Elevated Homocysteine Level or Laboratory Error?

Having MTHFR mutations increases the likelihood of elevated homocysteine levels.

Monitoring your homocysteine level is critical especially if elevated.

The issue is homocysteine testing is fraught with issues.

Properly prepare yourself to get your homocysteine level measured.

  • You should be fasting. Do not eat anything prior to testing. Ideally get tested in the morning to make this easier.
  • Many foods contain protein and most protein contains methionine.
  • High-methionine containing foods can falsely elevate your homocysteine levels.

Ensure the lab handles your blood sample properly.

  • Within 30 minutes of drawing your blood, the sample must be placed on ice and spun down.
  • Red blood cells continue to release homocysteine so they must be removed.
  • Homocysteine levels increase by 10% per hour if the red blood cells are not removed.
  • Once red blood cells and serum are removed, the remaining plasma remains stable at room temperature for 4 days.

Caution of Home Test Kits for Measuring Homocysteine:
There are homocysteine test kits online which claim you can do a finger stick and send in your sample on a card. Obviously, now that you know the above requirements are needed for proper homocysteine level measurement, this type of homocysteine testing is inaccurate.

Source of Information: Laboratory Medicine. 2006;37(9):551-553.  2006 American Society for Clinical Pathology

Question for you:
Is your homocysteine routinely elevated? Are you questioning it now? Comment below.

22 Responses to “Elevated Homocysteine Level or Laboratory Error?”

  1. Christie Hurwitz March 15, 2012 at 10:40 pm # Reply

    I’m inquiring about the MTHFR Mutation on behalf of my son. He has a hx of bipolar illness as well as GAD and social anxiety disorder. I am not sure if this is something to consider or not. If so, we live in San Diego. Where can we go to get this type of testing done. If we go to our usual lab (Scripps) I am not sure if they will follow all the steps indicated in your write up. So, where do we go if we decide to get this done. I guess I should as this first, do you think this might be an issue in my son? We have tried everything….Every medication, every type of therapy etc. He is on lithium which seems to control the bipolar symptoms, and is doing fairly well socially (on effexor) and has ativan for the real bad periods, but still is in agony every day. This may just be a wild card, but figure its worth asking about. Thank You Christie

  2. Lisa March 26, 2012 at 12:21 am # Reply

    I see all of the do’s and do not’s but where do you recommend getting the Homocystenine test done? What lab?

    • Dr Ben March 26, 2012 at 5:54 am # Reply

      Lisa -

      You can get homocysteine done by any lab.

      It is the preparation that is critical.

      Make sure the person who draws the blood follows the proper procedures.

      • Erica October 10, 2014 at 12:37 am # Reply

        Yes but how often should this level be checked?

  3. Cheri January 16, 2013 at 7:06 pm # Reply

    “High-methionine containing foods can falsely elevated your homocysteine levels.”

    Does this mean we should avoid proteins for a few days prior to testing, or will a 12 hour fast be sufficient to decrease likilihood of false elevation? Thanks!

    • Dr Ben January 16, 2013 at 9:20 pm # Reply

      Cheri –

      Overnight fasting should be fine. Talk with your doctor and the lab.

      If you avoid all proteins for more than 12 hours, your homocysteine levels may be falsely low.

      • Merle July 18, 2013 at 2:49 am # Reply

        What are normal levels of homocysteine? Mine was 4.5 umol/L – is that ok?

        I’m MTHFR hetero for both. TTC and prescribed Folgard and baby aspirin – but also taking Thorne pre-natal and Thorne B-Complex

        Any thoughts?

  4. Alan November 11, 2013 at 2:28 pm # Reply

    From the above, I’ve gleamed that 1) it is essential (necessary and sufficient) to fast at least 12 hrs beforehand and 2) avoiding all proteins for more than 12 hrs may give a false low
    Therefore, we can conclude that it is necessary to eat a protein containing meal exactly 12 hrs before our appointment for a blood draw for testing homocysteine if we want the best chance of getting an accurate reading.

    If we don’t have the luxury of this exact window of opportunity and we’ve fasted for closer to 15-18 hrs, is there a way of calculating the degree of accuracy of the false low reading? Thanks!

  5. Ryan January 10, 2014 at 9:26 am # Reply

    Can I deduce my homocysteine and/or histamine levels from an amino acid test (tests the usual 20)?

