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.

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

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

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

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

    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.

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

    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 #

      What does ‘low’ mean? Need a number.

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

      Glad you are ok.

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

    My homocysteine level was 4 after my DVT.

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

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

    • Muriel Hykes October 30, 2014 at 9:33 pm #

      A repeat test of my homocysteine is still at 4. I have C677T homozygous and a CBS mutation (supposed to make it higher as well, right?) I sometimes have low albumin levels and edema. I’m being evaluated for a metabolic disease.

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

    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 #

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

    • Julie April 9, 2015 at 1:24 pm #

      Tracy, My son is hetero C677t and A1298C. He used to have chronic bronchitis. Chronic infections are caused by poor immune systems. He needs good vitamins and a good diet to build up the immune system and stop the infections from occurring. Get him tested for food allergies preferably for delayed reactions IgG and IgE antibodies (need this test from an ND; medical community I think only tests for IgE allergies). My son can gain up to 10 pounds after eating something he is allergic to. He could never lose any weight; just kept gaining all his life until at age 17 a ND had him tested for food allergies. My son is allergic to bakers yeast so he cannot even eat gluten free bread because of the yeast. If you don’t want to go back to the ND check and see if any online labs do the IgG testing.

      Something else to know about food allergies — they can cause sleep apnea. My son was tested and it showed sleep apnea. The ND said it could be caused from food allergies and that is how it was decided to have him tested and he has lots of food allergies.

      Another suggestion is to seek out a clinical Nutritionist. There is one online that I follow that writes lots of good articles. Her name is Christa Orecchio at thewholejourney.com
      http://thewholejourney.com/differences-between-ige-and-igg-testing-for-allergies-and-sensitivities She has online classes at a reasonable price and probably would do a personal consult. Another one is Andrea Nakayama at http://www.replenishpdx.com

      My family is now using food as medicine which I have learned how to do from her and other nutritionists. To find a clinical nutritionist, go to this website:
      http://www.cncb.org/contactcncb.htm

      Keep your eyes open for another online AutoImmune Summit that is free coming this May. The first one was last November 2014. It was excellent. That is how I gained a lot of very useful information. They had 28 different speakers all talking about different aspects of the immune system.

    • Susie February 22, 2017 at 12:50 am #

      I am a healthy 66 year old woman who is homozygous C677T. My homocysteine levels had started to rise (18.8) so I started taking ALL the B vitamins daily, including Folate (Solgar 800 mcg) Just had my yearly physical and I am in excellent health. Homocysteine levels had decreased to 11.2 (normal range.) It is important to keep your weight in check (I am 5’7″ and weigh 130), as well as to stay very active. I walk over a mile each day for exercise and climb the two sets of stairs in my house at least 25 times a day. Eat well and take your vitamins!

      • Michele H February 24, 2017 at 2:16 am #

        Okay Susie, this is very interesting. My homocysteine in 7/2015 was 16.6. I was worried but seem to have a problem with the “proper” B vitamins. They give me a major headache amongst other things so I quit them. Have no idea what it is now. I particularly have a problem with Folate and have problems if I don’t get folic acid. Guess all the cells are filled up with folic acid (bad). I am 5’4″ and 123 lbs so weight is not a problem. I’m going to test the homocysteine soon again and try to get active–which I am not (67 years old) Thanks for your post.

        • Rachel R. February 25, 2017 at 9:40 pm #

          You might need to avoid methylated B’s. Have you tried folinic acid (not to be confused with folic acid) and adenosyl- and/or hydroxy-B12? Methyl-B’s made me really nauseated, but I seem to handle these fine.

          • Michele H February 26, 2017 at 8:17 pm #

            Hi Rachel, Yes I have Seeking Health Folinic Acid lozenge, also Seeking Health B-Minus (B12 & Folate Free), and Seeking Health Hydroo B12 lozenge. It’s been a long time since I took them, maybe I’ll just start with the folinic acid first and not do them all at once so I can see exactly where the problem lies. Thanks.

        • Susie February 28, 2017 at 1:05 am #

          I have had no issues taking any of the B vitamins, and I currently take B1, B3, B6, B9 (folate), and B12. I also walk daily, drink plenty of water and take other vitamins. So far so good. I do know that many people have sensitivities to some of the B vitamins. Be sure to avoid products containing folic acid. Start walking daily until you can walk a mile easily. Good Luck!

