Clearly it is important to restore methylation capacity where deficits exist.

We have all seen the effectiveness of folic acid food fortification programs at reducing neural tube defects and the success stories using supplemental natural folates and other methylation cofactors in addressing many conditions.

But excessive methylation in the body has the potential for harm too.

Science has already linked higher methylation states with immune dysfunction and cancer. Methylation is also a key epigenetic regulator of gene expression, with far-reaching implications (both beneficial and harmful).

High dosing of methylation cofactors does occasionally provide big clinical turnarounds for patients, but for many, it may be addressing the problem with a sledgehammer, pushing reaction rates forward regardless of other outcomes.

The truth is that we don’t know what other outcomes we’re creating with high dose methyl donor supplementation, especially over the long term.

A broader methylation toolkit is needed, with more nuanced and upstream interventions.

Our methylation toolkit now incorporates dietary patterns, food-based nutrients, mitochondrial and microbiome support, sleep, stress, detox, exercise and more. We are also mindful of correcting areas of excessive methyl-donor drain such as high catecholamine turnover.

We now use dietary and lifestyle practices with all our patients who need methylation support, either alongside or in place of supplemental cofactors. And for many, a dietary and lifestyle approach alone is our long-term goal.

Not least, we are incorporating specific phytonutrients that act as DNA methylation adaptogens, that protect the epigenome.

With our approach, I feel much more comfortable that we are doing the right thing for our patients both now and over the long term.

The tools that we have researched and adopted are comprehensively explained in our eBook Methylation Diet and Lifestyle

Methylation Diet and Lifestyle Study (MDL)

The maintenance of health and the progression of disease are associated with an individual’s genetic make-up and environmental factors, including lifestyle choices (such as diet, exercise, behaviors, stressors, sleep, tobacco and alcohol use), environmental exposures and socioeconomic determinants. Environmental factors have been shown to influence, sometimes rapidly, epigenetic processes thereby influencing genetic expression. Regulation of the human genome by the epigenome is now regarded as a cornerstone, heritable, physiologic process, playing a key role in phenotypic expression of health and disease.

DNA methylation is a well-researched, primary epigenetic process. Aberrant DNA methylation resulting in hyper- or hypomethylated regions of the genome, generally results in inhibition or expression of certain genes and has been associated with the pathogenesis of numerous conditions, ranging from inflammation and accelerated aging, to cancer, autoimmunity, diabetes, heart disease, dementia, allergic disease, posttraumatic stress disease and others. Likewise, certain healthy diet and lifestyle habits have been demonstrated to favorably influence DNA methylation patterns.

Understanding that environmental factors can potently and sometimes rapidly, favorably or negatively influence epigenetic expression, a short-term diet and lifestyle intervention may significantly augment DNA methylation expression.

The purpose of this study is to evaluate a 9-week diet and lifestyle intervention on patient-reported quality of life, symptoms, and DNA and biochemical methylation-related biomarkers in healthy males ages 50-72.

Methylation Diet and Lifestyle eBook


The “dance of methylation” extends far beyond supplementing with B12 and methylated folate. Indeed, long term outcome studies using this approach are lacking, and research suggests caution is advised with regard to imbalanced hypermethylation. However, much can be done to safely support methylation balance.

Methylation What’s all the Fuss

Methylation What’s all the Fuss?

If you or anyone you know has a history of heart disease, depression, Alzheimer’s disease, ADHD, diabetes, insomnia or autism, these are just some of the conditions that have been linked to faulty methylation.

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Methylation Diet and Lifestyle DrKF and Romilly Hodges, CNS

Listen to Dr. Kara Fitzgerald and Romilly Hodges discuss the rationale behind the Methylation Diet and Lifestyle and what you will find in the eBook.

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Listen to the Cleveland Clinic Webinars

The Cleveland Clinic Center for Functional Medicine is one of the nation’s foremost functional medicine programs, established in collaboration with the Institute for Functional Medicine.

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It’s time to rethink methylation

At the same time that the US Preventive Task Force recently reaffirmed the need for women to take in 400-800 mcg/d folate before conception and during pregnancy to prevent neural tube defects, Johns Hopkins cautioned about the increased risk for autism in the offspring of mothers who have elevated folate levels.

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Methylation Diet and Lifestyle Love

Kara has written and produced the most comprehensive, organized, and yes, dare I say WISE, guide to methylation that I have seen. I am so impressed with this e-book. As I was reading it, I kept thinking, ‘Here we have, in Kara, one of the next leaders of Functional Medicine’. Read this ebook, study it, and apply it. Your patients and your practice will be changed for the better.

