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BRS2-1-4 - Methionine Cycle Flux
(Balanced Methionine → SAM → SAH → Homocysteine Routing)
1. Mission & Overview + Dietary Levers
Mission
Maintain balanced methionine-cycle flux so methionine availability, SAM-dependent methylation, homocysteine recycling and transsulfuration remain coordinated across changing physiological demand.
Intervention Dominance: Diet-Dominant
-
Glycine
-
Methionine
-
Dietary protein
-
Vitamin B9 (folate)
-
Vitamin B12 (cobalamin)
-
Vitamin B6
-
Vitamin B2 (riboflavin)
- Methionine
- Vitamin B9 (folate)
- Vitamin B12 (cobalamin)
- Vitamin B6
- Vitamin B2 (riboflavin)
- One-carbon methyl-donor pool (folate, betaine, choline)
Individual KC inputs
Folate’s full provision disclosure is retained in the biochemical inputs; it is not repeated here.
- Betaine
- Choline
Overview
The methionine cycle forms S-adenosylmethionine from methionine, transfers its methyl group, and hydrolyses S-adenosylhomocysteine to adenosine and homocysteine. [2] Homocysteine is then remethylated to methionine or sent into transsulfuration toward cysteine. [12] SAM, SAH and methyl-tetrahydrofolate influence that split. [12] Every tissue can remethylate homocysteine, while transsulfuration is limited to liver, kidney, small intestine and pancreas. [12] Metabolite concentrations describe pool state, not the branch rates. [13]
- Benefits: Maintaining methionine-cycle flux lets cells keep donating methyl groups while directing sulfur toward cysteine. [2] [12] That coordination helps keep methylation and sulfur exit together.
- Implementation Notes: Methionine, dietary protein, vitamin B9 (folate), vitamin B12 (cobalamin), vitamin B6, and vitamin B2 (riboflavin) are the provision routes. [6] [13] Folic acid and vitamin B12 can lower blood homocysteine, and moderate vitamin B6 restriction can raise cystathionine, without a shown change in those branch rates. [6] [13]
- Biological Relevance: SAMe formation, each remethylation reaction, and the transsulfuration enzyme steps are neighbouring mechanisms. [12]
2. Primary Biological Effects
↑ coordinated throughput from methionine through SAM to homocysteine
↔ distribution of homocysteine between remethylation and transsulfuration
→ methylation continues while SAH is hydrolysed onward
3. Intervention Levers
Only categories with a substantive evidence-qualified intervention are shown.
No evidence-qualified lifestyle relationship is projected.
4. Mechanistic Basis
Summary
Methyl-group use and sulfur exit meet at homocysteine. What matters is how that intermediate is divided between return to methionine and transsulfuration, with SAM, SAH and methyl-tetrahydrofolate as effectors of the split.
(From methionine to homocysteine)
Methionine is converted to S-adenosylmethionine (SAM), the principal methyl donor. After the methyl group is transferred, S-adenosylhomocysteine (SAH) is hydrolysed to adenosine and homocysteine. Blocking that hydrolysis can affect methylation of phospholipids, proteins, DNA, RNA and small molecules together [Chiang et al. (1996) [2]].
(The regulated split)
Every tissue can remethylate homocysteine back to methionine. Transsulfuration, which converts homocysteine to cystathionine and onward toward cysteine, occurs in liver, kidney, small intestine and pancreas. Regulation is the distribution of homocysteine between those exits. SAM, SAH and methyl-tetrahydrofolate are effectors of that distribution [Finkelstein (1998) [12]]. Human postprandial studies can measure the same partition as remethylation, transmethylation and total transsulfuration rates [Lamers et al. (2011) [13]].
(Concentrations and rates)
Folic acid lowers blood homocysteine concentration, and vitamin B12 adds a further concentration reduction, while added vitamin B6 does not [Collaboration (1998) [6]]. A small trial also reported lower plasma homocysteine after vitamin B12, fish oil, or both [Huang et al. (2015) [11]]. In the tracer study, cystathionine concentration rose during vitamin B6 restriction while the mean total transsulfuration rate did not [13]. A concentration change is a different result from a branch rate.
