Symptoms of elevated homocysteine levels: High Homocysteine Levels (Hyperhomocysteinemia)

25.08.202318.07.2023 by alexxlab

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High Homocysteine Levels (Hyperhomocysteinemia)

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Medically reviewed by Suzanne Falck, M. D., FACP — By Kiara Anthony — Updated on September 18, 2018

What does it mean to have high homocysteine levels?

Homocysteine is an amino acid produced when proteins are broken down. A high homocysteine level, also called hyperhomocysteinemia, can contribute to arterial damage and blood clots in your blood vessels.

High homocysteine levels usually indicate a deficiency in vitamin B-12 or folate.

A normal level of homocysteine in the blood is less than 15 micromoles per liter (mcmol/L) of blood. Higher levels of homocysteine are split into three main categories:

Moderate: 15-30 mcmol/L
Intermediate: 30-100 mcmol/L
Severe: greater than 100 mcmol/L

Hyperhomocysteinemia itself usually does not cause any symptoms in adults, though it can in children. Symptoms can also vary from one person to the next and be subtle.

Doctors may order a homocysteine test if they suspect you have a vitamin deficiency, and if you begin exhibiting symptoms of a vitamin deficiency.

Symptoms of a vitamin B-12 deficiency include:

pale skin
weakness
fatigue
tingling sensations (like pins and needles) in the hands, arms, legs, or feet
dizziness
mouth sores
mood changes

Symptoms of a folate deficiency are often subtle and are similar to those of a B-12 deficiency. These include:

fatigue
mouth sores
tongue swelling
growth problems

Symptoms of vitamin deficiency anemia overlap with those of B-12 and folate deficiencies, also causing additional symptoms:

fatigue
muscle weakness and unsteady movements
pale or yellowish skin
personality changes
shortness of breath or dizziness
irregular heartbeat
numbness or tingling in hands and feet
mental confusion or forgetfulness
weight loss

Many factors contribute to high homocysteine levels. If you have a folate or B vitamin deficiency, you may develop hyperhomocysteinemia.

Other risk factors include:

low thyroid hormone levels
psoriasis
kidney disease
certain medications
genetics

If you test positive for elevated homocysteine levels, you could be at an increased risk of developing a number of health issues. Some common conditions associated with high homocysteine are:

osteoporosis, or bone thinning
atherosclerosis, or a buildup of fats and other substances in the arterial walls
thrombosis, a blood vessel blood clot
venous thrombosis, a blood clot in the veins
heart attack
coronary artery disease
stroke
dementia
Alzheimer’s disease

Your doctor can perform a simple blood test to measure how much is in your bloodstream. This can also detect if you’ve developed a vitamin deficiency or identify the cause of unexplained blood clots.

Your doctor may require you to fast a few hours before the test. Certain medications or vitamin supplements can affect your results. Talk to your doctor about any medications you’ve been taking prior to this test.

Results are usually available within 24 hours.

Once diagnosed, you may have to change your diet to lower your homocysteine levels. If you have a vitamin deficiency, you can increase your vitamin B intake and folic acid by eating folate-rich foods such as green vegetables, orange juice, and beans.

In some cases, doctors may prescribe daily vitamin supplements.

Once you begin treatment, you should have your homocysteine levels rechecked within two months. If your homocysteine levels are still high after taking these supplements, your doctor may prescribe medications with higher levels of folic acid and vitamin B.

If you have developed hyperhomocysteinemia as a symptom from other health conditions, treatment will focus on the underlying condition.

While it’s possible to lower high homocysteine levels, there’s not enough research to determine whether treatment can prevent associated diseases.

If diagnosed with hyperhomocysteinemia, discuss your treatment options with your doctor. Proper treatment and some lifestyle changes can help to ensure a higher quality of life.