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

    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…
    LynnD

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

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

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

    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 #

      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.

  9. Brenda November 16, 2014 at 4:11 am #

    Hi Dr. Lynch,

    I am a 52-year-old woman, and I have an EXTREMELY high homocysteine level of 231.8. That’s not a typo, it’s 231.8. So, I know I have hyper homocystinemia, to say the least. I was recently diagnosed with a cataract in my right eye and macular degeneration in my left eye, andI had a stroke when I was 35 years old.

    I have so many questions, but I guess the first one is exactly what kind of specialist should I be going to for treatment of this disease? My primary care doctor is sending me to a hematologist, but that was at my insistence, because I thought that might be a good place to start.

    Also, have you ever heard of anyone having a homocysteine level as high as what I have? I know there must be more people like me out there, I’ve just never met any!

    Thank you very much for your time. I look forward to hearing from you.

    • Dr Lynch November 16, 2014 at 8:36 am #

      Brenda –

      My first thought is to have the doctors check your kidneys.

      ‘Specialsts’ are going to ‘break’ your body systems apart – you need them integrated. You need to find a doctor who understands how the body works as a whole – not piece meal.

      Going to a nephrologist or urologist likely won’t help much – it may short term but long term need to find the source of the problem.

      I highly recommend finding a doctor from one of these organizations:
      American Association of Naturopathic Physicians
      Orthomolecular Institute
      American Academy of Environmental Medicine
      Institute for Functional Medicine
      American College for Advancement in Medicine
      American Holistic Medical Association

      I also would get on HomocysteX Plus along with a higher dose of TMG – such as 3 grams. You can get TMG on Amazon or your doctor.

      I do recommend you lower your protein intake by quite a bit – and eat more healthy fat and avoid carbohydrates. You need to shift to a more ketogenic diet to reduce your homocysteine and it will do it quickly. If you are not diabetic, the ketogenic diet is quite safe. Do read the book I mentioned below and find a health professional who can teach you how to do it. You may get good results fast with it.

      For testing:
      – I would ask a good doctor to order:
      — Organic acids test – urine
      — Amino acids – plasma
      — VAP Cholesterol panel
      — RBC Fatty acids
      — serum ferritin
      — RBC Essential Elements and Toxic Elements

      Read this:
      http://amzn.to/1x8IaMq

      and
      http://amzn.to/1us5p3g

      I would also get on Magnesium Plus – and take 2 a day – to assist with homocysteine elimination via active B6.
      One in AM and one in PM.

      I would also highly recommend Optimal Lipsosomal Glutathione to protect your eyes, kidneys, heart, lungs, etc – and to reduce oxidative stress. Start with 1 teaspoon in the evening say 20 minutes before dinner – away from food.

      • Brenda November 16, 2014 at 4:27 pm #

        Hi Dr. Lynch,

        Firstly, let me thank you for your comprehensive response to my question. I greatly appreciate the time that you took to write out all of your suggestions.

        I definitely agree with you that the Drs. are not looking at me as a whole person, they seem to be very invested in chopping me up into little pieces; my brain, my heart etc…
        I have tried throughout the years to be my own patient advocate with only spotty success. Doctors in general seem to be intimidated by how assertive I am for myself.

        I have increased my ingestion of vegetables and green leafy vegetables in particular, quite a bit. As I sit here writing this, I’m drinking a green smoothie made out of spinach, parsley, mangoes,and apples.

        I’m going to print out all of your suggestions, and show them to my primary care doctor this week. Thanks again for all your time.

      • Kate January 28, 2016 at 11:24 am #

        Hi Dr.
        I need your help. I am 37 years old female. I recently saw a Nathropatic Dr and she gave me a blood test. For the first time in my life i heard about homosustain. I did it at quest diagnostics the result was 10.0 the reference range was <10.4. It says in Range. The reference range doesn't say for example 4-8 is normal the only thing I got was that. But the naturopath dr scared me a lot. Tell me dr isn't this range normal for the equipment that quest used. As you said the rang can vary from lab to lab.
        However, I found out some error as well for example my glucose level was 88 for one dr and 91 for another. My Sodium level was 134 out of rang for one dr and 135 in range for another one. And all these tests were done at the same time and sent to two doctors. Now I don't know what to believe. Yes in websites it's says 6-8 for homocysteine test but for quest10 was normal. Should i repeat the test? And why they don't have standards range?
        Will you plz help me beacuse I'm getting crazy here.

