Only emailed if Hcy is over 7.5µmol/l Steff to programme in
Since your child’s homocysteine is over 7.5µmol/l this needs your attention.
Optimal levels haven’t been established for children. However, based on the evidence there is, we recommend for under 11 year-olds that an optimal homocysteine is not more than 5, and for teenagers, not more than 7.5µmol/l.
Homocysteine is a naturally occurring amino acid produced as part of the body’s methylation process. The level of homocysteine rises when methylation is sub-standard. Homocysteine in the blood plasma is increasingly being recognised as a risk factor for disease and is most widely known as a predictor of potential health problems such as cardiovascular disease and Alzheimer’s but is, in fact, a biomarker for over 100 diseases, including many mental and neurological conditions that occur in children.
This is not surprising since methylation is an essential process happening in the brain. It is vital for neurotransmitter signalling, protecting DNA and controlling gene expression. Faulty methylation is indicated by a raised homocysteine level. Healthy methylation requires nutrients – specifically vitamin B6, folate, B12.
The research of Professors David Smith, Helga Refsum and others, clearly establishes that a homocysteine level above 10µmol/L are both associated with increased rate of brain shrinkage and with cognitive decline and thus requires homocysteine-lowering treatment with these B vitamins. (reviewed in Smith & Refsum 2021)
Their recommendation is to supplement 400mcg of folic acid (or ideally methylfolate), plus 500mcg of B12 and 20 mg B6 daily. There are other nutrients involved in methylation, such as zinc and TMG (trimethyl glycine) which convert homocysteine in the liver into SAMe, Vitamin B2 (riboflavin) and B3 (niacin) are co-factors in methylation enzymes. Some homocysteine-lowering supplements may include these additional nutrients.
There is insufficient evidence at this time to confirm whether and to what extent these additional nutrients further help to lower homocysteine and reduce associated risks.
The good news is that homocysteine levels can be tested and high homocysteine levels can, in many cases, be normalised through diet and vitamin supplementation. The most important nutrients that help lower homocysteine levels are the B vitamins B6, folate and B12.
Supplementation to normalise homocysteine levels
Your homocysteine level is a very good indicator of the amount of certain B vitamins, and other nutrients, you need. The chart below shows you the approximate level that is worth supplementing on a daily basis for adults, especially later in life, if your homocysteine is below or above 10µmol/L. For children we consider the scale could be different such that the levels recommended for ‘low risk’ may be more appropriate for lowering a child’s homocysteine that is above 5mcmol/l and below 7.5mcmol/l.
| Nutrient | Very low risk | Low risk | At risk | High risk* |
|---|---|---|---|---|
| Below 7.5 | 7.5–9 | 10-15 | Above 15 | |
| Folic Acid or Methylfolate | 200mcg | 400mcg | 400mcg | 800mcg |
| B12 of methylB12 | 10mcg | 250mcg | 500mcg | 750mcg |
| B6 | 10mg | 20mg | 20mg | 40mg |
| B2 | 5mg | 10mg | 15mg | 20mg |
| Zinc | 5mg | 10mg | 15mg | 20mg |
| TMG | 500mg | 750mg | 1500mg | 1500mg |
| NAC or Glutathione* | 250mg | 500mg | 750mg | 750mg |
*N-Acetyl Cysteine or glutathione has been shown in studies to help lower homocysteine and improve memory in people with cognitive impairment, given in addition to B12, folic acid and B6.
If their level is above 5 but below 7.5 it is still advisable to take a high potency multivitamin and mineral supplement, providing the levels of nutrients shown in the table above for the purposes of maintaining a healthy low level.
If their level is above 7.5 but below 9 it is wise for them to take a supplement containing larger amounts of these nutrients, perhaps in a high potency multivitamin and mineral or a specific homocysteine lowering formula. The research suggests that above 8 could be associated with risks regarding miscarriage, pregnancy outcomes and infant development. Genetic damage has been shown to occur above 7.3µmol/L. For this reason, we would certainly recommend that children, who tend to have a lower homocysteine level, are best maintained below 7µmol/L. Since most of these are water-soluble you are best to divide the dose and take a supplement two or three times a day.
*If their level is above 10 it is important to supplement, at least, 20mg B6, 400mcg of folate and 500mcg of B12. The research is clear that a level above 11µmol/L is associated with increased rate of brain shrinkage however, to be on the safe side it is wise to supplement if your level is above 10 and, in children, about 7.5µmol/l and monitor with a repeat test 3 months later.
Homocysteine comes down quickly, so testing after 3 or 4 weeks of making changes is viable. Otherwise, it remains reasonably stable such that, if your or your child’s level is good, you could check it every three or so years.
It is best to a) stop supplementing B vitamin supplements for at least 2 days (48 hours) before testing, b) test on an empty stomach, only having drunk water.
To re-test visit https://foodforthebrain.org/tests/. For homocysteine lowering supplements visit https://foodforthebrain.org/homocysteine-lowering-b-vitamins/.