Last medically reviewed on January 2, 2018

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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American Academy of Family Physicians. (2014). High homocysteine level: How it affects your blood vessels.
familydoctor.org/high-homocysteine-level-how-it-affects-your-blood-vessels/
American Association for Clinical Chemistry. (2014). Homocysteine.
labtestsonline.org/understanding/analytes/homocysteine/tab/test/
Mayo Clinic Staff. (2016). Vitamin deficiency anemia.
mayoclinic.org/diseases-conditions/vitamin-deficiency-anemia/symptoms-causes/syc-20355025
Pizzorno J. (2014). Homocysteine: Friend or foe?
ncbi.nlm.nih.gov/pmc/articles/PMC4566450/
University of Rochester Medical Center. (n.d.). Homocysteine.
urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=homocysteine
Varga EA, et al. (2005). Homocysteine and MTHFR mutations. DOI:
doi.org/10.1161/01.CIR.0000165142.37711.E7

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Medically reviewed by Suzanne Falck, M.D., FACP — By Kiara Anthony — Updated on September 18, 2018

How It Affects Your Blood Vessels

What is homocysteine?

Homocysteine is an amino acid (a building block of protein) that is produced in the body.

How is a high homocysteine level harmful?

High homocysteine levels in the blood can damage the lining of the arteries. High levels may also make the blood clot more easily than it should. This can increase the risk of blood vessel blockages. A clot inside your blood vessel is called a thrombus. A thrombus can travel in the bloodstream. From there, it can get stuck in your:

Lungs (called a pulmonary embolism)
Brain (which can cause a stroke)
Heart (which can cause a heart attack)

Some people have very high levels of homocysteine. They are at an increased risk for heart disease.

What causes a high homocysteine level?

Homocysteine is normally changed into other amino acids for use by the body. Vitamin B helps your body use the homocysteine. If your homocysteine level is too high, you may not be getting enough B vitamins.

Most people who have a high homocysteine level don’t get enough folate (also called folic acid), vitamin B6, or vitamin B12 in their diet. Replacing these vitamins often helps return the homocysteine level to normal. Other possible causes of a high homocysteine level include:

Low levels of thyroid hormone
Kidney disease
Psoriasis
Some medicines
When the condition is common in your family

How is the homocysteine level measured?

Homocysteine is measured using a simple blood test. Your doctor will order the test only if they suspect you have high levels. If your homocysteine level is too high, you need to lower it. This is especially important if you have blockages in your blood vessels. Sometimes your doctor may take a watchful waiting approach. This means they will monitor your level closely but not take steps to lower it. Your doctor may do this if you have no other major risk factors for cardiovascular disease and you don’t have atherosclerosis (a buildup of plaque in your arteries). If your homocysteine level increases further, you may need to lower it.

No studies have shown that lowering homocysteine levels helps reduce strokes, heart attacks, or other cardiovascular conditions. But a high homocysteine level is a risk for heart disease. So, it’s a good idea to lower it if you can.

Path to improved health

How can I lower a high homocysteine level?

Eating more fruits and vegetables can help lower your homocysteine level. Leafy green vegetables such as spinach are good sources of folate. Other good sources of folate include:

Many breakfast cereals
Fortified grain products
Lentils
Asparagus
Most beans

You may need to increase the amount of vitamin B-6 in your diet. Foods that are rich in vitamin B-6 include:

Fortified breakfast cereals
Potatoes
Bananas
Garbanzo beans (chickpeas)
Chicken

You also may need to increase the amount of vitamin B-12 you eat. Good sources of vitamin B-12 include:

Dairy products
Organ meats (such as liver)
Beef
Some types of fish

Adjusting your diet may not be enough to lower your homocysteine level. If it’s not, your doctor may suggest that you take a folate supplement. You may also need to take a vitamin B-6 and vitamin B-12 supplement.

Things to consider

If you start taking folate or vitamin B supplements, you should have your homocysteine level rechecked after 8 weeks. If your homocysteine level remains high, your doctor may have you try a higher dose. You may need to have some tests to see if you have another health condition that causes high homocysteine levels. If you have had a high homocysteine level, you may need to have your level checked more regularly (2 or 3 times a year).

Questions to ask your doctor

What is causing my homocysteine level to be high?
Could a high level be the sign of another condition?
Can I lower my homocysteine level through diet alone?
Should I take a supplement?
Can I ask my doctor to check my homocysteine level even if I have no symptoms?