        • Kate February 6, 2016 at 7:44 pm #

          2016 at 11:24 am # Reply
          Hi Dr.
          I need your help. I am 37 years old female. I recently saw a Nathropatic Dr and she gave me a blood test. For the first time in my life i heard about homosustain. I did it at quest diagnostics the result was 10.0 the reference range was <10.4. It says in Range. The reference range doesn't say for example 4-8 is normal the only thing I got was that. But the naturopath dr scared me a lot. Tell me dr isn't this range normal for the equipment that quest used. As you said the rang can vary from lab to lab.
          However, I found out some error as well for example my glucose level was 88 for one dr and 91 for another. My Sodium level was 134 out of rang for one dr and 135 in range for another one. And all these tests were done at the same time and sent to two doctors. Now I don't know what to believe. Yes in websites it's says 6-8 for homocysteine test but for quest10 was normal. Should i repeat the test? And why they don't have standards range?
          Will you plz help me beacuse I'm getting crazy here.

          Your comment is awaiting moderation.

          • Dr. Aron February 22, 2016 at 1:36 am #

            Kate – I hear your concern. Lab values look are a snapshot at one point in time and they change constantly because the body is always changing. We have to interpret labs in the context of your overall health. I suggest discussing these concerns with your doctor.

  10. Brenda November 16, 2014 at 4:27 am #

    Dr. Lynch,

    Just a couple more pieces of information; when the lab got the highly abnormal homocysteine level, they did re-run the test three times. I am on sublingual B-12, and a number of additional medications to control HBP.

    I’m eating a TON of dark green, leafy veggies every day. My PCP also gives me a supplemental B12 shot every 2-3 months. (My B12 levels were normal on my labs taken in Oct of this year.)

    Due to the influx of veggies, I have lost 50 lbs since August. I’m having significant muscle weakness in my legs, and it is almost impossible for me to walk up and down stairs.

    Again, thanks for your time.

  11. Anna Atkins December 9, 2014 at 1:02 pm #

    I do not see how you can have an influence on how the lab treats the test!

    Fasting should take away the risk of wrong food, should it not?

  12. Claire December 16, 2014 at 11:04 pm #

    What do I do if I get feelings of tight chest. Some days I don’t get it but I have experienced tight chest feelings afte taking half dose of your optimal multivitamin powder each day last week. I have discontinued use. How can I foind out the cause?

    • Michele July 17, 2015 at 2:26 pm #

      Claire, Did you ever find out what your tight chest is? I have it and it progressed into the heart pounding and I had to lie down every time it did that. So, I wasn’t sure if it was the lungs or the heart for 6 months and when it progressed to the heart pounding then I figure it is the heart. But all around the chest feels tight and kinda hurts. I finally started eating bread again two weeks ago after 6 months of tight chest, and the pounding heart has gone away. (I never had this problem before I went Paleo). I still have tight chest somewhat So I figure there is something fortified in the bread that I need. Also, the other day I took a multivitamin with the B’s and folate (not folic acid) in it and my heart started racing again. I am curious if you found out what yours was.

      • Michle October 29, 2015 at 6:29 pm #

        Update: Now it is Oct 29, 2015 and I have no heart pounding or tight chest or hand and leg cramps since I have added back in raisin-cinnamon bread a few times a week. Good thing I am not celiac but the gluten can still damage my gut. I have looked at the bread label and it has B1, B2, B3, and B9 (in the form of folic acid). So I am playing around with these vitamins in the hope to discontinue the raisin-cinnamon bread. I don’t seem to be able to tolerate the 5-MTHF (B9 folate). Only have one C677T variant but lots of other potentially bad snps. Right now I am just trying to get the above vitamins to work instead of eating bread.

