I just got my annual blood test. I'm an 85% paleo guy.
The doctor tested for my homocysteine levels. The lab (and the Internets) say that the healthy homocysteine level is 3.7 to 13.9 umol/l. I'm a 15 -- far above the max!
My three questions are:
1.) Could this be caused by being (mostly) paleo? 2.) Does this increase any risks of mine? 3.) While staying within the paleo framework, any recommendations on what I can do to lower it?
The internets have not been that helpful; some pages recommend supplementing vitamin B...
Thanks for your help! morgan
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You may be a C677T genotype. This decreases activity of the MTHFR enzyme, leading to high homocycteine. Not sure your ethnicity but it is more common in some types. I'm walking out the door now but if nobody else chimes in about this I'll add more to my answer later today.
edit: I'll add a little more here, though Wildwabbit gave a pretty good answer as well...
This picture is from a textbook and may be helpful. You can see where the Methylene THF reductase works, that is the enzyme you're deficient in. First off, I'm not a doctor but I can wax poetic on what I'd do if I had this situation... I'd eat liver and egg yolks to take in B vitamins and choline (which also affects a pathway between homocysteine and methionine, it's not drawn in but it could be drawn on the right side between those two places).
Supplementing B12, B6, and folate seems to be good advice. 5-methyl THF is the functional form of folate, and is available as a supplement. I'm not sure if all supplements provide that form however. B12 supplement should probably use the methylcobalamin form. B6 as pyridoxal phosphate (PLP) might be the best form but I'm not sure if any B6 will do.
There are several ways to handle high homocysteine that usually involves a mix of b6,b12, and folic acid, or TMG. It can go one of 3 ways: 1. B12 on the methionine-cycle side + folic acid on the folic acid cycle side allows homocystein to convert back into methionine. 2. TMG (tri-methyl-glycine also called betaine) will also convert homocysteine to methionine, side-stepping contributions from the folic-acid cycle. 3. B6 will shunt homocysteine to outside of the methionine cycle down the path to glutathione which is a critical antioxidant produced by the body which reduces glutamate toxicity.
A buildup of homocysteine is produced either by a vitamin deficiency or by a genetic deficiency in the enzymes that convert among those pathways. I myself sent away for genetic testing to find out where my deficiencies are, as I have already learned B12 supplementation causes me issues through trial and elimination (both cyano and methyl cobalamin forms).
EDIT: Jeff did a really good expansion, this thread has alot of potential :)
If indeed there are any enzymatic issues that hold up any part of the folate cycle, whether with MTHFR or MTR (which recycles B12) the best bet for lowering homocysteine may be via TMG(Betaine) which side-steps both of those. I also ran across this interesting tidbit from the wikipedia methionine page:
"Homocysteine can also be remethylated using glycine betaine (NNN-trimethyl glycine, TMG) to methionine via the enzyme betaine-homocysteine methyltransferase (E.C.126.96.36.199, BHMT). BHMT makes up to 1.5% of all the soluble protein of the liver, and recent evidence suggests that it may have a greater influence on methionine and homocysteine homeostasis than methionine synthase."
(i.e. the path using tmg(betaine) may have greater relevancy than the path that consumes B12 - alas there is no cite for the above statement)
Moral of the story, there are 3 ways to try to lower homocysteine. You pretty much need to pick a path, supplement for awhile, then recheck. Or get your genome sequenced :)
Definitely sounds like MTHFR C677T. You do not want to take folic. People with the MTHFR gene variant have trouble converting folic into folate. Same with cyanocobalamin (b12). You want it to be in the form of methylcobalamin. Cyanocobalamin has been proven not to fight oxidative stress in people with the MTHFR gene mutation and can possibly deplete your methylcobalamin. And you want your B6 to be in the form of P-5-P as well. I have a web page called MTHFRsupport.com. I have links to lectures and am adding information and research daily. You also want to test your MMA (methylmalonic acid) levels as well as your homocysteine. Your homocysteine is not converting to methionine synthase or cysteine. This toxic amino acid will cause b anemia, cardiac events, dvt, pulmonary embolisms, elevated cholesterol, atrophy of the brain and much more. MTHFR should be taken seriously considering that 98% of children with autism have either the A1298C and/or the C677T gene mutations and the other 2% usually have gene mutations that are not commonly tested yet. Your homocysteine can fall back into an adequate range in a few months with active methyl donor forms of b vitamins, TMG (trimethylglyceine/betaine) and BH4 (if you have aluminum,lead, CBS and/or MTHFR A1298C). Most of us with and MTHFR gene mutation like to see our homocysteine stay between a 6-8. Mine stays at a 6.5. If mine goes below a 6, I reduce the amount of folate I am taking in and if it goes above and 8, I add additional folate. I had 13 pulmonary embolisms before I found out I had MTHFR and had a few after because my doctors who were initially treating me were not aware that inactive synthetic b vitamins and foods fortified with synthetic b's are not a good idea for people with MTHFR. Dr. Ben Lynch also helps us with our MTHFR issues. He is a great source of information and has many people with MTHFR on a paleo diet. You can find him at MTHFR.net. I am putting together an MTHFR conference/workshop in New Orleans. It is in the planning stages right now. If any of you know of any doctors interested in lecturing or attending, they may contact me at MTHFRsupport.com.
I thought wikipedia was pretty clear and helpful. "Homocysteine is not obtained from the diet." and it's got a published citation. It also points to 'chronic alcohol consumption (which can deplete your B vitamins). http://en.wikipedia.org/wiki/Homocysteine
What is the 15% that you are not paleo?
High homoceisteine is a positive test for folic acid (b9 def). Any corresponding blood lab work to indicate folic acid deficiency anemia? Sorry cant help much more. That's all they've taught us about homocysteine in med school so far!