Elevated homocysteine (Hcy) levels were addressed in each study, the amino acid is associated with risk factors for diseases involving cardiovascular, coronary heart, cognitive, cancer and congenital defects. Finding the best form of folic acid for those with MTHFR has been a topic of discussion. A clinical trial consisting of 149 people with elevated Hcy were placed on a natural folate-rich diet, 5-MTHF, folic acid, and placebo, the result showed Hcy levels were lowered significantly with introduction of additional fruits and vegetables along with supplementation of 5-MTHF and folic acid compared to placebo. The bioefficacy of natural folate from citrus fruit and vegetables ranges from 60% to 100% of folic acid. A folate rich diet could be beneficial to the population to maintain an adequate folate status, along with other healthy nutrients like antioxidants and vitamins 13. Other studies compared the types of folic acid available for treatment of MTHFR mutations, Knowles et al., (2016) tested 3 unrelated patients to see whether betaine, B12, and folate aid in increasing CSF levels. They found synthetic folic acid and calcium folinate ineffective in crossing the blood-brain barrier, calcium mefolinate in high doses the key for treatment 7.