  6. Mari Sloane January 21, 2014 at 3:00 pm # Reply

    Level elevated as tested by Dr Bullington . pretty sure pevious testd not handled correctly. Imagine she will yest again. IL-Bs, TNF, C4a, and TGIF-B1 consistently very high when with Dr Shoemaker. Wonder how methylation defect impacts TGIF-B1. Miserable, frankly. Have been seen 1996, but getting wiped out of coping. Cry and cry. Can’t control emotions or feeling of massive stress.

  7. Dr Mom June 2, 2014 at 1:21 am # Reply

    My homocysteine level was abnormally low after I suffered a DVT and massive, bi-lateral pulmonary embolism. I’m a TT homozygote. Did the Lovenox lower it? I typically am Vit. K deficicient. What could explain a low homocysteine?

    • Dr Lynch June 4, 2014 at 5:51 pm # Reply

      What does ‘low’ mean? Need a number.

      Also you need to evaluate your SAH and adenosine levels – not just homocysteine.

      Glad you are ok.

  8. Dr Mom June 7, 2014 at 8:46 pm # Reply

    My homocysteine level was 4 after my DVT.

    • Dr Mom June 7, 2014 at 9:05 pm # Reply

      They pushed 2 boluses of adenosine on the ambulance incoming to the ED.

  9. Tracy June 12, 2014 at 11:21 am # Reply

    We’ve recently uncovered the mthfr mutation in my family. My daughter is homozygous c677t. Two weeks ago her homocysteine level was 17 and yesterday we received results of a test that said she was 8.8? I read the article above, she did not eat anything before both tests but she did have a coffee before test resulting in level of 17 is the coffee enough to cause such a variance? She’s been referred to a cardiologist based on symptoms and homocysteine level of 17. Should I disregard results and start over this is all overwhelming. She’s had health issues for 12 years and she’s only 24. She’s been diagnosed with Polycystic ovary syndrome, subclinical hypothyroidism , chest wall syndrome. She gets strep throat 2 to 3 times a year she’s had mono three times. She went to Peru for two weeks and came home so sick at the age of 17 that it took months to get back on her feet. We’ve been trying to find the root issue for a long long time. She constantly has pain in chest, her joints give her issues frequently and her bone structure is very large. I don’t even no who to turn to anymore I have told this same story to three MD’S , two endocrinologist ,one pediatric cardiologist, one gynecologist a naturopath and two nurse practioners and a dentist because she still has baby teeth, at 24! We’ve hired personal trainers to help her lose weight she just keeps expanding even with reduced caloric intake and strenuous exercise. The last personal trainer said she’d never seen anything like it. I thought we were onto something with the homozygous C677t but the homocysteine variance is confusing.
    Thanks for listening
    Tracy Grant

    • Carrie July 26, 2014 at 4:23 am # Reply

      Tracy, please find a Lymes Doc for your daughter. It sounds like chronic lymes.

  10. LynnD August 26, 2014 at 5:37 pm # Reply

    Dr Ben,

    My current Dr (county clinic ) did do a methelmalonic acid test and it came back 0.10.
    That was a good number meaning dont have low B12. Though used to always feel better when did small supplementing (couldnt take RDA or would loose more weight and even more anxiety! ). Told her with MTHFR 677 homozyg for difference, wanted to know if needed to deal with homocysteine.
    She said those test results also show homocystein is good level. Does methylmalonic acid results correlate to both HC and B12 ? (my B12 and folate results for serum are always around 950/28 ).
    Thanks for info
    mostly deal with low muscle,weight , blood pressure…

  11. Marie August 30, 2014 at 2:22 pm # Reply

    Who should get tested for this? I have fibromyalgia. Is that illness a sign of this mutation?

  12. Sarah B October 16, 2014 at 9:19 am # Reply

    Hello Dr Lynch, thank you for sharing this – would you mind sharing what levels you use for optimal Homocysteine and what you have based that range on?

    • Dr Lynch October 30, 2014 at 7:04 pm # Reply

      Sarah –

      I like to see homocysteine for adults around 7 to 8 micromoles/liter.

      I base that on how I’ve seen people’s methylation labs and how they are feeling – including my own.

      If lower than this, then I suspect too low of protein intake or upregulated CBS enzyme for various reasons. Too low is not good because there there is not enough homocysteine to recycle back into SAMe – which is supportive of methylation.

      If higher than this, then I suspect some block in various pathways – BHMT, MTR/MTHFR, CBS, AHCY or faster utilization of SAMe (stress) or too high of protein intake.
      I’d also consider kidney issues if older, diabetic or some history of higher creatinine levels or kidney disorders.


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