(Boundaries of the mechanism)
This mechanism is the integrated throughput and the split at homocysteine. Formation of SAM is BRS2-FM1-PM3 — SAMe Synthesis. Folate- and vitamin B12-dependent remethylation is BRS2-FM1-PM1 — Folate/B12-Dependent Homocysteine Remethylation. Betaine-dependent remethylation is BRS2-FM1-PM2 — Betaine/BHMT Remethylation. The transsulfuration reactions are BRS2-FM2-PM5 — Transsulfuration Pathway. Methionine-restriction experiments in ageing models, and homocysteine associations with dementia or ADHD, do not show that changing these rates treats a cognitive or attention disorder [Fanti et al. (2026) [3]; Luzzi et al. (2022) [8]; Lukovac et al. (2024) [9]].
(Integration within methylation cycle efficiency)
SAM synthesis feeds this throughput. Remethylation returns homocysteine to methionine, and transsulfuration is the catabolic exit. Downstream methyl acceptors include phospholipids, proteins, DNA and RNA [Chiang et al. (1996) [2]]. The parent account of methylation cycle efficiency is BRS2(FM1) — Methylation Cycle Efficiency.
4.1 Scientific Findings (5)
Summary
A controlled human tracer study found unchanged mean postprandial remethylation, transmethylation and transsulfuration rates during moderate vitamin B6 restriction, despite sharply reduced plasma PLP and increased cystathionine concentration. [13] Pathway reviews provide the regulatory context for these measured branch rates. [2] [12] The combined evidence shows why an altered intermediate concentration cannot be treated as an equivalent change in overall cycle flux; individual responses and the restriction conditions limit generalisation.
Methionine becomes SAM, SAM donates a methyl group, and SAH is hydrolysed to homocysteine. Homocysteine is then either remethylated to methionine or sent into transsulfuration toward cysteine.
What this means
This is the integrated route and the branch. It does not assign the MAT, remethylation or transsulfuration reactions to this mechanism, and it does not show that ordinary diet changes the rates.
Evidence confidence: Not yet scored
Finding ID: PM4-F1
Finding Statement: Methionine-cycle throughput runs from methionine to SAM, methyl transfer and SAH hydrolysis to homocysteine, after which homocysteine is distributed between remethylation and transsulfuration under the influence of SAM, SAH and methyl-tetrahydrofolate.
Synthesised Evidence Confidence: Not yet scored
Synthesis: A methylation review establishes SAM as the methyl donor and SAH hydrolysis to adenosine and homocysteine, and it shows that blocking that hydrolysis can affect methylation of phospholipids, proteins, DNA, RNA and small molecules together. A pathway review then places regulation at the distribution of homocysteine between remethylation, which every tissue can perform, and transsulfuration to cystathionine, which is limited to liver, kidney, small intestine and pancreas, with SAM, SAH and methyl-tetrahydrofolate as effectors. A human tracer study uses that same partition, measuring postprandial remethylation, transmethylation and total transsulfuration as rates.
Synthesis Limitations: The pathway accounts are reviews. Transsulfuration is not present in every tissue. The human rate study was a 28-day vitamin B6 restriction in nine healthy young adults. It does not show that ordinary changes in methionine, folate, or B-vitamin intake change those rates. Individual enzyme reactions remain neighbouring mechanisms.
Evidence Considered:
- Study
- Narrative review of SAM-dependent methylation, SAH hydrolysis and downstream methyl acceptors.
- Population
- Review of biochemical and cellular literature; no new human cohort.
- Result
- SAM is the methyl donor. SAH is hydrolysed by SAH hydrolase to adenosine and homocysteine. Blocking that hydrolase can affect methylation of several classes of acceptor at once.