Robert Hedaya
Robert J. Hedaya, MD, DLFAPAClinical Professor of Psychiatry, Georgetown University Hospital

I have known Kara Fitzgerald, ND for many years. She is generally the smartest person in the room. Dr Fitzgerald is a deep and inclusive thinker. With this eBook on methylation she is bringing a rational, no nonsense approach to a complex topic. Brushing aside the mostly nonsense on this topic from across the internet, Dr Fitzgerald gives clear and science-based advice for methylation abnormalities.

Tom Sult MD
Tom Sult, MDFaculty, Institute for Functional Medicine

A methylation masterpiece! This comprehensive, user-friendly guide covers the methylation landscape from nutritional biochemistry to application in practice. The methylation assessment checklist, whole foods menu rich in methylating nutrients and delicious recipes are essentials for your clinical toolkit. A ‘must-have’ educational resource that provides the ‘much needed’ clarity we’ve been searching for!

Kathie Madonna Swift
Kathie Swift MS RDN LDN FANDCo-Founder IFN Academy

It takes a special skill to be able to make the complex understandable and accessible without losing the original essence. Kara has that skill in abundance and her Methylation book is a latest shining example. She has a rare gift to impart the tenets of Functional Medicine and produce brilliant guides and case studies, and in this field I have been fortunate to learn more from her writings and lectures than from any other professional. I have been involved with nutrigenomics professionally for a number of years, and I can honestly recommend this book wholeheartedly no matter how experienced the reader. This is a book that works on many different levels and is representative of standards that all writers in the genre should aspire to.

Jonathan Cohen MSc mBANT, NGC, rCHNC
Jonathan Cohen MSc mBANT, NGC, rCHNCClinic Director - Can Health

Finally, an easy to read and understand explanation of methylation that is suited for both clinicians and the public.  In Methylation Diet and Lifestyle, Dr Kara Fitzgerald demystifies the genetics and offers a rational approach that steers away from high dose supplementation as the answer, and instead focuses on using food as medicine.  Thank you for bringing balance to this conversation!

Susan Blum, MD, MPH
Susan Blum, MD, MPHFounder & Director, Blum Center for Health

Dr. Fitzgerald’s book is an extraordinary integration of a vast amount of diverse information that makes practical sense of the complex interplay between our genes, the folate/vitamin B12 cycle, homocysteine, and the clinical importance of methylation. 

Jeffrey Bland, PhD, FACN, FACB
Jeffrey Bland, PHDPresident PLMI

This book provides the tools you need to make an important contribution to your health, by understanding and applying the nutritional and lifestyle factors that impact the methylation process in every cell of your body.

Jeffrey Bland, PhD, FACN, FACB
Jeffrey Bland, PHDPresident

The Methylation Diet and Lifestyle Book contains “news to use” that makes the very complex human biochemistry story of methylation reader friendly. It is a wonderful introduction to how nutrition and lifestyle can influence the epigenetic regulation of gene expression.

Jeffrey Bland, PhD, FACN, FACB
Jeffrey Bland, PHDPresident

These days, methylation is a ‘hot’ topic in functional medicine: everyone knows it’s important, but there is debate about which is the most effective clinical protocol is for the best outcome. What I like about the Methylation Diet and Lifestyle E-book is that it takes a whole-self, lifestyle-medicine approach to this complicated area of clinical medicine and makes it actionable for the millions of us with variability in our ability to detoxify through methylation. This 140-page report is grounded in practical steps to get those with methylation deficits on their way to feeling empowered and healthy.

Dr. Deanna MinichAuthor of Whole Detox

I LOVE LOVE LOVE your new ebook, Methylation Diet & Lifestyle! It’s brilliant! Kara and Romilly make a complex biochemical subject easy to understand. I love your explanation of methylation, the nuance and distinctions like considering the complex interplay among the SNPs, the needed nutrients, and the food recommendations! It’s a must read for practitioners and patients.” – Certified Nutrition Consultant and Author of Nourishing Hope for Autism.

Julie MatthewsCertified Nutrition Consultant

The central role that methylation plays demands more careful attention than simply reaching for supplements. That’s why I’m excited to incorporate the ideas from the new eBook for cliniciansThe Methylation Diet and Lifestyle into my own practice. In this book, Dr. Fitzgerald and Romilly Hodges explain how to use a broader and safer approach to healthy methylation expression, including diet, limiting methyl donor drain, stress response, exercise and gut health. It’s a must-read!

Dr. Mark Hyman, MD9 Time NY Times Best Selling Author

It’s time that we, practitioners, re-consider the approach that ‘pushing’ methylation reactions with supplementation alters epigenetic methylation expression. In their new eBook, Fitzgerald and Hodges explain how to support epigenetic and metabolic methylation. Learn how to support methylation the RIGHT WAY with The Methylation Diet and Lifestyle — a smart, safe plan that includes diet, exercise, gut health, stress, resilience, sleep and ways to limit “methyl donor drain.

Patrick Hanaway
Patrick HanawayMedical Director, Center for Functional Medicine, Cleveland Clinic