Homocysteine: What Is It & What Levels Are Normal?

Functional Medicine Practitioner By William Cole, D.C., IFMCP
Functional Medicine Practitioner
Dr. Will Cole, D.C., IFMCP, is a leading functional medicine expert who specializes in clinically investigating underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. Cole is also the bestselling author of Ketotarian and The Inflammation Spectrum.

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As a functional medicine practitioner, it's my job to uncover the root causes of why you're feeling less than 100 percent. By running labs, I'm able to determine the underlying dysfunctions that might be contributing to ongoing health problems and make a plan based on those results. Then, I work with my patients to naturally restore their body to a state of optimal wellness.

One of the main things I look at when someone comes into my clinic is something that often goes overlooked: homocysteine. Homocysteine is an amino acid that every single person has in their body. Even though it's important in certain amounts, when it's too high, it has been linked to autoimmune conditions, heart disease, and more.

Understanding homocysteine levels and what they mean for your health.

Homocysteine is regulated during a biochemical process known as methylation. And if you haven't heard of it before, methylation is this big biochemical superhighway that makes sure we have a healthy immune system, brain, hormone system, and gut. The methylation process occurs about a billion times every second in your body, and if something is going wrong with the process of methylation, you're probably not feeling all that well. Methylation-gene mutations, such as MTHFR are closely associated with autoimmune-inflammation spectrum issues and keeping homocysteine at healthy levels. For example, I have a double mutation at the MTHFR C677t gene, which means my body is not good at managing homocysteine and I have to be extra diligent in supporting that genetic weakness. For a full rundown of the different methylation genes we look at in functional medicine, click here.

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High homocysteine levels.

Elevated homocysteine levels can be brought on by gene mutations like MTHFR as well as medications, poor diet, toxin exposure, hormone imbalances, and stress. B vitamins from our food and supplements act as methyl donors that help keep your body's homocysteine at healthy levels and methylation working optimally. Homocysteine will use these methyl donors to produce the über-beneficial compounds SAMe and glutathione.

This is extremely important because your body needs SAMe and glutathione to put autoimmune reactions into remission. This happens through glutathione's role as the body's most powerful antioxidant and SAMe's ability to protect nerves and support neurotransmitters like serotonin and dopamine. Homocysteine can build up and continue to increase when methyl donors are inadequate. The optimal range for homocysteine in functional medicine is less than 7 μmol/L. When homocysteine is higher than this, you can see it play out in a multitude of seemingly unrelated health problems, including those related to autoimmunity and chronic inflammation.

Homocysteine and autoimmunity.

When it comes to DNA and the protection it needs, it's extra important to keep methylation pathways and homocysteine levels healthy. When methylation isn't working correctly, it doesn't keep the good genes working and the bad genes in remission, and this can lead to autoimmune issues. High homocysteine levels are associated with incredibly common autoimmune diseases like Hashimoto's disease, rheumatoid arthritis, and psoriasis.

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Homocysteine levels and heart disease.

Moderate levels of homocysteine can increase the risk of cerebrovascular, heart, coronary, and peripheral artery diseases. Especially high homocysteine levels have been connected to coronary artery disease and higher risk of hardening of the arteries.

Heart attack and stroke can be brought on by autoimmune conditions—lupus and autoimmune thyroid disease, in particular—which we have seen are also affected by homocysteine levels. I've written many articles before about how cholesterol is not a good indicator of a healthy cardiovascular system. In fact, research shows that not only is it more important than cholesterol, but inflammatory markers like homocysteine are actually a better indicator of heart disease than other well-known risks like smoking and high blood pressure.

Homocysteine and cognitive decline.

High homocysteine levels can also affect the brain because it can be toxic to neurons and other cells. And while old and damaged cells do get flushed out of our systems from the autophagy process (which is our cells' self-cleaning process) to avoid disease, the premature death of healthy cells can affect our bodies and brains negatively.

Parkinson's disease, Alzheimer's, and multiple sclerosis are all neurological autoimmune spectrum diseases and can be linked to high homocysteine levels. As these levels rise, they can start to destroy the brain barrier to develop leaky brain syndrome. According to recent research, when homocysteine levels increase to 14 µmol/L or higher, the risk of Alzheimer's doubles. This is especially important considering the growing rate of Alzheimer's; over 5.7 million Americans suffer from Alzheimer's today, and that number is expected to rise to 14 million by 2050. Keeping methylation pathways healthy by lowering homocysteine is a crucial step in protecting the brain from Alzheimer's and other forms of dementia.

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Homocysteine levels and depression.

Homocysteine can also affect the brain emotionally by increasing the risk of depression. Various studies have been completed that connect depressive thoughts to higher homocysteine levels because of its correlation to low serotonin levels. According to some, the high homocysteine levels present in women after giving birth is the contributing factor to postpartum depression. This is also proven in a recent study involving a large group of men. The men with the highest third of homocysteine levels were two times more likely to struggle with depression than those in the lowest third.

Homocysteine level tests.

If you think high homocysteine levels could be an issue you deal with, the first step is to run labs to test your levels, as well as methylation genetic testing. This genetic test can give you and your doctors more insight into why your homocysteine levels might be higher than normal. The more gene polymorphisms you have, the more susceptible you will be to methylation issues. When you know that you're at a higher risk for autoimmune disorders from genetic predisposition, you can understand your health case better and take the correct steps to overcome them, like making sure you're correcting any nutrient deficiencies, supporting the health of your immune system by eating an anti-inflammatory diet, getting plenty of sleep, moving your body regularly, and repairing your gut health.

Another helpful step is to see a functional medicine practitioner. Along with the homocysteine and methylation labs, a functional medicine practitioner will call for additional labs to get a better understanding of your entire health case to bring any other underlying health issues to light to help you reach optimal health.

If you want to start lowering your homocysteine levels right away, you can start by ensuring that you're consuming enough B vitamins. Activated forms of folate (methylfolate), B6 (oyridoxyl-5-phosphate), and B12 (methylcobalamine) are the best options to ensure healthy methyl pathways. Great foods to focus on to support healthy methylation pathways include green leafy vegetables, sulfur-rich vegetables like cabbage and broccoli sprouts, wild-caught fish, grass-fed beef, and organ meats like grass-fed liver.

William Cole, D.C., IFMCP
William Cole, D.C., IFMCP
Will Cole, D.C., IFMCP, is a leading functional-medicine expert and a Doctor of Chiropractic. He...
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