- Effect / Magnitude
- No quantitative flux or concentration effect size.
- Evidence Summary
- Establishes methyl transfer and the SAH-to-homocysteine step as a shared route into many methylation reactions.
- Limitations
- Does not describe remethylation, transsulfuration or a measured SAM:SAH ratio, and does not test diet or cognition.
- Evidence Source
- Inherited repository evidence
- Reference
- [2]
- Study
- Review of mammalian methionine-cycle and transsulfuration pathways and their regulation.
- Population
- Mammalian pathway review; no new human experiment.
- Result
- Every tissue can synthesise SAM, use it for transmethylation, hydrolyse SAH and remethylate homocysteine. Transsulfuration catabolises homocysteine in liver, kidney, small intestine and pancreas. Regulation is the distribution of homocysteine between remethylation and conversion to cystathionine.
- Effect / Magnitude
- No numeric rate or intake-response estimate.
- Evidence Summary
- Establishes the regulated branch between recycling and transsulfuration and names SAM, SAH and methyl-tetrahydrofolate as effectors.
- Limitations
- Review-level pathway evidence. It does not measure human rates, test ordinary diets, or show a cognitive or attention outcome.
- Evidence Source
- Bounded external search
- Reference
- [12]
- Study
- Primed constant infusion of labelled methionine and leucine in the postprandial state, repeated after 28 days of dietary vitamin B6 restriction.
- Population
- Nine healthy adults (4 men, 5 women), aged 20–35 years.
- Result
- The protocol quantified remethylation, transmethylation and total transsulfuration. Mean rates were unchanged by the restriction.
- Effect / Magnitude
- Plasma PLP fell from 49 ± 4 nmol/L to 19 ± 2 nmol/L. Mean cycle rates did not change. No rate delta is reported because the mean change was null.
- Evidence Summary
- Shows that human cycle throughput can be partitioned into measured rates.
- Limitations
- Small healthy-adult sample, 28-day restriction, postprandial state only, and large individual variation. Not a test of cognitive or attention outcomes.
- Evidence Source
- Bounded external search
- Reference
- [13]
Connected / Supportive Evidence:
- Kumar et al. (2017) [5] — MechanisticWhy relevant: The repository record describes a review of transsulfuration from homocysteine toward cysteine and glutathione.Why excluded from the primary synthesis: That record does not establish remethylation or the regulated split between the two exits.
- Aragão et al. (2024) [1] — MechanisticWhy relevant: Riboflavin was listed beside this mechanism because vitamin B2 is a cofactor of a folate-cycle enzyme.Why excluded from the primary synthesis: The paper is a general riboflavin physiology review and does not test methionine-cycle throughput or the homocysteine split.
- Fanti et al. (2026) [3] — MixedWhy relevant: Tests how little or how much methionine sits inside a low-amino-acid longevity diet.Why excluded from the primary synthesis: The mouse endpoints are frailty and metabolic signalling, and the human component is epidemiology rather than a methionine trial. Neither measures cycle branch rates or an attention or cognitive treatment effect.
- Parkhitko et al. (2026) [4] — MechanisticWhy relevant: Reviews methionine restriction as an ageing intervention.Why excluded from the primary synthesis: It is an ageing and disease review, not a measurement of human cycle rates and not an ADHD treatment study.
Informs: Cognitive Clarity; Focus / Attention Stability
In healthy young adults, 28 days of dietary vitamin B6 restriction lowered the active B6 coenzyme in blood but did not change mean postprandial remethylation, transmethylation or total transsulfuration rates.
What this means
A lower vitamin B6 supply in this range did not limit the integrated rates. The rise in cystathionine is a separate intermediate signal.
Evidence confidence: Not yet scored
Finding ID: PM4-F2
Finding Statement: Moderate dietary vitamin B6 restriction that lowered plasma pyridoxal 5'-phosphate did not change mean postprandial remethylation, transmethylation or total transsulfuration rates in healthy young adults.