Resources

National Institutes of Health, MedlinePlus: Homocysteine Test

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

norm, causes of elevated blood levels in women

Homocysteine is a sulfur-containing amino acid, which is an intermediate product of the metabolism of the amino acids methionine and cysteine.

Methionine is the only source of homocysteine in the body. The content of homocysteine in foods is negligible, and human needs for methionine and homocysteine are provided precisely by food methionine. An important role in the metabolism of homocysteine belongs to vitamins B6, B12 and folic acid.

A high level of homocysteine in the blood (hyperhomocysteinemia) indicates either a violation of the metabolism of homocysteine, or a deficiency of folic acid, vitamins B6, B12, or impaired renal function. In the kidneys, 70% of homocysteine is converted to methionine. Patients with renal insufficiency have a high risk of developing cardiovascular diseases [3].

Retrospective and prospective studies show a close relationship between hyperhomocysteinemia and cardiovascular diseases: venous and arterial thrombosis, pulmonary embolism, stroke and myocardial infarction [5, 6]. People with elevated homocysteine levels have an increased risk of Alzheimer’s disease and dementia [11]. With a combination of hyperhomocysteinemia and diabetes mellitus, vascular complications occur more often – peripheral vascular disease, nephropathy, retinopathy. During pregnancy, elevated levels of homocysteine lead to impaired fetoplacental circulation, which may be the cause of miscarriage and infertility as a result of implantation defects of the embryo.

Causes of increased homocysteine levels

Deficiency of vitamins B6, B12, folic acid.
Renal failure.
Diseases of the gastrointestinal tract, accompanied by impaired absorption of vitamins (malabsorption syndrome).
Diabetes mellitus.
Hypothyroidism.
Leukemia.
Genetic defects in enzymes involved in homocysteine metabolism (rare).
Smoking, alcoholism, drinking a lot of coffee.
Taking certain medications: methotrexate, anticonvulsants (phenytoin), nitrous oxide, metformin, aminophylline, hormonal contraceptives (not always).

Results of clinical studies conducted in recent years

Conducted clinical studies (HOPE) 2 [7] and NORVIT [1] showed that the administration of folic acid, vitamin B6 and vitamin B12 does not reduce the number of recurrent heart attacks. However, Refsum H. and Smith A.D. made a number of critical remarks about the data obtained in these studies, which are very likely [8]:

Patients’ mean levels of homocysteine, vitamin B6, vitamin B12, and folic acid were within the normal range in both studies. Therefore, no great effect should be expected.
70% of patients in study (HOPE) 2 received folate-fortified flour products. Therefore, the control group also had good levels of homocysteine in the blood.
The study duration (2-3 years) was too short as atherosclerosis develops over decades.
Reanalysis of data obtained in the VISP study (excluding patients with renal insufficiency) showed a reduction in the number of strokes by 21% [9, 10].
Since 1998, the US and Canada have introduced National Flour Fortification Programs with folic acid. Studies have shown a significant reduction in mortality in women from stroke after 5 years (see Fig. 1). The level of homocysteine in the blood of the population also decreased [12].
A study of men and women aged 50-70 years with increased levels of homocysteine in the blood showed that with the appointment of folic acid for more than 3 years, the level of homocysteine decreased by 26% [2].

The reduction in stroke deaths in women in the US and Canada after flour fortification with folic acid is shown in the chart below:

Rice. 1. Mortality from stroke in women in the US and Canada before and after flour fortification with folic acid (number of cases per 100,000) [12]

The mean reduction in stroke mortality in Canada was -1.0% annually from 1990 to 1997 and increased to -5.4% annually from 1998 to 2002 (p < 0.0001).

Clinical guidelines

The above indicates the importance of maintaining normal levels of lipids and homocysteine in the blood. According to recent studies, it is very important to check the level of homocysteine in the blood regularly, for example, at the age of 30 years, 40 years, 50 years, 60 years. Early prevention (see data on the use of flour fortified with folic acid) has shown positive results.