        • Lori November 21, 2015 at 11:21 pm #

          Michele, I’m curious if you have tried natural yeast bread (sourdough WITHOUT any added commercial yeast)? My current research is leading me to believe that Paleo is NOT for everyone and wheat is not the demon that it is made out to be. It’s only that way because it is no longer pre-digested during a long fermentation process. I am NOT a doctor or health professional. Just a mother who has been researching and trying to help my children and their health issues. I only recently found out about the MTHFR factor and I find it interesting that b vitamin deficiencies occur often in people consuming a Gluten free or Grain Free diet. Check out the research that http://www.thebreadgeek.com has done on Natural yeast bread vs commercial bread

          • Michele February 22, 2016 at 1:44 am #

            Lori, It ended up being something to do with the B vitamins and glutathione. Now bread has B1, B2,B3, and B9 (folic acid–the wrong kind of folate). So my daughter was having the same problems and more (including brain seizures) and I sent her to a health practitioner and the following helped her so I bought the same and this has helped me: Neuro Logix Glutathione Plus Topical Cream which we put 1 pump over our liver AND Seeking Health B-Minus capsules. You can find the Glutathione Cream on Amazon and Ben Lynch has the B-Minus. Now I don’t have to eat the bread.

  13. tasha April 17, 2015 at 4:13 am #

    Dr. Ben
    I was diagnosed 6 years ago with a rare immune disorder called autoimmune hepatitis so basically autoimmune liver disease of unknown cause. This year i recently found out i also have hasimotos thyroiditis. I am suffering from a ferritin of 16 with normal iron and a progesterone level of less than .10 and am 30 years old. I am hetero for C677t and A1298C. I am looking for a physician to treat mthfr and digestive and liver congestion along with healing gut but my insurance does not cover ND practitioners and i am unable to continue paying so much out of pocket for office visits. I cannot find anyone who treats these conditions other than naturopathic physicians…any recommendations? I have supplements but just need the direction and dosages figured out and advice. I live in the portland oregon area. Any advice would be helpful!!! I feel like im falling apart and im far too young to let these health issues rule my life. I am now worried for my 3 year old daughter and have slowly begun replacing items in my home with your suggested protocol items for the health of my entire family.

    • Aron April 24, 2015 at 9:16 pm #

      Hi Tasha,

      I completely hear you that it can be tough to find the right doctor.

      There are a couple physicians in Oregon in the Physician Directory here . Not sure how close to Portland they are, but maybe reaching out to them could be a good start. One of them might be able to point you in the right direction.

      Wishing you the best!

  14. Sara May 29, 2015 at 7:49 pm #

    Diagnosed w one mutation at c677t started taking the suggested supplements and the end of my tongue turned beet red and hurt. Anyone ever experience this and what causes it? Thanks

  15. anne June 1, 2015 at 10:40 pm #

    Dr Ben,
    I am 36 yrd old and have had 9 miscarriages since 2012. I learned that I inherited from my dad a balanced translocation. but even after doinf ivf pgd I still lose the pregnancy with “normal embryos”.I beg for the RPL tests knowing there was more to it. well, I have mthfr heterozygous c677t. but my homocysteine is normal (7,8).I am gearing soon to another ivf cycle. do you think I should push to have my doc prescribed me lovenox (enoxaparin sodium) shots? I already take neevo dha, baby aspirin and folgard. thanks in advance. ANNE.

  16. Kristin Elam June 12, 2015 at 1:01 pm #

    Hello,

    I am hetero for C677t and A1298C and my fasting homocysteine level is 11. Is that considered high or normal?

    My husband is also hetero for C677t and A1298C. I feel like I need to assume and treat my son as if he has the snips as well. He is 9 yrs old – do you recommend any supplements or avoidance for kids differently than adults?

    Thank you!

    • Dr. Aron June 17, 2015 at 9:19 pm #

      Kristin – The normal/high range varies a little bit from lab to lab. It should say on your lab report. This is probably on the upper end of normal. This has to be considered in the entirety of your other lab results and medical history.

      If you and your husband are compound heterozygous, then the chances are high that your 9 yr. old has one or more MTHFR mutations. You should consider having him tested for MTHFR. This knowledge will allow you to understand your son’s susceptibilities.

      One example is Nitrous Oxide’s effect on individuals with MTHFR mutations: http://mthfr.net/nitrous-oxide-mthfr-trouble/2015/02/06/.

      Dr. Ben’s own story with MTHFR could give you some insight on what this means for you and your family: http://mthfr.net/dr-lynch-family-myriad-of-mthfr-mutations/2012/02/05/.