Synthesised Evidence Confidence: Not yet scored
Synthesis: One controlled feeding study measured the three cycle rates with methionine tracers before and after restriction. Plasma pyridoxal 5'-phosphate fell sharply. The mean rates did not change, although individuals differed. Cystathionine concentration rose, and its fractional synthesis rate rose in most participants. The integrated rates and that intermediate marker moved differently.
Synthesis Limitations: Nine healthy young adults, 28 days, and the postprandial state only. The authors report large individual variation, so a mean null result does not describe every person. The study does not test severe deficiency, folate or vitamin B12 restriction, ordinary mixed diets, or any cognitive or attention outcome.
Evidence Considered:
- Study
- Within-person tracer study of methionine-cycle kinetics at usual B6 status and after 28 days of dietary vitamin B6 restriction.
- Population
- Nine healthy adults (4 men, 5 women), aged 20–35 years.
- Result
- Mean remethylation, transsulfuration and transmethylation rates were unchanged. Plasma cystathionine rose, and fractional cystathionine synthesis increased in 8 of 9 participants.
- Effect / Magnitude
- Plasma PLP fell from 49 ± 4 nmol/L to 19 ± 2 nmol/L (P < 0.0001). Cystathionine rose from 142 ± 8 to 236 ± 9 nmol/L (P < 0.001). Fractional cystathionine synthesis rose by a mean of 12% in 8 of 9 participants. Mean cycle-rate changes were null.
- Evidence Summary
- Direct human evidence that this degree of vitamin B6 restriction did not change the integrated postprandial rates.
- Limitations
- Small sample, short restriction, healthy young adults, postprandial conditions, and wide individual variation. Cystathionine kinetics are not a substitute for the total transsulfuration rate.
- Evidence Source
- Bounded external search
- Reference
- [13]
Folate-dependent remethylation and the mainly hepatic/renal BHMT route return methionine to the integrated cycle; choline can supply betaine.
What this means
These are evidenced methionine-return routes within this PM’s integrated cycle. Their existence does not establish that donor availability limits integrated branch rates or that greater intake improves cycle balance.
Evidence confidence: Not yet scored
Finding ID: PM4-F5
Finding Statement: Folate-dependent remethylation and the mainly hepatic/renal BHMT route return methionine to the integrated cycle; choline can supply betaine.
Synthesised Evidence Confidence: Not yet scored
Synthesis: Froese and Obeid identify the folate/B12 and betaine routes of methionine regeneration. Human BHMT biochemistry identifies betaine donation, and choline oxidation evidence identifies its precursor route. PM4-F1 independently establishes that regenerated methionine participates in the integrated methionine cycle. These links support donor-fed remethylation within that cycle, not a claim about measured net throughput or remethylation–transsulfuration balance.
Synthesis Limitations: Parallel-route compensation, dietary methionine and tissue-specific BHMT expression limit interpretation. Human circulating homocysteine responses are not branch-rate measurements. Donor inadequacy as a limiting determinant of integrated cycle rates remains unresolved.
Evidence Considered:
- Froese et al. (2019) [15] — Mechanistic — Establishes folate/B12 remethylation and placement before MAT synthesis; reviewed on PM1-F1.
- Obeid (2013) [17] — Mechanistic — Establishes betaine donation and choline provision in connected remethylation; reviewed on PM2-F1/F2.
- Evans et al. (2002) [18] — Cellular / Molecular — Human BHMT reaction identity; supports betaine-to-methionine provision, not dietary MAT responsiveness.
- Salvi and Gadda (2013) [19] — Cellular / Molecular — Choline oxidation through betaine aldehyde to betaine; supports route identity, not MAT flux.
Evidence Dependency:
- Pathway reviews and enzyme studies are reused to identify reaction identities; they are not independent human integrated-cycle intervention trials.
A small human tracer study measured increased whole-body remethylation and transmethylation after three weeks of folic acid; concentration changes did not establish those rates.
