What does it mean to have raised Homocysteine but normal MMA?

[GW1000]

Hi

After some wonderful support here and from my neurologist, I am now a week into eod B12 injections. The last time I posted I didn’t have my actual results. I do now:

MMA: 0.21 umol/L (Ref < 0.43)

Homocysteine 22 umol/L (Ref 0-20)

Can anyone help me understand what it means to have raised homocysteine but normal MMA? Intrinsic factor was negative - no values given.

I think the upper limit on the lab range for homocysteine is also quite high - most info I’ve looked at has the top of the range as 14 or 15. 22 seems quite high in comparison to that, but not very high given this lab range. Does that mean my result isn’t comparable on the same scale with e.g. papers that use 15 as a cutoff for ‘high’?

So far I’m feeling a bit better mood wise, had one day of much improved motivation (overdid it that day…) but generally more tired and new pain across the back of my hands. Am aware it’s very early days though.

[Technoid]

Following info from Medline:

"A high homocysteine level may be a sign that:

* You are not getting enough vitamin B12 or folic acid in your diet.

* You (or your child) have homocystinuria. You will probably need more testing to rule out or confirm a diagnosis of homocystinuria.

* You may have a higher risk of heart disease, stroke, or other blood vessel disorders.

Higher than normal homocysteine levels may also happen with other conditions, such as osteoporosis, chronic kidney disease, hypothyroidism, or Alzheimer's disease or other types of dementia.

If your homocysteine levels are high, it doesn't always mean you have a medical condition that needs treatment. Your results may be affected by:

* Your age. Homocysteine levels may get higher as you get older.

* Your sex. Males usually have higher homocysteine levels than females, but levels in females increase after menopause.

* Smoking

medlineplus.gov/lab-tests/h...

Lifestyle changes including diet/supplementation may be sufficient to bring it back into range. Supplements like B6 (active form, P5P), Folate and Betaine/Trimethylglycine (which independently recycle homocysteine) may also be worth looking into.

[GW1000 in reply to Technoid]

Thank you! I do have hypothyroidism - well managed according to TSH but when last measured (a while ago) my FT3 was lower than I’d like. I have been hoping to see an increase in it with better B12 levels. More to look into too. Many thanks.

[Noelnoel in reply to GW1000]

Homocysteine 22 umol/L (Ref 0-20)

This test shows you at 10% over the range. You can use a particular calculator to see how far within or outside the range you are for your previous test

thyroid.dopiaza.org/

[Nackapan]

Hopefully your bloods will 'normalise' further into b12 treatment. It was good you got them tested

Rarely done

Were your serum b12 value in range? And looking into functional b12 deficiency?

I got worse before improvements.

Don't worry about that as nerves are waking up.

I hope you improve soon.

Also bloods get repeated in 4 months

[GW1000 in reply to Nackapan]

The serum B12 taken at the same time was 208 ng/L (187-883), one just a month before was 194 ng/L . My folate has been similarly low - one just below range, one just above the bottom of the range.

I am v. grateful to have had the tests. They will be repeated - I don’t have a date yet. Yes, I’m hoping it will come down. I’m leaping ahead, but if it lands between 15 and 20 (the more typical upper end of the range than the one used here) I’m unsure as to whether that should be a concern. I think I just need to wait and see really!

And thank you - the improvement in my mood is already really encouraging.

[Nackapan in reply to GW1000]

Sounds as though 'caught' early enough .Yes very good you were offered these tests and the repeats.

Some Gp's won't even treat at your level.

Hang onto that G.p.

My first ever serum b12 was 106ng/L( 200-900)

First Gp in the practice I saw didnt consider it that low and stated it couldnt be the cause of such severe symptoms!!

I had to go through all 6. Gps

To date nothing else has been found to treat!!

That first G.p wouid still not sign repeat prescriptions for B12

Before this I considered him an okay G.p

Keep a copy of your blood test results .

Get a referral to a specialist too going o your symptoms

[am111]

MMA is most specific to B12 while homocysteine is affected by both B12 and folate. Your MMA is still not ideal and can be lower. Homocysteine is high. Thus, your B12 can be better and folate is on the lower side.

BTW, from what I understand, it takes about a week or perhaps even a bit longer for these things to normalise once the vitamins are in place, so you have to consider this as well when analysing your results. Also, folate can take 1-4 months even with the high dosages to normalize. Good luck!

[WiscGuy]

It's recommended that when B12 and folate are both low, B12 should be started first. Then after some period of time (I don't remember how long; a week comes to mind) folate supplement should be added. Over-the-counter pills are usually said to be fine. Some people on the Thyroid forum are quite adamant that methyl folate is preferred. I personally get folate in multivitamins, and also in supplemental B vitamins. Apparently it's bad to have folate above range. I am out of my depth here, but hopefully others will pipe up.

[MrJustatip]

Hello GW1000, One thing I will tell you is that with PA, there is rarely one case exactly like another. For instance, when I went to the hematologist, he said I could not possibly have PA because I look entirely too healthy and I do not appear to have a pale complexion. Well, he had never met me before, so he couldn't possibly know what I used to look like. People used to often tell me that they liked my dark suntan (I have rarely had a suntan). Anyway, the medical profession today is absolutely insane or downright evil with its only care-to-make-profit mindset. Vitamin B12 deficiency does not automatically mean you have PA, but it could. Even after I tested positive for the IF antibodies, doctors have still tried to convince me that all I need to do is eat more liver or other meat and I'll be fine. Research, research, research, and people on this forum will help you so much too. Good luck and Happy New Year. MJat