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31 Because serine is required (1) for the conversion of folic acid to its active form, (2) as a shuttle for methyl groups between the cytosol and the mitochondria, and (3) as a cofactor in the transsulfuration pathway of methionine/homocysteine metabolism, supplementation with betaine should be included with folic acid, cobalamin, and P5P to optimize the interrelated pathways of homocysteine metabolism