Do you need Homocysteine bloodwork? What to do if it is high/low.

Dr. Daniela Steyn shares advice on how to live your best life with optimal health.

I sometimes need to test Homocysteine levels in some of my patients at my Wellness Clinic.
In case your doctor asks you to go for bloodwork to test for homocysteine, here is a quick explanation why.

Homocysteine is an amino acid. Vitamins B12, B6 and folate break down homocysteine to create other chemicals your body needs. If your bloodwork comes back with high homocysteine levels, it may mean you have a vitamin deficiency. Without treatment, elevated homocysteine increases your risks for dementia, heart disease and stroke.

When Homocysteine interacts with the B vitamins, homocysteine converts to two substances:
Methionine is an essential amino acid and antioxidant that makes proteins.
Cysteine, a nonessential amino acid (an amino acid that your body can produce on its own) synthesized from methionine reduces inflammation, increases communication between immune cells and increases liver health.

High homocysteine is the most common.
In a healthy person, normal homocysteine levels between 5- 15 umol/L.

If you have more than 50 umol/L, the excess homocysteine may damage the lining of your arteries and increase your risk of blood clots or blood vessel blockages (which may lead to a stroke or heart attack).

Deficiencies in vitamins B12, B6 or folate.
Heart disease
Rare inherited diseases, such as homocystinuria (when your body can’t process methionine).
What are the risks of high homocysteine levels?
Without treatment, elevated homocysteine levels can lead to severe health complications. Too much homocysteine increases your risk for blood clots (heart attack, stroke), dementia and osteoporosis.

It is very infrequent to see a patient with low homocysteine. However, I saw someone with low homocysteine today in my Clinic, and I sometimes see it in young kids with diabetes. Someone with low homocysteine has a decreased ability to methylate, so they will have lower glutathione (your antioxidant defence).


How do I know if I need a homocysteine test?
I recommend a homocysteine blood test in patients with low vitamin B levels, and I typically do Vitamin B bloodwork for patients who I suspect a vitamin B deficiency because they come to me with dizziness, fatigue, muscle weakness, generally looking pale, tingling in their feet/arms/hands. Some people might have a sore tongue or mouth sores from vitamin B/ Vitamin C deficiency.
For patients with heart disease, I might test
For people with chronic inflammation I might test
For patients with high homocysteine levels I typically advice a supplement that contains Vitamin B6, Vitamin B12 and Folic acid . For people who smoke I advice to stop, that on it's own will lower your homocysteine levels. It helps to cut back on your salt intake to less than 2,300 milligrams of sodium daily. Exercising at least three to five times weekly will also help normalize your homocysteine levels.
How to increase a low homocysteine:
increase your protein intake. Make sure you chew your protein well. People on antacids are not able to absorb the protein in their diet well.
increase your sulfur intake (cruciferous vegetables)
You might consider a NAC or molybdenum supplement.