What this means
Pharmacological folic acid, not ordinary food folate, a deprivation trial or isolated tissue/whole-pool effect. Evidence access: Primary abstract.
Evidence confidence: Not yet scored
Finding ID: PM4-F6
Finding Statement: A small human tracer study measured increased whole-body remethylation and transmethylation after three weeks of folic acid; concentration changes did not establish those rates.
Synthesised Evidence Confidence: Not yet scored
Synthesis: A small human tracer study measured increased whole-body remethylation and transmethylation after three weeks of folic acid; concentration changes did not establish those rates.
Synthesis Limitations: Pharmacological folic acid, not ordinary food folate, a deprivation trial or isolated tissue/whole-pool effect. Evidence access: Primary abstract.
Evidence Considered:
- Study
- Three-week before/after folic acid with stable-isotope methionine kinetics
- Population
- 12 healthy subjects; 5 mg/day folic acid
- Result
- Whole-body remethylation increased 59% and transmethylation 20%; concentrations did not track kinetic changes.
- Effect / Magnitude
- No general dietary efficacy or tissue-uniform effect is inferred.
- Evidence Summary
- Whole-body remethylation increased 59% and transmethylation 20%; concentrations did not track kinetic changes.
- Limitations
- Pharmacological folic acid, not ordinary food folate, a deprivation trial or isolated tissue/whole-pool effect. Evidence access: Primary abstract.
- Evidence Source
- Bounded external search
- Reference
- [20]
GNMT uses glycine during SAM-dependent methyl transfer; loss of the enzyme changes hepatic methionine-cycle metabolites in mice.
What this means
Human enzyme kinetics and mouse genetic effects support a bounded substrate-capacity relationship, not a glycine deficiency model, whole-cycle flux assay, food response or brain benefit.
Evidence confidence: Not yet scored
Finding ID: PM4-F7
Finding Statement: GNMT uses glycine during SAM-dependent methyl transfer; loss of the enzyme changes hepatic methionine-cycle metabolites in mice.
Synthesised Evidence Confidence: Not yet scored
Synthesis: Recombinant human GNMT has measurable catalytic kinetics for SAM-dependent glycine methylation. Loss of hepatic GNMT changed methionine, SAM and SAH in mice, supporting its role in methyl-group handling.
Synthesis Limitations: Human enzyme kinetics and mouse genetic effects support a bounded substrate-capacity relationship, not a glycine deficiency model, whole-cycle flux assay, food response or brain benefit.
Evidence Considered:
- Study
- Purified enzymes and crystallography; no dietary intervention.
- Population
- Recombinant human, mouse and rat enzymes.
- Result
- Recombinant human GNMT has measurable catalytic kinetics for SAM-dependent glycine methylation.
- Effect / Magnitude
- Only the specified source-level endpoint is assessed; no pooled effect or food-dose estimate is inferred.
- Evidence Summary
- Catalytic kinetics and protein structure.
- Limitations
- Enzyme activity is not a dietary intake-response or proof of brain methylation benefit.
- Evidence Source
- Bounded external search
- Reference
- [21]
- Study
- Gene disruption; not glycine restriction or supplementation.
- Population
- Gnmt-deficient mice and wild-type comparisons; liver assays.
- Result
- Loss of hepatic GNMT changed methionine, SAM and SAH in mice, supporting its role in methyl-group handling.
- Effect / Magnitude
- Only the specified source-level endpoint is assessed; no pooled effect or food-dose estimate is inferred.
- Evidence Summary
- Hepatic metabolite concentrations and GNMT activity.
- Limitations
- Genetic loss of enzyme is not glycine deficiency; SAM:SAH is not a direct measurement of whole-cycle flux. No human dietary dose or brain benefit follows.
- Evidence Source
- Bounded external search
- Reference
- [22]
Evidence Dependency:
- The source-specific observations support different links; food composition, biochemical identity, intervention exposure and clinical outcomes are not interchangeable. Reuse across PMs is not independent replication.