Studies of blood cholesterol and homocysteine levels after myocardial infarction, stroke, or in the case of dementia and attempts to reduce their levels are not particularly useful, since the degree of atherosclerotic vascular damage can hardly be reduced. It is impossible to achieve any great success, even with constant vitamin therapy, in 2-3 years. Therefore, it is very important to explain to patients the importance of early prevention of hyperhomocysteinemia.

It is recommended to check the level of homocysteine in all persons with a history of arterial or venous thrombosis, coronary heart disease. It is mandatory to check the level of homocysteine in patients with previous obstetric complications and women whose relatives had strokes, heart attacks and thrombosis under the age of 45-50 years.

A detailed review of the significance of hyperhomocysteinemia was presented by the international expert prof. Wolfgang Herrmann in 2006 in Clin Lab magazine [4].

Diagnosis of hyperhomocysteinemia

Study code: 22-20-108 – Homocysteine

Material for research: blood serum

Research method: immunochemiluminescence

Units: µmol/l

Reference values: 3.7-13.9 µmol/l*

* – Reference values are given according to NCCLS Document C28-A, Wayne (PA): NCCLS; 1995.

Additional research:

95-13-211 – Vitamin B12
33-20-038 – Folic acid (folates)

References

Bonaa K.H. et al. // N Engl J Med 2006;354(15):1578-88.
Durga J. et al. // Lancet 2007; 369:208-16.
Faria-Neto J.R. et al. // Braz J Med Biol Res 2006;39(4):455-63.
Herrmann W. // Clin Lab 2006; 52:367-374.
Kazemi M.B. et al. // Angiology 2006;57(1):9-14.
Kothekar M.A. // Indian J Med Sci 2007;61(6):361-71.
Lonn E. et al. // N Engl J Med 2006;354(15):1567-77.
Refsum H., Smith AD. // N Engl J Med 2006;355:207.
Spence J.D. et al. // STROKE 2005;36(11):2404-09.
Toole J.F. et al. // JAMA 2004;291:565-75.
Wald D.S. et al. // BMJ 2006;333:1114-17.
Yang Q. et al. // Circulation 2006; 113: 1335-1343.

Why is the level of homocysteine in the blood elevated?

Year of publication: 2019

Author of the article: doctor of clinical laboratory diagnostics Zaytsev Evgeny Gennadievich sign up for an online consultation →

Homocysteine is a sulfur-containing amino acid that is formed during protein metabolism.

It was first discovered in a bladder stone in 1933 by the American biochemist Vincent du Vignot. Homocysteine is formed as a result of the metabolism of dietary methionine, which is found in animal proteins.

Hyperhomocysteinemia is an increase in the level of homocysteine in the blood, which can damage the arteries and form blood clots in your blood vessels (eg, deep vein thrombosis and pulmonary embolism). There is epidemiological evidence of an association between elevated homocysteine and neurodegenerative conditions, including Alzheimer’s disease, Parkinson’s disease, and stroke. Elevated levels of homocysteine reduce the availability of ATP to neurons and cause severe damage to the nervous system. Serum homocysteine can serve as a biomarker used to assess methylation.

Reference intervals

The normal level of homocysteine in the blood is less than 15 micromoles per liter (µmol/l) of blood. An increase in homocysteine concentration can be:

Moderate: 15-30 µmol/l

Moderate: 30-100 µmol/l

Severe: more than 100 µmol/l

Causes of an increase in homocysteine

Homocysteine levels may increase with age . The following are the main causes of an increase in homocysteine.

Genetic factors

Elevated homocysteine may be caused by genetic defects in enzymes that are involved in the metabolism of homocysteine. The human body contains over 50 trillion cells, and each cell contains a complete set of instructions for you. The instructions are encoded in your DNA. Short segments of DNA are called genes. Your DNA is a cookbook, your genes are recipes. Genes code for certain proteins, and these proteins play a critical role in the functioning of tissues and organs in the body. Humans have about 20,000 genes. Among these 20,000 genes are the MTHFR, MTR, MTRR, CBS genes. Most people have two copies of these genes. The MTHFR gene is needed to make the enzyme methylenetetrahydrofolate reductase. When you eat foods that contain folic acid (vitamin B9), the enzyme methylenetetrahydrofolate reductase converts it to methylfolate, the active form of folate. Methylfolate is a key player in methylation, the process of adding a methyl group to a chemical compound. Methylation is fundamental to the proper functioning of almost all body systems.

