I have MTHFD1 hetero, paired with hetero MTHFR 677CT (folate), an MTR mutation (B12), and hetero CBS 699CT (homocysteine/sulfur). I'm researching MTHFD1 and just found this thread, so thought I'd comment.
TL;DR version in bold.
From what I understand/remember, MTHFD1 utilizes
choline to assist MTHFR in recycling folate / generating MTHF. So people who over-focus on MTHFR mutations while having an MTHFD1 mutation might be missing a big part of the picture.
My theory a couple months ago was that supporting choline intake would support my folate+methionine cycles as a whole. Can't say I've had much success, as it seems my folate is still becoming deficient on a semi-regular basis, even while taking 1.25g choline at bedtime. (I took it at bedtime hoping it would help with sleep, since taking 1-3mg of an MTHF tablet before bed or upon early insomnia usually helps. If I'm slow to fall asleep, or wake up after specifically 5 hours, it's often low folate/MTHF, or perhaps low serotonin via low BH4 via low folate.)
According to the Chris Masterjohn genetic choline calculator (using a 23andMe file for example), I needed 8 eggs worth of choline, which I believe was 2.5g/day. So at bedtime I'm getting half my genetic needs, and the goal was to take the other half during the day, but I've fallen short of that.
When I first tested choline with a 2g dose, I did notice a prompt improvement in roughly-folate-related symptoms (tingling-sizzling-fizzy eyes and tongue, fatigue, hazy mind, brain fog). Maybe I need to test taking higher multi-gram doses. It's just hard to intake that much choline.
I'm using NOW choline + inositol which works, when it works. I've also had good experience with sunflower lecithin.
Phosphatadylcholine did
not work. I also have PEMT mutations and figured this would be a useful supplement, but if it is useful, it wasn't noticeable in my symptoms.
So in sum, I theorize that MTHFD1 can be tossed aside and taking MTHF can compensate for it, since its only job, from what I understand, is to use up choline to assist MTHFR in recycling folate / making MTHF. And naturally this has consequences down the line, impacting MTR(R) with B12 recycling, and that then impacting efficacy of the methionine cycle as a whole.
For reference, I take Life Extensions Optimized Folate which I can often find for $15 a bottle on Vitamin Shoppe I believe. I am not partial to brands, only efficacy. There was only one other form of MTHF that worked for me and it stopped being stocked on Amazon. Powder capsules of 5mg and 10mg didn't even work for me. So I've settled on taking these Life Extension 1mg tablets, sublingually under the tongue. I get the sense that swallowing/digesting them doesn't work, making me wonder if I have folate absorption issues; or maybe I really just need that much MTHF. I average 5mg, with 1-3mg on the low end and 8mg on the top end, before I begin noticing distinct over-methylation symptoms (such heavy sleepiness, which is honestly more soothing than undermethylation wired-tiredness).
There were a couple times where taking B2 helped me, but it hasn't been consistent. (Where it noticeably helped was in resolving the disgust-rage symptom I now associate directly with SAM-e/methionine deficiency, meaning it would've helped folate cycling which reached the methionine cycle.)
Maybe MTHFR mutations paired with MTHFD1 mutations imply an even higher need for MTHF intake, because whereas MTHFR is slow recycling of folate / production of MTHF, I get the sense that MTFHD1 failures might be totally preventing recycling, as the Folate Cycle is a multi-step cycle involving MTHFD1 three times!
I just looked up the pathway, and forgot that I also have DHFR mutation, which IIRC means I can't utilize folic acid well. I'm surprised my DNA is still functioning with this catastrophe of a folate cycle! But it does explain why I've had chronic serotonin + dopamine deficiency issues (BH4 impairment from low folate), and why I likely need so much MTHF.
MTHF might as well be an essential nutrient for me.
Pathway reference:
https://ndupdate.com/mthfr_ben_lynch/