What Causes Abnormal Homocysteine Levels?

Abnormal homocysteine levels can have various causes, ranging in severity from 'needs attention' to 'generally fatal'. Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms. In order to diagnose abnormal homocysteine levels, we could:

Research the topic
Find a doctor with the time
Use a diagnostic computer system.

The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "abnormal homocysteine levels" as a symptom. Here are four possibilities:

Vitamin B-Complex Need
Crohn's Disease
Ulcerative Colitis
Chronic Renal Insufficiency

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:

elevated ESR

forgetting dreams

low dairy product consumption

frequent stools

highly elevated lymphocyte count

microcytic red cells

weak appetite

genital sores

spacey/unreal feelings

chronic renal insufficiency

hiccups

nails turning white towards the ends

... and more than 30 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of abnormal homocysteine levels:

Cause	Probability	Status
Ulcerative Colitis	98%	Confirm
Chronic Renal Insufficiency	14%	Unlikely
Crohn's Disease	5%	Ruled out
Vitamin B-Complex Need	0%	Ruled out

* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate having had recent lab tests, The Analyst™ will ask further questions including this one:

Homocysteine (plasma). Unit: umol/L

Possible responses:

→ Don't know
→ Under 5
→ 5 to 9.9 (normal)
→ 10 to 14.9
→ 15 or higher

Based on your response to this question, which may indicate low homocysteine levels, normal homocysteine levels or high homocysteine levels, The Analyst™ will consider possibilities such as:

Ulcerative Colitis

Because people with inflammatory bowel disease (IBD), like ulcerative colitis and Crohn's disease, have a much higher risk of both thromboses and osteoporosis, a team of researchers from McGill University in Montreal explored the idea that homocysteine excess may play an important role in this chronic gastrointestinal disease.

To test this hypothesis, they measured homocysteine levels in the plasma of 65 patients with IBD and in 127 healthy controls. Their results revealed a striking difference: The patients with IBD had nearly a six-fold increased incidence of hyperhomocysteinemia (homocysteine levels above the normal range) compared to controls.

About one in every seven patients in the IBD group had hyperhomocysteinemia. As expected, those with vitamin B12 deficiency tended to have higher homocysteine levels. Yet researchers were also surprised to find that 80% of the IBD patients with hyperhomocysteinemia had normal blood levels of vitamins.

This suggests that homocysteine imbalances could be an early warning sign of B-vitamin deficiency inside cells - one that occurs well before vitamin levels actually decline in serum. It is still too early to tell if treating high homocysteine could actually reduce IBD symptoms in patients.

Importantly, as homocysteine levels rose in the patients with IBD, so did the clinical ratings of IBD disease severity, including its length of duration and the use of steroid medications to treat it. [Am J Gastroenterol. 2001 96(7): pp.2143-9]

Crohn's Disease

See the link between Elevated Homocysteine and Ulcerative Colitis.

Vitamin B-Complex Requirement

Homocysteine imbalances could be an early sign of B-vitamin deficiency inside cells, one that occurs well before vitamin levels actually decline in serum. "Homocysteine may, in fact, be a more sensitive marker of vitamin B12, B6 or folate deficiency and... may precede deficiency of circulating vitamins." [Am J Gastroenterol. 2001 96(7): pp.2143-9]

Chronic Renal Insufficiency

Homocysteine levels in patients suffering from chronic renal failure are significantly elevated at an early stage. The kidney plays a very significant role in homocysteine metabolism but this does not occur during chronic renal failure. In addition, there is a decreased extra-renal catabolism, which contributes to the hyperhomocysteinemia state. [Hyperhomocysteinemia: A Role in The Accelerated Atherogenesis of Chronic Renal Failure?, Netherlands Journal of Medicine, 1995;46: pp.244-251]

Your Homocysteine Level