Methylfolate is involved:

In the repair and regeneration of your cells, tissues and DNA.
Regulation of gene and protein expression.
In the synthesis of neurotransmitters that affect mood, sleep, behavior, cognition and memory.
In the control of homocysteine.
Keeps inflammation under control.
Helps your liver process fats.
In the activation and regulation of the immune system.

What to do if there is a mutation in the MTHFR gene? Methylation is extremely important!

Those of us with mutations in the MTHFR gene (A1298C or C677T) have a defective methylenetetrahydrofolate reductase enzyme and produce 30-70% less methylfolate (synonyms: metafolin, levomefolic acid, methyltetrahydrofolate) than someone who does not have the mutation.

Although knowledge of the MTHFR status is very important, it may not fully reflect the entire clinical picture. Research shows that a number of genes other than MTHFR influence not only methylation cycles, but also secondary by-products and gene function. Genes such as MTR, MTRR, COMT and AHCY play an important role in the patient’s ability to methylate.

Mutation in the MTR gene (A2756G) results in methylcobalamin deficiency. This cytoplasmic enzyme methionine synthase (MTR) catalyses the methylation of homocysteine to methionine using 5-methyltetrahydrofolate. The reaction proceeds by transfer of the methyl group from 5-methyltetrahydrofolate to form methylcobalamin and subsequent transfer of the methyl group from methylcobalamin to homocysteine to form methionine. With a deficiency of methylcobalamin, there is also an increase in homocysteine in the blood.

The MTRR gene encodes methionine synthase reductase, an enzyme that helps methionine synthase (MTR) recover and further convert cobalamin to methylcobalamin.

Mutation (A66G) in the MTRR gene can result in a less effective or no more effective enzyme. It is specifically associated with neural tube defects, colorectal cancer, cardiovascular disease, and an increased risk of Down syndrome. In combination with the MTHFR C677T polymorphism, MTRR AG/GG genotypes influence total plasma homocysteine levels. In addition, the combination of genetic polymorphisms in MTRR and MTHFR has been associated with increased DNA damage. Vitamin B2 is essential for the normal functioning of the enzyme methylenetetrahydrofolate reductase (MTHFR).

The CBS gene codes for an enzyme called cystathion beta synthase. This enzyme, along with the coenzyme vitamin B6, is required to convert the amino acids homocysteine and serine into a molecule called cystathionine. Another enzyme then converts cystathionine to the amino acid cysteine, which is used to form proteins and glutathione. More than 150 mutations have been identified in the CBS gene that cause an increase in homocysteine in the blood. The presence of a mutation in the CBS gene also leads to homocystinuria. Homocystinuria can be detected by tandem mass spectrometry. Such an analysis of amino acids in urine is performed in Russian laboratories. Genetic defects in the folate cycle enzymes: MTHFR, MTR, MTRR (4 points) are detected in many private laboratories.

Metabolic pathway for the synthesis and utilization of homocysteine. MTHFR: methylenetetrahydrofolate reductase; MTRR: methionine syndrogenase.

An increase in homocysteine occurs due to malnutrition (lack of essential nutritional components). If a person eats high-protein foods every day: meat, eggs, chicken, milk, then he should also include certain vital amino acids in his diet. The absence of these vital amino acids causes hyperhomocysteinemia. Coffee consumption (4 cups per day) is associated with a modest increase in homocysteine. Strict vegetarians are often at risk for hyperhomocysteinemia due to low plasma B12 levels.

