thank you to you all!  This site was where I found and got most of the information and help I needed (@Bulbo, @Quantum, @Muon, etc). Thanks also to those of you who recently posted https://www.reddit.com/r/POIS/comments/zfxkdl/pois_cured_and_heres_how_i_did_it/ to the reddit thread who had had success with a similar mix...(@HopeOneDay and others) (I had not realized methylfolate was the missing key)
TT

[Edit: I've had to adjust a bit at 5 months to use the low dose kids gummy multivitamin almost daily in addition to the methylfolate and phosphatidylcholine to fully keep symptoms away]
[Second edit- I'm working on how often to take the kids gummy multivitamin as they still wind me up a bit at night if I take them daily. Working on every few days but will update when I get something that works reliably)

[Warrior]

Amazing, great to hear. Many others including myself have had a lot of success with methylation nutrients.

How much 'mild variability' do you experience? And has this changed over the course of the 3 months? I've found that when it comes to methylation, it's rather difficult to have it perfectly balanced in relation to inhibiting symptoms completely. I myself find a variability of 80-100% for food sensitivity relief, and this is somewhat easily adjustable through supplemention depending on whether I need more or less of something.

[ThisType]

Thank you
Variability is primarily sometime the afternoon or evening I might start feeling lips are beginning to swell or energy is lower than usual.

 The new chapter gummy kids b vitamin includes methylfolate and methylcobalamine (methyl b12) among other things. For some reason it almost always resolves the issue. Possibly just more methylfolate but could be any of the others.

I just can't take those daily as they bump up heart rate (given prior experience it's likely b12 side effect, though there's only a few mcg in each)

[Edit - thinking about it further, exercise is the thing that smooths out the variability for me.  It may be a heart rate or metabolism thing.  If I over hydrate that may have somewhat similar impact]

Does that answer your questions?

[Muon]

Did you ever do a test for B12 and B6?

[JayDeeSee]

I recently picked up some phosphatidylcholine and will start using it now. I've always suspected it's an issue with the parasympathetic nervous system, and choline is an important nutrient for it.

Do you take these with food or on an empty stomach?

[berlin1984]

Could you please post your exact mutations also here:
https://poiscenter.com/forums/index.php?topic=3694.0

Then Prospero can incorporate them.

[ThisType]

Did you ever do a test for B12 and B6?

@muon, B12 levels were fine.didnt check b6
@JayDeeSee usually around breakfast time. I do sometimes skip phosphatadylcholine after a few days as I feel like it builds up
@berlin1984 added genetics links here: https://poiscenter.com/forums/index.php?topic=3694.msg48480#msg48480

[JayDeeSee]

How long after starting these supplements did you notice improvement?

[ThisType]

For me I noticed almost immediately. Like same day. I was initially also taking a basic b, but that that amped me up too much and went for the low dose version.

For me at was really important to get the right form of folate and choline. I'd done multivitamins before with no impact.

[Sisyphus]

Congratulations on being symptom free for the past 3 months, must be amazing  . Couple of questions.
My last full blood count showed high MCH, low Haematocrit and low RBC, all of which are indicative of possible anaemia. However, my serum Folic Acid and B12 are normal. Do you think I could still have the poor folate metabolism you describe?
Are you able to share the results of your last full blood count?

[ThisType]

First the caveat that I'm not qualified to give you medical advice.

My own understanding is that I wasn't using the folic acid due to genetic issues (e.g. not producing the right enzymes) so it was high or normal.
 The only time Ive done "Folate, RBC" levels (which is a different test than the RBC in a CBC and different than the serum folate  and folic acid tests), I was on the low end of the normal range even though Id supplemented for a few weeks with methyl folate.  Folate RBC focused primarily on the amount of methyl folate and has a 120 day time constant. Having both normal/high folic acid and low RBC Folate fit what I was seeing in terms of genetic tests and In terms of the symptoms/ reaction to methyl folate supplements

Re: hematocrit , that has been normal for me in the past, as well as mch

Hopefully this is of use

Ps. I've had to adjust a bit at 5 months to use more of the low dose kids multivitamin in addition to the methylfolate and phosphatidylcholine to fully keep symptoms away. Will note above

[Sisyphus]

Thanks for the info ThisType.
It's just good to read of other people having some success with treating pois. The main thing is that it sounds like your plan is working.
I've only ever been tested for serum folic acid but I will consider getting a Folate RBC test sometime like you did. I had not thought of that before. I've added this to my list of things to investigate for my pois.

[JayDeeSee]

So, there is really something to this method. This is probably the easiest POIS period I've ever had. The symptoms have mostly been a light wisp of what they usually are and I've felt very functional. I'm gonna keep experimenting with this because so far this had been the most promising method I've tried.

On a related note I'm really starting to lean towards the possibility that POIS is caused by genetic factors that inhibit our body's ability to produce/use key nutrients properly. I'm guessing those nutrients are choline and folate (and maybe others I haven't found yet). As somebody else had hypothesized on here, maybe our bodies have just enough to function on during low demand times but during high demand times we don't have enough of these nutrients and everything just crashes.

I should also add that agmatine sulfate helps me.

[ThisType]

Update:
I've split the treatment into two periods.
1)  The first is replenishment (e.g replenish neurotransmitters). For the first 3 days post O I take the supplements daily.
2) The second is sustainment. For the remainder of days I take the supplements every other day.

This reduces the getting wound up I see from the b/multivitamins/choline if I take it daily