5. BRS Pathways and Connections
5.1 BRS Pathways
BRS2-FM1-PM3 — SAMe Synthesis
↓
BRS2-FM1-PM4 — Methionine Cycle Flux
↓
BRS2-FM1-PM1 — Folate/B12-Dependent Homocysteine Remethylation / BRS2-FM1-PM2 — Betaine/BHMT Remethylation
↓
or BRS2-FM2-PM5 — Transsulfuration Pathway
5.2 Cross-BRS Mechanism Relationships
Primary Mechanisms in other Biological Regulatory Systems that directly interact with, constrain or support this mechanism.
- None listed
5.3 Local BRS Mechanism Relationships
Related Primary Mechanisms within the same Biological Regulatory System that collectively support the integrated biological function.
- BRS2-FM1-PM1 — Folate/B12-Dependent Homocysteine Remethylation — Remethylates homocysteine to methionine and thereby carries one recycling exit. The split between that exit and transsulfuration is the upstream allocation.
- BRS2-FM1-PM2 — Betaine/BHMT Remethylation — Remethylates homocysteine to methionine by a betaine-dependent route that runs parallel to folate-dependent recycling and stays separate from transsulfuration.
- BRS2-FM1-PM3 — SAMe Synthesis — Produces SAM from methionine and ATP. That SAM is the methyl donor consumed as throughput moves from methyl transfer to homocysteine and the branch.
- BRS2-FM2-PM5 — Transsulfuration Pathway — Carries homocysteine onward to cystathionine and cysteine after the branch has directed it into transsulfuration, which is the catabolic exit rather than the recycling arm.
7. Phenome Connections
These mappings are translational relationships, not single-mechanism outcome claims. Phenomes are emergent functional patterns supported by multiple interacting PMs across the BRAIN Framework.
Each Phenome relationship has two independent ratings. They are not combined or averaged.
Biology → Phenome Relationship Strength
How direct and important is this biological mechanism expected to be to the Phenome within the BRAIN model?
Evidence Confidence
How strongly does the adjudicated evidence support this particular biology → Phenome relationship?
- Biology → Phenome Relationship Strength: Low–Medium
- Evidence Confidence: Low–Medium
- Rationale: SAM donates methyl groups, and homocysteine is then split between remethylation and transsulfuration Chiang et al. (1996) [2]; Finkelstein (1998) [12]. Homocysteine concentration is discussed as a risk marker for cognitive decline and Alzheimer disease Yu et al. (2020) [7]; Luzzi et al. (2022) [8]. Those studies measure a metabolite level. They do not measure branch rates, and they do not show that changing cycle throughput improves Cognitive Clarity.
Supporting evidence
Reviews link higher homocysteine with cognitive decline and Alzheimer risk. They do not measure cycle branch rates, and they do not show that changing those rates improves Cognitive Clarity.
What this means
Homocysteine can mark strain at the branch point. A dementia risk association is not evidence that this mechanism treats a cognitive disorder.
Evidence confidence: Not yet scored
Finding ID: PM4-F3
Finding Statement: Evidence linking homocysteine concentration to cognitive decline or Alzheimer risk does not demonstrate that integrated methionine-cycle rates modulate Cognitive Clarity.
Synthesised Evidence Confidence: Not yet scored
Synthesis: A narrative review treats homocysteine as a risk factor for cerebrovascular disease and degenerative dementias and states that effects on specific cognitive domains are poorly mapped. A large prevention review places hyperhomocysteinaemia among Class I factors for Alzheimer disease. Both concern homocysteine level or status. Neither measures remethylation or transsulfuration rates, and neither tests an intervention on integrated cycle throughput.
Synthesis Limitations: This is a boundary on the attached cognition sources, not a claim that homocysteine is irrelevant to brain disease. Methionine-restriction experiments were assessed separately and address ageing phenotypes rather than Cognitive Clarity.
Evidence Considered:
- Study
- Narrative review of homocysteine, cognitive functions and degenerative dementias.
