Homocysteine

[MarMcL]

Anyone know if there's a point in checking homocysteine level once you've begun supplementing B12 and folic acid? How accurate would a result be regarding cellular absorption of B12? Thanks in advance!

[Sleepybunny]

My understanding is that most tests used in diagnosing B12 deficiency are affected if you are already taking B12.

I think Sally Pacholok's book "Could It Be B12" mentions something about this.

b12deficiency.info/b12-test... Useful link about testing.

I wasted a lot of money getting private blood tests for MMA, Homocysteine etc and asked about whether the fact I was already supplementing would affect the results. I had a vague reply but found out from other sources afterwards that the results were very likely unreliable.

[MarMcL in reply to Sleepybunny]

Thanks. I thought so too.

[Frodo]

It should be 'normal' after B12 supplementation. I had a test before and it was high, just over top of the range. My GP has suggested I get a re-test after treatment to see if it's changed - but said I will probably have to pay - so I probably won't be re-testing although I'd like to know.

[MarMcL in reply to Frodo]

It would be good to know alright, even just for peace of mind. Hopefully, your level is now normal.

[NJMommy]

My Homocysteine and MMA began going up immediately. If you're looking for reliable results I believe you have to stop supplementing for at least a minimum of 3 months. To be on the safe side, I'd go longer.

[NJMommy]

Sorry, got things backwards. What I meant so to say was my B12 began going up immediately and the other 2 went down as soon as I started supplementation.

[MarMcL in reply to NJMommy]

Sounds about right!

[Gambit62 Administrator in reply to NJMommy]

Rather relieved by that you did mean that they went down rather than they went up.

[NJMommy in reply to Gambit62]

Me too :), that's what happens when you reply to a post before morning coffee!

[_tracy_]

My doctor, who didn't know much about PA and testing protocol, ordered MMA and homocysteine tests 2 weeks after I started B12 treatment. Both tests were in normal range. I suspect they were high before that but I'll never know as there is no way I am stopping B12 for several months.

From what I later learned in my online research, MMA and homocysteine levels drop fairly rapidly after getting B12 into your system.

[MarMcL in reply to _tracy_]

Thanks Tracy.

[Gambit62 Administrator]

Think it's probably like most tests in relation to B12 - 'normal/high' isn't going to tell you anything - but a low result would be significant - indicative that there is now a functional deficiency - ie something is going wrong at the cell level.

[MarMcL in reply to Gambit62]

Do you mean a low homocysteine level is a sign of functional deficiency?

[Gambit62 Administrator in reply to MarMcL]

A high homocysteine after supplementation would be a sign that B12 isn't doing what it should be doing and most likely explanation would be functional deficiency - ie plenty of B12 in blood but none of the TC11 form that cells use is actually getting through to the cells - so things that the body should be doing with the B12 just aren't happening ... and one of those would be recycling homocysteine and MMA into good things.

I don't know if anyone has ever studied it though or even looked into it - may be some obscure study out there but...

[MarMcL in reply to Gambit62]

Thank you for that. I wasn't sure as I'm getting mixed replies regarding homocysteine.

[MarMcL in reply to Gambit62]

Do you know if a low RBC is anyway connected to functional deficiency?

[Gambit62 Administrator in reply to MarMcL]

Sorry can't help - definitely not good on anything to do with red blood cells as hasn't been one of my symptom areas.

However it may be that you have absorption problems generally and are having problems getting enough iron as a result. It could also be folate related or anyone of a number of other things.

[MarMcL in reply to Gambit62]

Thanks!! I appreciate your advice. Very confusing trying to figure it all out.

[helvella in reply to MarMcL]

This might help:

Some causes of a low RBC count (anemia) include:

Trauma

Red blood cell destruction, for example hemolytic anemia caused by autoimmunity or defects in the red cell itself; the defects could be a hemoglobinopathy (e.g., sickle cell anemia), thalassemia, an abnormality in the RBC membrane (e.g., hereditary spherocytosis), or enzyme defect (e.g., G6PD deficiency).

Sudden (acute) or chronic bleeding from the digestive tract (e.g., ulcers, polyps, colon cancer) or other sites, such as the bladder or uterus (in women, heavy menstrual bleeding, for example)

Nutritional deficiency such as iron deficiency or vitamin B12 or folate deficiency

Bone marrow damage (e.g., toxin, radiation or chemotherapy, infection, drugs)

Bone marrow disorders such as leukemia, multiple myeloma, myelodysplasia, or lymphoma or other cancers that spread to the marrow

Chronic inflammatory disease or condition

Kidney failure—severe and chronic kidney diseases lead to decreased production of erythropoietin, a hormone produced by the kidneys that stimulates RBC production by the bone marrow.

labtestsonline.org/understa...

[MarMcL in reply to helvella]

Oh wow! Thanks. I hope it isn't any of those. I'm in enough trouble with my health at the minute! I appreciate you taking the time though.

[Allyson1 in reply to Gambit62]

Wouldn't a functional deficiency lead to high homocysteine, not low?

Because in the absence of b12, homocysteine doesn't get recycled and instead builds up?

My understanding is b12 and homocysteine levels have an inverse relationship, so high homocysteine would be a sign of a functional deficiency despite normal serum b12.

So isn't a low homocysteine after supplementation a sign that b12 is getting back on track?

[MarMcL in reply to Allyson1]

Hi Allyson1. I'm really not sure but a poster up thread says low homocysteine indicates low B12 absorption. Confused.com

[Allyson1 in reply to MarMcL]

As far as I have read it is the exact opposite- perhaps it is a typo?

Homocysteine builds up when b12 goes low. The current thinking is that high homocysteine is destructive to the cardiovascular system, but they are not completely sure if homocysteine itself is toxic, or if it is a byproduct of a process which causes the damage.

Homocysteine is sometimes used to test for a functional b12 deficiency. If b12 is getting used properly, than high homocysteine should go down.

According to the test standards I have read (BSCH, NICE, BNF) high homocysteine is a fairly good indicator of b12 deficiency even with "normal" serum, and having homocysteine lower in response to supplementation is a good sign the b12 is working.

Now, if there is any evidence of that not being the case, I would love to hear it, because I seem to be a weird exception - b12 mid range, always low homocysteine, and a plethora of neurological symptoms!

[MarMcL in reply to Allyson1]

So, in theory, your B12 is being utilized? Interesting.... Yet you have symptoms.

[Allyson1 in reply to MarMcL]

Yes, it's strange. I started having nerve problems with serum b12 in the 400s pg/ml. My homocysteine was low to begin with, (although it did drop a point with supplements).

So technically, to my primary care, I was fine.

Homocysteine is not 100% perfect test, so perhaps my case is one of the exceptions. I am homozygous for MTHFR a1298c, but don't know if that's important.

[MarMcL in reply to Allyson1]

My neuro symptoms began in the mid 200s. Was technically in range but folates and iron were low. I put it down to those other factors too. Its so confusing. I'm just hoping I can treat successfully with B12 as the doctors insist, as I'm well in range, it can't be PA related.

[Gambit62 Administrator in reply to Allyson1]

Homocysteine is a bad element in a necessary cycle that builds up if there isn't enough B12 and folate to recycle it into the good part.

It's like plaque on teeth without the regular brushing ... except for the bit about being a building block for something positive ... though I think plaque does have a positive part in the dental cycle but its just that our diet generates too much of it these days.