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High homocysteine / CBS / P5P / 2-Hydroxybutyric

renski

Senior Member
Messages
338
Location
Honolulu
My homocysteine is 9.6, I've been taking P5P for about 6 months but only recently increased it to about 15mg. I get weird side effects from P5P and B6 and even after 6 months those side effects haven't improved. I was taking it in the hope it would lower my homocysteine but I'm wondering if all it's doing is speeding up the CBS pathway? Don't know if anyone can make sense of this but I've been told my CBS pathway is upregulated, so I assume that means it's sped up very fast, and that's why my homocysteine is accumulating? Or do I have it the wrong way round, is CBS slowed down because B6 is low and that's why homocysteine is accumulating? My methionine is high as well, so I don't think taking folate/B12 would help. I'm taking Allithamine/Benfotamine, R5P, Niacitol, Niacinamide (some days), Biotin, Zinc, Manganese, Selenium (all of these were low). I've read P5P can increase quinnolic acid (which mine was high) so I wonder if that's why I'm having issues with P5P. Or is it just that my other B's are possibly still too low to introduce P5P/B6 yet?

In one of my OAT tests 2-Hydroxybutyric reports as being high, this seems to indicate the CBS pathway is sped up.

According to Great plains laboratory, 2-Hydroxybutyric is a marker of cysteine accumulation, they describe it here:
https://www.greatplainslaboratory.com/gpl-blog-source/2016/4/14/dna-methylation-pathway
CBS
Cystathione beta-synthase (CBS) is a pyridoxal-5’-phosphate (vitamin B6) dependent enzyme that converts L-serine and L-homocysteine into L-cystathionine. L-cystathionine is later converted into the amino acid cysteine. Mutations to the CBS gene are the most common cause of hereditary hyperhomocysteinemia. The adverse effects of homocysteine accumulation in the body are related to the substitution of homocysteine for methionine in protein synthesis. The resulting complications include an increase in immune response, increase in cell death, and protein damage. The degree of homocysteinemia is relative to the mutation. Hyperhomocysteinemia has been linked to multiple mutations to the CBS gene. The most common of these are the Ile278Thr and the Gly307Ser, which cause homocysteine to build up in the blood. Complications of hyperhomocysteinemia include mental retardation, seizures, and vascular disease. One of the most common causes of death for patients with homocystinuria (CBS deficiency) is heart attack. Patients with CBS polymorphisms are recommended to take glutathione and B6. There are reports that the CBS polymorphisms A360A (rs1801181) and N212N (rs2298758) can lead to an increase in CBS activity. Some claim that these mutations lead to a buildup of ammonia and decrease in glutathione. Since ammonia is a very unstable compound that must be measured STAT for accurate results, the better marker for increased ammonia is orotic acid which is very stable and accumulates when excessive amines are filtered through the urea cycle. I recommend that patients with this mutation do an Organic Acid test (OAT) and look at marker 60 (orotic acid) for ammonia and markers 58-59 (Pyroglutamic and 2-hydroxybutyric acid) for glutathione synthesis and cysteine accumulation respectively.

Great plains also says this about 2-Hydroxybutyric acid in the OAT report:
High 2-hydroxybutyric acid (Marker 59) This organic acid is elevated when there is increased production of sulfur
amino acids derived from homocysteine. The reasons for an increase can be due to the following reasons (which are
not mutually exclusive):
1. There is increased need for glutathione to detoxify a host of toxic chemicals, resulting in increased shunting of
homocysteine into the production of cysteine for glutathione. This is the most common reason.

2. There are genetic variants of the DNA such that methylation of homocysteine by betaine homocysteine methyl
transferase or methionine synthase is impaired.
3. There are nutritional deficiencies of betaine, methylcobalamin, or methyltetrahydrofolate that reduce the
enzyme activities of the enzymes in #2 above.
4. There is a genetic variant in cystathionine beta synthase (CBS) enzyme such that there is excessive shunting
of homocysteine into cysteine production that results in excessive 2-hydroxybutyric acid formation.
 