- Population
- Published human studies of homocysteine and dementia or cognitive decline; no new cohort.
- Result
- The review treats homocysteine as a risk factor for cerebrovascular disease and degenerative dementias, and states that domain-specific cognitive effects are poorly investigated.
- Effect / Magnitude
- No single pooled effect size is reported.
- Evidence Summary
- Supports a homocysteine-concentration association with cognitive decline contexts.
- Limitations
- Does not measure methionine-cycle rates or test a dietary cycle intervention against Cognitive Clarity.
- Evidence Source
- Inherited repository evidence
- Reference
- [8]
- Study
- Systematic review and meta-analysis of prospective observational studies and randomised trials on Alzheimer prevention.
- Population
- 243 observational prospective studies and 153 randomised trials across 104 factors and 11 interventions.
- Result
- Hyperhomocysteinaemia is listed among Class I, Level A suggestions for Alzheimer prevention.
- Effect / Magnitude
- The paper assigns an evidence class. It does not report a methionine-cycle rate effect.
- Evidence Summary
- Places homocysteine status among modifiable Alzheimer risk factors.
- Limitations
- The factor is hyperhomocysteinaemia, not integrated cycle throughput. The review does not show that changing branch rates improves Cognitive Clarity.
- Evidence Source
- Inherited repository evidence
- Reference
- [7]
Informs: Cognitive Clarity
- Biology → Phenome Relationship Strength: Low–Medium
- Evidence Confidence: Low–Medium
- Rationale: Boys with ADHD had higher serum homocysteine and lower vitamin B12 than controls, and a separate case-control study linked less healthy diets with lower folate, vitamin B6 and vitamin B12 and with ADHD Lukovac et al. (2024) [9]; Wang et al. (2019) [10]. Those are concentration and dietary-pattern associations. They do not measure remethylation or transsulfuration rates Finkelstein (1998) [12]; Lamers et al. (2011) [13].
Supporting evidence
Children with ADHD have been reported to have higher homocysteine, lower B vitamins, and less favourable diets. Those associations do not measure cycle branch rates and do not show that changing the rates improves attention.
What this means
Serum homocysteine and B-vitamin differences can sit beside attention disorders. They are not evidence that this mechanism determines focus or that a diet treats ADHD.
Evidence confidence: Not yet scored
Finding ID: PM4-F4
Finding Statement: Homocysteine and B-vitamin differences in ADHD cohorts, and dietary-pattern associations, do not demonstrate that integrated methionine-cycle rates determine Focus / Attention Stability.
Synthesised Evidence Confidence: Not yet scored
Synthesis: One case-control study of boys found higher serum homocysteine and lower vitamin B12 in ADHD than in controls. Another case-control study found lower folate, vitamin B6 and vitamin B12, together with a less favourable dietary pattern, and modelled nutritional biochemistry as a link between diet and ADHD. Both are observational concentration or intake associations. Neither infused tracers or reported remethylation or transsulfuration rates.
Synthesis Limitations: The studies can still describe real group differences in homocysteine and B vitamins. They cannot isolate this mechanism from the many other nutrients that differed, and they contain no attention outcome after a cycle-rate intervention. Methionine-restriction literature was assessed separately and is not an ADHD treatment result.
Evidence Considered:
- Study
- Cross-sectional serum comparison with behavioural and cognitive tests.
- Population
- 133 boys aged 6.5–12.5 years (67 with ADHD, 66 controls).
- Result
- Homocysteine was higher and vitamin B12 was lower in the ADHD group. Logistic regression treated homocysteine as a prognostic indicator.
- Effect / Magnitude
- The abstract states significant differences and does not report the mean difference or an odds ratio.
- Evidence Summary
- A serum association between homocysteine, vitamin B12 and ADHD status in boys.
- Limitations
- Male children only, cross-sectional, no cycle-rate measurement, and no dietary intervention.
