Homocysteine
- An intermediate of various biochemical pathways
- Involved with production of glutathione, transfer of methyl groups
- Elevated homocysteine also called hyperhomocysteinemia contributes to inflammation and damage to blood vessels and other organ systems
- Optimal levels of homocysteine are <9
- High homocysteine levels indicate a deficiency of folic acid, B-6, B-12 and methyl donors
Methyl Donors
- Methionine and homocysteine are identical except that methionine has an extra methyl (CH3) group
- Methyl donors are needed to reconvert homocysteine to methionine
- Methyl donors include 5-methyl folate and tri-methyl-glycine (also known as anhydrous betaine), choline, lethicin
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MTHFR (Methylene Tetrahydrofolate Reductase)
- An important enzyme that helps biotransform 5,10 methylene tetrahydrofolate into methylated folate
- Some people have a variant of the normal gene known as the MTHFR gene (a single nucleotide polymorphism) which impairs proper methylation
- An MTHFR SNP can contribute to high homocysteine and related diseases
MTHFR Variants (or single nucleotide polymorphisms =SNP)
- There are two relatively common SNP’s:
- A1298C – clinically irrelevant – will not effect homocysteine levels – does not require any specific supplementation
- C677T – can effect homocysteine levels – patient may need more folate or 5-methyl-folate
- Utilizing the methionine pathway by adding methyl donors like trimethyglycine and choline can bypass the problem of MTHFR variants
Manifestations of Elevated Homocysteine
Sources of Methyl Groups
- B vitamins – folate, B-6, B-12
- Trimethylglycine (betaine)
- Choline
- Methionine
- SAMe
Metabolically Directed Approach to Elevated Homocysteine
- Look for root causes of homocysteine elevation – chronic inflammation, hypothyroidism, poor diet, MTHFR variants
- When replacing needed B vitamins, take into account the patient’s individual metabolic needs
- For example, a Dysaerobic patient will benefit from folate, but may suffer from increased Dysaerobic imbalance from B-6 and B-12.
- On the other hand, the Anaerobic patient’s imbalance will be exacerbated by folate, yet may benefit more from B-12 and B-6
- In summary, the treatment for elevated homocysteine is best personalized depending on the patient’s individualized metabolic requirements and balance
Ready to Take Control of Your Health?
If you’re ready to prioritize your health and are seeking effective, metabolically directed treatments, contact us online or call (732) 268-7663 for a consultation with Dr. Rothman.
Other Considerations
- Avoid sugar, smoking and caffeine – all can increase homocysteine
- Low B-12 levels are not necessarily caused by low intake or decreased absorption, but also by increased utilization by abnormal bowel flora
Hypothyroidism raises homocysteine