      Hope this helps. Please keep us updated!
      Dr. Aron

  17. Domenico June 24, 2015 at 4:38 pm #

    Hi Dr. Ben,
    please pay attention to my question.
    while I was looking for information on the cycle of homocysteine, I’ve found
    out your site, and I must say there are very effective and well-informed articles on this area of medicine, and I congratulate you on it!
    First I have to understand if I am undermethylated or overmethylated, I must also get tested for the MTHFR mutation, I only know that three years ago my homocysteine level was 17. Many doctors and you as well, like to see homocysteine for adults around 7 to 8 micromoles/liter.

    IF I COULD CONVERT HOMOCYSTEINE EXCESS VIA THE TRANSULFURATION PATHWAY I MIGHT LOWER HOMOCYSTEINE LEVELS AND SUPPORT DETOXIFICATION AT THE SAME TIME, BY RAISING GLUTATHIONE AND METALLOTHIONEIN, IS IT RIGHT?

    At this address:
    http://www.alternativementalhealth.com/commentary-on-nutritional-treatment-of-mental-disorders/
    there is a wonderful Commentary on Nutritional Treatment of Mental Disorders by Dr. William Walsh.
    It contains extracts about methylation, metallothionein, heavy metals poisoning, imbalances in metabolism of metals, along with his advices of nutritional treatment to rebalance them.
    IT IS THE RESULT OF MANY RESEARCHES CARRIED OUT FOR MORE THAN 25 YEARS BY CARL PFEIFFER, MD, PHD OF PRINCETON, NJ, WHO WAS A PIONEER IN THIS FIELD, AND BY HIS ASSISTANT DR. WALSH. THEY’VE TREATED MORE THAN 20,000 CASES, SO THEY HAVE SOME EXPERIENCE…

    About SAM cycle Dr. William Walsh says:
    “SOME PRACTITIONERS LIKE TO TINKER WITH THE SAM CYCLE TO PROMOTE CONVERSION OF HOMOCYSTEINE TO METHIONINE, SUPPLEMENTING WITH METHYLFOLATE OR METHYLCOBALAMIN, BUT THIS CAN DEPLETE THE CYSTATHIONE PATHWAY AND RESULT IN DEFICIENCIES OF GLUTATHIONE, CYSTEINE, ETC.
    UNDERMETHYLATED ADULTS TYPICALLY REQUIRE 2,000 – 3,000 MG/DAY OF METHIONINE FOR SEVERAL MONTHS TO SEE GOOD RESULTS. ALSO, AUGMENTING NUTRIENTS SUCH AS CALCIUM, MAGNESIUM, B-6, AND ZINC ARE ESSENTIAL.
    TMG IS A GREAT WAY TO TREAT INDIVIDUALS WITH DANGEROUSLY HIGH HOMOCYSTEINE LEVELS. TMG can be very useful in augmenting methionine therapy along with B-6/P-5-P , serine, etc.
    THE CHALLENGE IS TO SUPPLY ENOUGH METHYL GROUPS TO HELP THE PATIENT, WITHOUT CREATING DANGEROUSLY HIGH LEVELS OF HOMOCYSTEINE. Use of TMG is an “insurance policy” against this happening.

    A quick way to test for need for methylation therapy is to carry out a cautious trial of SAMe. Within a week or two you should have your answer. If a patient clearly is improving on the SAMs (which is frightfully expensive)….. you can get usually the same benefits (albeit more slowly) using methionine plus calcium, magnesium, and B-6. This should be side-effect free unless (a) the methylation is begun too abruptly or (b) the patient has a rare genetic enzyme disorder which disrupts the SAM cycle.
    WE’VE FOUND THAT DIRECT METHYLATION IS USUALLY MORE SUCCESSFUL THAN TINKERING WITH THE SAM CYCLE. THE PRIMARY WAY HUMANS RECEIVE MOST OF THEIR METHYL GROUPS IS FROM DIETARY METHIONINE. It’s often hard to improve on Mother Nature.”

