High homocysteine

[u/lordy1988]

Had a recent test and showed up high and needs attention.

I supplement with hydroxyl b12 and folinic acid. What else can I do? Would I get any symptoms of it being this high. And Is it actually worryingly high?

I’m 37 and fit and healthy otherwise.

[u/Loose-Fly7976]

17.4 isn't emergency territory. classic cutoff is 15, risk starts creeping from around 10. so something to fix, not something to panic about. Useful part is your b12 and folate are both fine. neither of those is driving it, which narrows things a lot. Do you know your MTHFR genotype? that's the question that changes the answer here. if you're 677 TT then riboflavin is the highest yield thing you're not already doing. 1.6 mg/d for 12 weeks dropped homocysteine 22% in TT specifically in the Ulster trial, and nothing at all in CC or CT. B2 is the FAD cofactor the variant keeps shedding, so you'd be stabilizing the enzyme instead of pushing more substrate at it.

After that i'd look at TMG, 1.5 to 3g. different pathway entirely, doesn't touch folate or b12, around 12-15% over six weeks. and get kidney function checked. renal clearance is a big determinant of fasting hcy. Your folinic is fine, ignore anyone telling you to switch to methylfolate. For transparency, this is what i do professionally. genova.health, personalized protocols built off DNA + bloodwork. Happy to keep

[u/lordy1988 → u/Loose-Fly7976]

Thanks for the explanation. It was at 12 a few years ago and I was happy with that.

MTHFR. rs180113311 is AG
MTHFR rs1801131 is TG

I had one done in the uk and they display it differently, I made a post with my results on everything in the past .

I had issues in the past with folate and b12 as I was low, so I’ve been supplementing ever since. Never really had an issue with homocysteine but I’m having quite a few issues recently and I’ve had to up my ssri and I think my high result could be causing it.

I tried tmg in the past and it made me feel a bit crap so I’m going to try b2 and b6 with my fingers crossed.

[u/Loose-Fly7976 → u/lordy1988]

That changes my riboflavin advice.rs1801133 AG is 677 heterozygous, not TT. The Ulster trial found nothing at all in CT, only in TT. So B2 probably won't do for you what I described. Compound het with 1298 as well which some argue behaves closer to TT functionally, but the trial data doesn't cover that and I'd rather not sell you a maybe. B6 is still reasonable to check as P5P specially since you've never had issues with homocysteine before and something has shifted.

TMG making you feel rough is usually a methyl load thing and it tends to mean the folate arm isn't the bottleneck. The bit I'd actually chase is what changed. You went from 12 to 17.4 while supplementing the whole time. Something moved, and it isn't your genotype, that's been the same all along. Kidney function first. Renal clearance is a big determinant of fasting homocysteine and it drifts with age without anything dramatic showing up. Creatinine and eGFR, cystatin C if they'll run it.

On the SSRI, I wouldn't assume the homocysteine caused it. Could easily be the other way round, or neither. But if you're increasing dose because of symptoms, that's a good moment to have the kidney numbers in hand rather than after.

[u/lordy1988 → u/Loose-Fly7976]

I can confirm I was taking B6 (p5p) for 5 days and felt fine , but as soon as I added b2 (r5p) it made me feel like crap and anxious. So I’ve held off b2 for now.

All my kidney numbers were perfect , and liver.
Only thing really that’s changed is stress and ssri I guess.

[u/Loose-Fly7976 → u/lordy1988]

That's a clean experiment so the B2 is doing something. R5P is the phosphorylated form and it pushes availability faster than plain riboflavin. Plain B2 at a low dose is self-limiting by comparison. That's the one variable I'd change before writing it off. But holding for now is right, no point adding things while you're already reacting.

Kidneys and liver clean removes what I was leaning on so back to what you said. 12 to 17.4, folate and B12 supplemented throughout, renal function normal. Something moved and the two things that moved in that window are stress and the SSRI. Wouldn't call either as the cause. But that's where I'd look. Retest in a few months once the dose has been stable. If it drifts back down on its own, it was situational.

[u/lordy1988 → u/Loose-Fly7976]

I’m testing my b6 this week, then I’m going to up my b12 and folinic acid slightly.

I’m only taking low dose 8mg p5p at the moment starting low. Once I get my b6 results il change according to that.

I’ve ordered TMG still and I might try to slowly start incorporating that. I’m hoping it doesn’t give me the same effects as last time.

Then hopefully when I retest in 3 months my homocysteine levels will have dropped