Homocysteine: a trifle on which it is a shame to stumble25.05.2022
Who and why should pay attention to the level of homocysteine in the blood, says the therapist-hemostasiologist of the Nova Clinic network of reproduction and genetics centers Lidia Olegovna Buzyan .
Patients come to the consultation with a hemostasiologist with a variety of requests. Miscarriage and complications of pregnancy, unsuccessful IVF protocols, thrombosis, risk assessment when prescribing hormonal contraceptives…
My patients are women of reproductive age and postmenopause, young girls and even men. Of course, each patient is treated individually, depending on the problem. But there is one general recommendation that I give to absolutely everyone. Guess what?
If you have thought about a healthy lifestyle, giving up bad habits, physical education and rational nutrition – well done. But that goes without saying. Today we will talk about the need to check the level of homocysteine in the blood.
What is homocysteine
Indeed, I recommend this simple analysis to absolutely everyone who falls into my field of vision, regardless of reproductive plans. Why?
The fact is that homocysteine is a rather toxic amino acid, which in high concentrations has a number of adverse effects on human health. Namely:
- with a blood homocysteine level of more than 10 μmol / l, the likelihood of developing thrombosis, strokes and heart attacks during life significantly increases;
- at a homocysteine level of more than 8 μmol / l, it becomes toxic to placental cells during pregnancy: it prevents the normal laying of the chorion in the first trimester, causing programmed death (apoptosis) of its cells. An elevated level of homocysteine (more than 8) can be the cause of missed pregnancies, miscarriages, placental abruption, preeclampsia, fetal growth retardation;
- high levels of homocysteine in men can adversely affect sperm quality. There are cases when, after a decrease in this indicator, a man in a couple had a long-awaited natural pregnancy after many years of incomprehensible infertility!
When and how to test for homocysteine
Obviously, when planning a pregnancy or an IVF program, it is necessary to determine the level of homocysteine in advance, before entering the planning cycle or protocol. After all, if it turns out to be elevated, then it will take some time to normalize.
On a note
You can donate blood for homocysteine in any laboratory, there are no preferences here: the analysis is simple.
It is very important to follow the rules for preparing for analysis:
- Firstly, you need to take this analysis strictly on an empty stomach. Even taking a small amount of food can distort the result “out of recognition.” Once a patient gave me the result of a homocysteine test – more than 20, but admitted that she did not pass on an empty stomach. After the retake, it turned out to be about 5. Imagine the difference!
- Secondly, on the eve of blood donation in the evening, you should not eat a large amount of protein foods. It is better not to consume meat, fish, poultry, legumes, dairy products after 18 hours (well, before 18 hours, do not eat up, for example, barbecue to satiety).
If homocysteine is elevated
If your homocysteine is high, don’t worry. Folic acid supplements will help reduce it. Homocysteine is a metabolic intermediate and accumulates in the body during folic acid deficiency.
Folic acid deficiency can be:
- absolute – if folic acid is supplied in insufficient quantities with food and vitamin preparations;
- relative – when folic acid is supplied in sufficient quantities, and at the same time, perhaps even a blood test for folic acid shows a normal or elevated level.
If homocysteine is elevated, then folate is simply not absorbed, and continuing to take it in the form in which you took it is useless and may even be harmful.
Speaking of harm
Elevated folic acid concentrations have at least three potential adverse side effects:
- Long-term (long-term) uncontrolled intake of high doses of folate is associated with an increased risk of developing bowel cancer.
- The level of folic acid in the blood over 40 nmol/l is a risk factor for obtaining oocytes of lower quality and in smaller quantities in the IVF program.
- During pregnancy, a persistently elevated blood folic acid level (over 60 nmol/l) is associated with a 2-fold increase in the incidence of autism in children!
Errors in the selection of treatment
When choosing a treatment, there are a number of common mistakes to avoid, which I would like to draw attention to. The simplest step, which usually begins the path to the normalization of homocysteine, is the appointment of drugs containing high doses of folate. Attention: for a short time! It is a common mistake to continue taking such drugs for many months and even years. Usually no more than a month is required to evaluate the effectiveness of the drug. But if the patient has previously taken high doses of folic acid, or the level of folate in the blood is significantly elevated, then, of course, high doses should not be prescribed.
1. If homocysteine does not decrease at the first stage, then the doctor individually selects the second-line therapy. This may be a replacement for folate in the “active” form, the addition of B vitamins or other dietary supplements that have the property of lowering homocysteine. It usually doesn’t make sense to swap treatment steps in the hope that “active folate helps better; why waste time, I’d better start right away with it.” This approach is erroneous: what helps one patient may have absolutely no effect on another, and vice versa.
It is important!
There is no folate that is best for everyone. This is a selection method, a trial and error method, and it is impossible to foresee which drug will lower homocysteine for you – expensive imported or cheap domestic ones!
2. Polymorphisms of the folate cycle genes have nothing to do with the choice of folic acid preparation. Although the opposite opinion is very common among both doctors and patients. It is possible to have a full set of “mutations” of the folate cycle, but at the same time – normal blood homocysteine. And in such a situation, no research is required with the choice of the drug: we take regular folic acid in small preventive doses, like all ordinary patients planning a pregnancy. And you can not have a single polymorphism, but a very high homocysteine. And then we will already reduce it, choosing a suitable drug, according to the usual scheme.
3. In addition to genetic predisposition, the most common reasons for the increase (as well as the difficult process of reducing with treatment) of homocysteine include smoking and drinking large amounts of coffee.
As you can see, one relatively simple and inexpensive analysis can sometimes shed light on the causes of a wide variety of problems. I would place slogans calling for checking homocysteine in all clinics and women’s clinics! And now you know why. If homocysteine is elevated – come, we will help!
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