    I am particularly concerned about the b) issue: unless the patient has a rare genetic enzyme disorder which disrupts the SAM cycle. AND IF HE WAS REFERRING EXACTLY TO THE MTHFR MUTATIONS?
    I have yet to understand whether having one or more MTHFR mutations means to be undermethylated or overmethylated.
    IN YOUR OPINION, HOW DOES A DOCTOR HAVE TO ADDRESS AN HETEROZYGOUS MTHFR MUTATION, FOR EXAMPLE?
    IT MAY MEANS THAT THE MTHFR ENZYME IS REDUCED BY ABOUT 50% IN FUNCTION, THEN THE METHYLATION CYCLE IS WEAKENED AND A PERSON IS UNDERMETHYLATED?
    I should like to thank in advance you, I hope you will answer me.
    Best Regards

  18. Jackie July 31, 2015 at 12:44 am #

    Hi, I know I am a bit late to the conversation, but I’m hoping someone can help… I am in the UK and have just looked for where to test homocysteine levels (it is not as simple as just going to your GP and requesting it here, you’d get nowhere…

    Anyway, this is what they advise at Biolab – which obviously goes against what is taught here…….

    Homocysteine is not a component of food or nutritional supplements, so the patient should not fast prior to the test and may continue taking any nutritional supplements as normal. The blood sample of choice should be taken at midday, four hours after a protein-containing breakfast, so as to ensure an adequate methionine challenge (equivalent to about 0.5 gm of methionine).

    Any thoughts? Or any advice?

    Thank you

  19. Lori September 25, 2015 at 7:55 pm #

    Dear Dr. Lynch,
    Thank you so much for this site and your Seeking Health products!! My husband and I are both heterozygous c677 and a1298. We recently lost a pregnancy due to a neural tube defect. I’m trying to get us properly methylated before trying again. We just got our labs back, My levels: folate-37.8, B12-1104, homocysteine-6.9. I’ve been taking optimal multi plus extra 1200 MCG methylfolate and 1000 MCG B12. My husbands levels: folate-15.8, B12-384, homocysteine-19.8. He is taking Thorne multi with 800 MCG methylfolate and 1000 mcg B12. I want to know what we need to do to get his homocysteine level down (more methylfolate and b12?) and are my levels of folate and b12 OK even though they are elevated (since I’m trying to over power my system to prevent NTD)?

  20. Carol Bart October 20, 2015 at 2:52 am #

    Dear Dr. Lynch:
    I have had a handful of MTHFR tests from Quest that came back negative even though the patients seem to clinically fit the profile and had the following test results, roughly speaking: normal levels of B12 & Folic Acid, and normal MMA with high Homocysteine. None of the leves were so dramatic that I can remember them, but it made me wonder if the MTHFR tests have a fail rate and should be re-sent? I read above that if they are not fasting, then the homocysteine level might be suspect, so that is something I did not know, but have you ever found that the MTHFR test result was wrong? Perhaps there are more than the two more common mutations?
    Thanks,
    CB

    • Dr. Aron October 29, 2015 at 12:25 am #

      Carol – This is an interesting question. I haven’t personally heard of or seen MTHFR testing inaccuracies. It might be the case that you might want to add more possibilities to your D/Dx. Let me do some digging and will get back to you with what I can find. Have you taken any training through SeekingHealth.org? As a clinician, this would be a great resource for you.

      • Carol Bart November 26, 2015 at 5:12 pm #

        Dear Dr. Aron:
        I also understand that kidney disease can contribute to the elevation of homocysteine. Do you have any idea why? Also, going back over my first question, it is clear that the gene tests only the most common mutations and may be missing other less common ones. No, I have not taken any training through your website.

  21. Camelia November 25, 2015 at 6:56 am #

    Thank you for keeping up this incredibly useful website! I have a question regarding MTHFR mutation and elevated homocysteine. I am compound heterozygous for MTHFR, taking Thorne supplements (1/3 of the recommended dose as I cannot tolerate more) with active forms of B6, B9 and B12. My booldwork shows that both my folate and B12 is above the norm, however, that haven’t helped bringing down my homocystein level – it is above 9, the most recent test shows even 10. I have also low levels of D vitamin (I am taking it now) and lower iron levels. I am also taking falxeed oil and coenzyme Q10.

    I am worried because I have lost 2 pregnancies in the last 2 years and in the coutry I live I haven’t been able to find any doctor who has a clue about MTHFR. All they say is that about 30% of people have this mutation and it is not connected with my recurrent miscarriages.

    Can D vitamin and iron deficiency affect my methylation and thus also impair breaking down homocysteine?

