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This sounds somewhat like Dr/ Amy's approach, in which she recommends raising the alternative pathway first with TMG, then adding the B12 and folate to support methionine synthase, and then adding DMG to shut down the alternate pathway somewhat, in order to transfer the flow to methionine synthase.

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The other pathway is the betaine homocysteine methionine methyltransferase (BHMT) pathway. It uses betaine (trimethylglycine or TMG) and homocysteine as reactants, and it produces methionine and dimethylglycine (DMG). These two pathways are in parallel, and both are important to humans, especially depending on their current nutritional situation.

When betaine-HCl is used in large dosages to compensate for low stomach acid, which is present in many PWCs, the concern is that the betaine will overdrive the BHMT pathway, taking flow away from the methionine synthase pathway, which is the one we are trying to encourage.

The BHMT pathway does complete the methylation cycle, though, and therefore it does help to produce SAMe, which is in this cycle, and which is needed for methylation reactions. One of the methylation reactions is the methylation of cobalamin (B12). This is necessary to supply new methylcobalamin as a coenzyme for the methionine synthase reaction from time to time. So it's important to have some SAMe on hand, even to support the methionine synthase pathway.

Dr. Amy Yasko has suggested that the BHMT reaction can be encouraged initially, and then, when the supplements are in place to support the methionine synthase reaction (that is, the B12, 5-methyl tetrahydrofolate, and other B vitamins and cofactor minerals), then the flow that is being carried by the BHMT pathway can be shunted to the methionine synthase pathway, by supplementing DMG, thus slowing the BHMT reaction by what is called in chemistry "product inhibition."

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