- Evidence Source
- Inherited repository evidence
- Reference
- [9]
- Study
- Case-control food-frequency and fasting biochemistry study with structural equation modelling.
- Population
- 216 children with ADHD and 216 age-, height- and sex-matched controls from elementary schools in Taiwan.
- Result
- The ADHD group had lower serum vitamin B12, folate, vitamin B6, ferritin and monounsaturated fatty acids, and higher saturated fatty acids, n-6/n-3 ratio and inorganic phosphorus, with higher intake of nutrient-poor foods.
- Effect / Magnitude
- Group differences are described as significant. The abstract does not report mean concentrations or a single nutrient effect size.
- Evidence Summary
- Dietary pattern and several biochemical markers differ together in childhood ADHD.
- Limitations
- Observational, multi-nutrient, and not a measurement of methionine-cycle rates. The path model does not isolate cycle throughput.
- Evidence Source
- Inherited repository evidence
- Reference
- [10]
Informs: Focus / Attention Stability
Stage 2A/2B dietary-target assessment — 23 October 2026
ENRICHED. Coordination of methionine recycling and SAM-dependent methyl-group handling.
Admit glycine as Direct Type A substrate supply for GNMT methyl-group handling, bounded by primary human-enzyme kinetics and mouse loss-of-function. Add separate human folic-acid tracer evidence without changing existing folate admission or treating concentrations as flux.
New implementation: 1 dietary-input admissions (0 completed Unset candidates), 0 practices, 0 biochemical participants, 1 unscored Findings. Existing accepted inputs, source assessments, mission, KCs, Phenome relationships and scores are retained.
Source-to-claim boundary: Assessment source. Stop after adjudicating the stated material candidate and tracing supported delivery. Keep uncertain specificity, formulation, anatomical or measurement links explicit; no negative evidence is inferred from incomplete retrieval.
8. References
- [1] Aragão et al. (2024) — Riboflavin physiology review
- [2] Chiang et al. (1996) — SAM methyl transfer and SAH hydrolysis
- [3] Fanti et al. (2026) — Methionine balance in a mouse longevity diet
- [4] Parkhitko et al. (2026) — Methionine restriction and ageing
- [5] Kumar et al. (2017) — Transsulfuration toward cysteine
- [6] Collaboration (1998) — Folic acid, B12 and blood homocysteine
- [7] Yu et al. (2020) — Homocysteine among Alzheimer prevention factors
- [8] Luzzi et al. (2022) — Homocysteine and cognitive decline
- [9] Lukovac et al. (2024) — Homocysteine and B12 in boys with ADHD
- [10] Wang et al. (2019) — Diet, B vitamins and childhood ADHD
- [11] Huang et al. (2015) — B12, fish oil and plasma homocysteine
- [12] Finkelstein (1998) — Homocysteine split between remethylation and transsulfuration
- [13] Lamers et al. (2011) — Vitamin B6 restriction and methionine-cycle rates
- [14] FAO (2013) — Dietary protein quality evaluation (DIAAS)
- [15] Froese et al. (2019) — Vitamin B12, folate and methionine remethylation
- [16] Meier et al. (2001) — Human cystathionine beta-synthase structure
- [17] Obeid (2013) — Metabolic Burden of Methyl Donor Deficiency
- [18] Evans et al. (2002) — Human BHMT structure and catalytic zinc
- [19] Salvi and Gadda (2013) — Choline dehydrogenase and betaine formation
- [20] Stam et al. (2005) — Folic Acid and Whole-Body Methyl Flux
- [21] Pakhomova et al. (2004) — Glycine N-methyltransferases: a comparison of the crystal structures and kinetic properties of recombinant human, mouse and rat enzymes.
- [22] Luka et al. (2006) — A glycine N-methyltransferase knockout mouse model for humans with deficiency of this enzyme.
No validated structured conversion route is currently projected for this PM. This does not remove or reclassify its existing dietary inputs.
Mapping state: admitted-food-coverage-gap.