  22. Kate February 12, 2016 at 10:31 am #

    Hi Dr.
    I need your help. I am 37 years old female. I recently saw a Nathropatic Dr and she gave me a blood test. For the first time in my life i heard about homosustain. I did it at quest diagnostics the result was 10.0 the reference range was <10.4. It says in Range. The reference range doesn't say for example 4-8 is normal the only thing I got was that. But the naturopath dr scared me a lot. Tell me dr isn't this range normal for the equipment that quest used. As you said the rang can vary from lab to lab.
    However, I found out some error as well for example my glucose level was 88 for one dr and 91 for another. My Sodium level was 134 out of rang for one dr and 135 in range for another one. And all these tests were done at the same time and sent to two doctors. Now I don't know what to believe. Yes in websites it's says 6-8 for homocysteine test but for quest10 was normal. Should i repeat the test? And why they don't have standards range?
    Will you plz help me beacuse I'm getting crazy here.

    Your comment is awaiting moderation.

    • Michele March 1, 2016 at 1:54 am #

      Kate, my homocysteine is 16.6 and I see a lot of gene problems that say I would probably have high homocysteine and that and other genetic snps say I would have high cholesterol also, sometimes related to this homocysteine genetic thing. Both are true so far at age 66 (high homocysteine and high cholesterol). If my homocysteine was 10 I would be really happy (easier to get down closer to 7). I am going to try taking TMG which is supposed to lower homocysteine and am still studying what I can do to adjust these genetic snps, Sounds like you are worrying a little too much. Some people I have read about have homocysteine of over 200!

  23. Kate February 29, 2016 at 6:29 pm #

    Dr. Aron
    Thanks for answering me but you didn’t tell me which number is normal?
    My level for homocysteine was 10.0 and for quest diagnostic it was normal? While my ND told me that I have genetic problem.
    But I want to know more. Therefore, what tests I suggests me to do.
    Please help me

  24. Kate March 1, 2016 at 3:30 am #

    Hi Michel
    Tnx for replying to me. Yes I am worrying about the number cause what I’ve read in the Google freaks me out. My dad died of a heart attack at the age of 50. Yes he was a heavy smoker and drinker and never went to a doctor. His both brothers had heart attacks too but in little older ages the scond uncle also was a heavy smoker too. But younger brother was better than both brothers. But they both are alive beacuse they went to dr. However, thier situation scared me it makes me think what they all had this genetic mutations edit without knowing it. And what if I have it too. I asked my Nathroparhic Dr. that what if I have the gene mutation? She said she doesn’t know yet. Therefore, I asked her to order a genetic test.
    Michel the thing that make me worried is that unlike my father and his brother I never drank and smoked. I watch what I eat. My cholesterol and blood presure are normal. Only my A1c was 5.7. So I don’t understand why the homocysteine was 10.0.

  25. B from Norway March 13, 2016 at 10:42 pm #

    Dr. Lynch

    You might add to your list that taking benzodiazepines will reduce homocysteine in blood tests!

    http://www.ncbi.nlm.nih.gov/pubmed/19409441

    I have always taken a benzo before visiting my doctor because of the severe anxiety I have. My test always came back in the higher range. It might be the benzo that is causing it in range?

    I find it very interesting that benzo’s can do such regulation of homocysteine and other nutritions when we know that benzodiazepine receptors only works in the brain.

    • Dr Lynch March 15, 2016 at 5:21 am #

      Thank you 😉 Noted!

      • Kate April 13, 2016 at 5:46 pm #

        Hi Dr. Lynch
        I hope you read my message and listened to my concerns,
        I need your help. I am 37 years old female. I recently saw a Nathropatic Dr and she gave me a blood test. For the first time in my life i heard about homosustain. I did it at quest diagnostics the result was 10.0 the reference range was <10.4. It says in Range. The reference range doesn't say for example 4-8 is normal the only thing I got was that. But the naturopath dr scared me a lot. Tell me dr isn't this range normal for the equipment that quest used. As you said the rang can vary from lab to lab.
        However, I found out some error as well for example my glucose level was 88 for one dr and 91 for another. My Sodium level was 134 out of rang for one dr and 135 in range for another one. And all these tests were done at the same time and sent to two doctors. Now I don't know what to believe. Yes in websites it's says 6-8 for homocysteine test but for quest10 was normal. Should i repeat the test? And why they don't have standards range?
        Will you plz help me beacuse I'm getting crazy here.

  26. Turu March 24, 2016 at 4:02 pm #

    In your opinion what constitutes number a high-methionine food? How much should a person have daily of these foods ?

