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Neurobiol Aging 51:104112

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Acute pancreatitis (AP) is a common abdominal inflammatory disease

While C677T and A1298C do decrease enzyme activity and make MTHFR function suboptimal, carriers can generally expect to have no trouble converting enough homocysteine to methionine

The most common typically strongest in the first 48 weeks as the body adapts include: Nausea (most common, usually dose-dependent) Diarrhoea or constipation Fatigue , especially during dose escalations Mild headache Reflux and acid reflux Loss of appetite (this is the therapeutic effect, not a side effect, but it can be uncomfortable) Less common but more serious effects warranting immediate physician review include pancreatitis, gallbladder disease, and kidney issues, particularly in patients with pre-existing conditions