Lifestyle factors

Smoking is associated with vascular disease and other complications associated with elevated homocysteine. The number of cigarettes smoked per day is the strongest determinant of homocysteine levels. Nicotine directly affects methylation and catabolizes the folate cycle. Insufficient physical activity reduces the concentration of total homocysteine in plasma and increases the likelihood of developing cardiovascular diseases in healthy and already sick people. Chronic alcohol consumption affects the metabolism of folic acid and cyanocobalamin. This is due to gastrointestinal disturbances, which lead to reduced absorption of vitamins and folic acid, which contributes to an increase in homocysteine levels. It also inhibits methionine synthase to reduce liver absorption and increase urinary excretion.

Drug side effect

Some drugs, such as cholestyramine and metformin, prevent the absorption of vitamins from the intestines. Methotrexate, nicotinic acid affect the metabolism of folic acid, thereby affecting homocysteine. Oxcarbazepine and topiramate can cause hyperhomocysteinemia due to their ability to activate liver enzymes.

Kidney disease

Patients with renal insufficiency have extremely high homocysteine levels due to less efficient renal clearance of homocysteine. Patients with kidney disease have high rates of cardiovascular morbidity and death. Homocysteine levels increase as kidney function decreases. The underlying cause of hyperhomocysteinemia in kidney disease is not yet fully understood, although a decrease in the rate of excretion of homocysteine by the kidneys is the most likely cause.

Prevalence

The prevalence of hyperhomocysteinemia varies widely by geography, gender, ethnicity, and age. Homocysteine is elevated among the American population at 5-7%, among the Chinese – 27.5%, among Indians – 52-84%. Indians have been found to have higher levels of homocysteine than Europeans. Mild hyperhomocysteinemia occurs in 5-7% of the general population and in 40% of patients with vascular disease. In 1990-98, stroke mortality in the United States fell by 0.3% per year, but after legislative fortification of products (fortification) with folic acid in 19In 1998, the death rate dropped to 2.9% per year, which is 10 times more. The frequency of polymorphism (a mutation in the MTHFR gene responsible for increasing homocysteine) is very low in some populations (<1% in African ancestry) and very high in others (11-15% in Anglo-Americans, more than 20% in Italians and Spaniards, 25 -57% in the Mexican population).

Pathophysiology

Homocysteine increases the synthesis of reactive oxygen species by activating nicotinamide adenine dinucleotide phosphate oxidase. It inhibits endothelial nitric oxide (NO) synthase and thus reduces the bioavailability of NO. Homocysteine also induces the expression of various adhesion molecules and promotes the formation of modified LDL particles, which play an important role in the formation of atherosclerotic plaques. In addition, it increases the production of pro-inflammatory cytokines. The pathway of homocysteine metabolism depends on the proper functioning of the enzyme methylenetetrahydrofolate reductase (MTHFR), methionine synthetase, vitamin B12, folic acid, etc.

Homocysteine as a risk factor

Thrombosis

Homocysteine elevation is now generally accepted as a strong, independent risk factor for stroke, myocardial infarction and other vascular complications. Homocysteine is an unstable amino acid that undergoes auto-oxidation to form oxygen free radicals, further increasing oxidative stress. This contributes to atherosclerosis in two ways. The first includes free oxygen radicals, which convert low-density lipoproteins of subendothelial tissues into oxidized low-density lipoproteins (LDL). Stroke is the leading cause of death worldwide. Along with hypertension, dyslipidemia, smoking, diabetes mellitus (DM), elevated homocysteine is one of the risk factors for stroke.

Oncology

Elevated plasma homocysteine is a risk factor for cancer and is even being used as a new tumor marker. Folate depletion in the body contributes to the development of colorectal cancer. And while high doses of folic acid enhance the growth of cancer cells. Folic acid deficiency leads to DNA damage that can accumulate, leading to cancer.

Diabetes mellitus

An increase in homocysteine has been observed in many diabetic patients. In the West, the incidence of hyperhomocysteinemia in diabetic patients is reported to be about 5 times higher than in the general population. Homocysteine concentrations correlate with the presence of diabetic peripheral neuropathy and are also associated with the presence of autonomic neuropathy in patients with type 1 diabetes. An increase in homocysteine in patients with diabetes mellitus occurs only with a deterioration in kidney function. Therapy with insulin and medications such as metformin and glitazones can raise or lower homocysteine levels.