  27. Beaula March 29, 2016 at 11:42 am #

    I am new to all of this. Someone has advised that i get my self checked for MTHFR and i have read that it’s easiest to have homocysteine levels checked. Will the NHS do this if i ask? If not, are there any home tests which are recommended? I see a wide range of tests/costs from £47 to £150 and they all involve sending a sample to their lab through the post, but on some test descriptions i have seen this – ….”whereby a few drops of blood from a pin-prick are dropped onto a card and the membrane within the card then separates the plasma from the blood cells….” Are these tests ok? Thank you

  28. Dee June 25, 2016 at 3:13 am #

    I have C677T homozygous and a CBS mutation. I have had homocysteine levels of 25, 45 and my last one was 50. I am working with an ND and am on a basic MTHFR protocol, yet the numbers are still up. My ND suggested I look into further genetic testing. Are there other gene mutations I should be looking for?

    Dee,

    • Dr Lynch July 2, 2016 at 6:30 am #

      I’d also be looking at heavy metals and oxidative stress – along with yeast overgrowth. Consider also using Betaine – a few grams a day spread out throughout the day may be useful and vitamin B6 as pyridoxal 5 phosphate 50 mg – but doses need to be discussed with your doctor.

      SNPs are only part of the picture – not all.

      May need to evaluate how much protein you are eating as well. A ketogenic diet may also be useful.

  29. Chrissy August 15, 2016 at 6:57 pm #

    I am currently learning all I can about this mutation. Still really confused on what I should do and not do. I had a stoke with deficits 6 years ago at 31yr. Currently, diagnosed with narcolepsy (no family history). I am completely drained and wiped out no matter what I do or take, I don’t get out of the bed and live a normal life. I’m on 400 mg of modafinil, baby aspirin, and metanx twice a day. Dec. Homocysteine was 48 and vitamin b low but still within range, july Homocysteine 61!!!! And b12 340…tested and I’m homozygous for C677T…started b12 shots and they made me so sick. What is my next step, what specialist can I see? What meds should I take? What other blood work should be taken and how often to monitor? Desperate to feel better!chrissy

    • Michele Herrmanns August 16, 2016 at 1:06 am #

      Google Gail Clayton. She can help you definitely.

  30. drmom5 August 16, 2016 at 3:38 am #

    Narcolepsy? Did you by any chance get a Gardasil shot around the same time?

  31. tracey October 10, 2016 at 8:44 pm #

    i have recently been diagnosed with mthfr C677T hetero – I also have a CBS, MTR and MTRR issue. what prompted me to see a dr was unexplained weight gain, swelling in my hands, feet and face. I’ve seen a functional medicine dr who has diagnosed me and is currently treating me with fish oil (for inflammation – my crp is 6.6 and has been as high as 8.8) – she also has prescribed B12 and methylfolate injections twice a week. I have started those but am still having the occasional swelling. can you answer why this is happening? I see you recommend combating the inflammation prior to methylation – do I need to go back and work on that first? thank you for your help!

  32. Dr Mom March 4, 2017 at 7:34 am #

    I figured out why my homocysteine was so low, despite me being C667T homozygous, CBS homozygous mutation. It’s amazing when bad mutations are not so bad.

  33. Shelly July 16, 2017 at 1:27 pm #

    I am 59 and homozygous for C677T. I have generally very good health. Recently I had my Homosycetine checked and was at 8. I was going back through my records and my blood platelets have been high for at least 3 years. 399 on average. I am over weight despite the fact that i eat only 900-1400 calories daily andcexercise 1-2 hours daily. I have never been able to lose weight unless i take a stimulant like ephedra or phentermine. I need help figuring out how to lose weight and build my blood so i am no longer anemic.

  34. erika July 16, 2017 at 7:07 pm #

    hello, I am homozygous for c677t mutation. I had blood clots in my early twenties when I was on birth control and 20 years later I had blood clots again when I was 42. I am supplementing with B12 and folate but my doctor also has me on warfarin do you think I can get off of the warfarin and just take B12 and folate supplements?. I am otherwise a healthy 46 year old woman. I did take Lovenox injections during my pregnancy at age 36 I have beautiful twin daughters that are now 9 years old neither one of them are homozygous for this mutation.

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MTHFR Basics from Dr Erlich

There is much confusion about MTHFR genetic mutations. While a source of much research, conventional medicine remains unable to agree...

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