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synergy · 3
Choline and betaine are the two ends of one methyl ledger. In the liver choline is oxidized to betaine (a one-way step with no route back), and betaine hands over its methyl group to turn homocysteine back into methionine. Run the other way: when choline intake is short, the liver takes the backup line (PEMT) and makes choline-containing phospholipid itself, using up three methyl groups per molecule. So not eating enough choline and a strain on methylation are two descriptions of the same thing in the liver.
Betaine (TMG) is the methyl donor on the backup route. When the main route is limited by low B12 or folate, or by an MTHFR gene variant, betaine can take over and turn homocysteine back into methionine. In trials, betaine supplements lowered fasting homocysteine in healthy people.
There are two routes for turning homocysteine back into methionine: one depends on folate and vitamin B12, and in the other betaine (TMG) hands over a methyl group directly. When the demand for methylation is high, the two routes run in parallel, and neither replaces the other.