Symptoms of elevated homocysteine

Hyperhomocysteinemia itself usually does not cause any symptoms in adults. Doctors may order a homocysteine test for you if they suspect a vitamin deficiency, if you have had at least one case of thrombosis. Blood vessel abnormalities, atherosclerosis, mental retardation in children, thrombosis, and bone loss are common symptoms of hyperhomocysteinemia.

Vitamin B12 deficiency symptoms include:

pale skin
tingling sensation in arms, hands, legs or feet

Symptoms of folic acid deficiency are often subtle and similar to those of B12 deficiency. They include:

fatigue
mouth ulcers
swelling of the tongue
growth problems

Symptoms of anemia (due to deficiency of vitamin B12 and folic acid):

unsteady movements
pale or yellowish skin
shortness of breath
dizziness
arrhythmia
numbness or tingling in arms and legs
confusion
forgetfulness
weight loss

Laboratory diagnostics

In human plasma, there are many unstable types of homocysteine: bound to albumin, freely circulating disulfide and sulfhydryl form. Homocysteine can be checked in several ways: chromatographic method, immunoassay method, cyclic enzymatic method, capillary electrophoresis and chemosensors. Current laboratory methods determine the presence of all three forms – the total concentration of homocysteine. High levels of homocysteine may indicate a deficiency of vitamins B6, B12 or folic acid, so it is advisable to determine their concentrations too.

Treatment of hyperhomocysteinemia

If you have a mutation in the MTHFR, MTR, MTRR genes, talk to your doctor about prescribing metafolin (methylfolate, an active form of folic acid), methylcobalamin (an active form of vitamin B12). Internationally recognized treatment for elevated homocysteine includes the use of a complex of vitamins: B2 (riboflavin), B6 (pyridoxine), B9 (folic acid), vitamin B12 (cyanocobalamin). Pyridoxine reduces homocysteine levels by 22%. Folic acid alone reduces homocysteine levels by 22% and vitamin B12 by 11%. The simultaneous intake of these vitamins leads to a decrease in homocysteine by 38.5%.

After diagnosis, you may need to change your diet to lower your homocysteine levels. If you are deficient in vitamins, you can increase your intake of B vitamins and folic acid by eating foods such as green vegetables, orange juice, and beans.

Folic acid is found in many vegetables and lettuce.

In some cases, doctors may prescribe daily vitamin supplements: 400-800 mcg/day folic acid, 500 mcg/day B12, and 25-100 mg/day B6. After you start treatment, you should recheck your homocysteine levels within two months. If your homocysteine levels are still high after taking these supplements, your doctor may prescribe medications with elevated folic acid and vitamin B levels. Treatment may also include anticoagulant, antiplatelet drugs. In the diet, foods rich in methionine are limited: cheese, meat, peas, peanuts, etc.

It is not recommended to violate the dosage of the doctor’s prescription!

When taking more than 1000 mcg/day of folic acid, dihydrofolate, an inhibitor of methylenetetrahydrofolate reductase, is produced in excess, which leads to a deficiency of active folates. And also an excess of folate can stimulate proliferative processes and contribute to the set of excess body weight.

Prognosis

Hyperhomocysteinemia is regarded as an independent risk factor for various cardiovascular diseases such as endothelial dysfunction, vascular inflammation, atherosclerosis, hypertension, cardiac hypertrophy and heart failure. There is much evidence that ignoring homocysteine levels in patients with vascular disease was highly unwise. While it is possible to lower high homocysteine levels, there are not enough studies to determine whether treatment can prevent comorbidities. If you have been diagnosed with hyperhomocysteinemia, discuss your treatment options with your doctor. Proper treatment and some lifestyle changes can help ensure a better quality of life.

Conclusion

Over the past decade, homocysteine-related research has generated a huge amount of scientific literature on the topic and sparked a heated discussion about a new risk factor in the development of neural tube defects, fetal pathology and non-communicable diseases, including type 2 diabetes and cancer.

Symptoms of elevated homocysteine levels: High Homocysteine Levels (Hyperhomocysteinemia)