Never stop or change a medication without consulting your prescriber.
Active supplements — educational reference
L-methylfolate (titrating to 15mg) — bypasses the MTHFR enzymatic block to directly supply the active form of folate. Reduces homocysteine, supports neurotransmitter production (serotonin, dopamine, norepinephrine), and is required for SAMe production which drives estrogen clearance, DNA repair, and detoxification.
Methylcobalamin (B12) — works with methylfolate to convert homocysteine to methionine. Without adequate B12, methylfolate builds up unused (the "methyl trap"). Sublingual bypasses gut absorption issues common with oral B12.
B6 (P5P) — completes the homocysteine-lowering triad. Drives the transsulfuration pathway (the alternative exit route for homocysteine into glutathione). Also essential for estrogen clearance and GABA (calming neurotransmitter) production. P5P is the active form — pyridoxine HCl requires conversion that TT impairs.
Riboflavin (B2) 400mg — direct cofactor for the MTHFR enzyme itself. Strongest direct evidence for TT genotype support. May cause bright yellow urine — harmless and expected.
Beet root 1000mg — rich in betaine (TMG), which provides the BHMT backup methylation pathway that bypasses impaired MTHFR. Also converts to nitric oxide — directly supports vascular relaxation relevant to Raynaud's.
Magnesium glycinate 200mg — supports over 300 enzyme reactions including methylation cofactors. Glycinate chelate form absorbs via dipeptide transport in small intestine — gentler on digestion than other forms. Mild vasodilatory effect — take 2 hours after guanfacine and Ristela to avoid additive blood pressure lowering. eGFR of 63 confirms this dose is safe.
Ristela (L-arginine, L-citrulline, Pycnogenol) — nitric oxide precursors that complement beet root for vascular health and Raynaud's. Monitor blood pressure alongside guanfacine — both lower BP via nitric oxide.
Turmeric/ginger 3000mg — anti-inflammatory, supports liver detox pathways TT individuals rely on heavily. Originally co-prescribed with vitamin D for arthritis. Take with fat source for curcumin absorption.
Melatonin 0.5mg — TT impairs melatonin production through reduced serotonin conversion. 0.5mg is the evidence-backed dose — works as circadian signal, not sedative. Consistent timing matters more than dose.
Vitamin D3 — PAUSED — was 4,000 IU (physician-prescribed for arthritis). Level reached 107 ng/mL — above safety ceiling. Calcium elevated as a result. Do not restart until doctor advises new dose (typical safe adult range: 1,000–2,000 IU). Add K2 (MK-7) when restarting.
Discuss with doctor — not yet started
Vitamin K2 (MK-7) 90–120 mcg — pairs with D3 for calcium direction. Especially important given CKD history and elevated calcium result. Add when D3 is restarted.
Zinc 15–25mg — zinc at 66 µg/dL is low-normal; ratio to copper is 0.60 (below optimal 1.0). Discuss with provider before adding — confirm kidney status with current eGFR first.
Omega-3 (EPA/DHA) 1–2g — anti-inflammatory; supports cardiovascular health and homocysteine-driven vascular inflammation. Discuss with provider given kidney history.
Increase magnesium glycinate to 300–400mg — current dose of 200mg is a conservative starting point. eGFR of 63 supports higher dosing but confirm with provider first.