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renski

Senior Member
Messages
338
Location
Honolulu
This is what I think is happening with me and possibly why b6/p5p just makes me worse even though i'm low in it.

http://www.themethylationdoctor.com/part-4-homocysteine-and-the-transsulfuration-pathway/
My take on CBS activity is that there are multiple influences of CBS as with any enzyme. A person with a CBS SNP and plenty of B6 may show some upregulation at least temporarily. But since CBS is dependent on vitamin B6 and to some degree iron and serine, deficiencies in these co factors can halt or slow a CBS upregulation. A person’s upregulation of the enzyme may deplete their B6 stores slowing the enzymes activity.
 

alicec

Senior Member
Messages
1,572
Location
Australia
Lots of people are sensitive to B6 - there could be several reasons for this but it is not because you have some SNP which is upregulating CBS.

All the SNPs known to have significant effects on activity of the CBS enzyme are downregulations. A couple of the more well known ones are mentioned in the GPL quote.

There is no research supporting the two said to be upregulations, nor would you expect them to have any real effect since they result in no change to the protein product. The enzyme produced by the variant is identical to that produced by the wildtype gene.

There is another SNP not mentioned in that quote, rs234706 AKA C699T, which is usually the one claimed to result in dramatic upregulation. This claim is wildly exaggerated and is based on a complete misreading and misinterpretation of research unrelated to the SNP. There are a couple of studies which suggest there might be a slight upregulation associated with this SNP but this appears to be protective, since it slightly lowers homocysteine.

Other studies though have not reproduced this so it may be a study error. Again this SNP causes no change to the enzyme, so the explanation for the observed effects, if real, may lie elsewhere.

Here is a thread discussing CBS.

The quote in your second post is just fudging it. There are indeed multiple influences on CBS activity but, as already explained, not upregulating SNPs, nor has B6 been described as a significant regulator of the enzyme.

Of course if B6 were deficient, enzyme activity might be slowed and so addressing the deficiency might stimulate the enzyme. In cases of known genetic defects producing an enzyme with very reduced activity, very high doses of its cofactor B6 can sometimes stimulate the defective enzyme.

These genetic defects are very rare and not I suspect what the author is referring to.

In any case you were taking quite a small dose of B6 - this in itself would have little influence on CBS.

You seem to be confused about what CBS does and how this affects homocysteine. CBS is the first enzyme in a pathway which converts homocysteine to cysteine and then to a variety of other products depending on cellular needs. One of the most important of these is the master antioxidant glutathione (GSH). Need for GSH is one of the important upregulators of CBS activity.

High CBS activity means that more homocysteine is converted to cysteine and so homocysteine levels will be lower.

Low CBS activity means that less homocysteine is converted to cysteine and so homocysteine levels will be higher.

In your own case your homocysteine is in the normal range. This gives no clues to what is happening with CBS.

The elevated 2 hydroxy butyric acid does indicate increased flux through the pathway. Perhaps you are under oxidative stress and your needs for GSH have increased.

You say you have high methionine. This could be another reason for increased flux through CBS.

Homocysteine can follow two pathways. It can remain in the methylation cycle and be remethylated to methionine by the action of the enzyme methionine synthase (B12 dependant), which in turn is dependant on the enzyme MTHFR to supply methylfolate which is the ultimate methyl donor in the reaction. The enzyme BHMT also carries out the same conversion but using betaine as the methyl donor rather than methyl folate.

Alternatively homocysteine can exit the methylation cycle via the action of CBS and be used to make GSH and other things.

The other important regulator of the balance of these two pathways is the universal methyl donor S adenosyl methionine (SAM) which is derived from methionine. When methionine is high (eg after a protein rich meal), SAM is high. This stimulates CBS to remove homocysteine so levels of SAM don't become too high. In addition, SAM inhibits MTHFR and BHMT to slow down formation of methionine and again prevent SAM getting too high.

As SAM falls, CBS slows down so less homocysteine exits the methylation cycle and MTHFR and BHMT speed up so more homocysteine is converted to methionine.

The normal overall balance in the cell is about 50:50 between the two pathways, but there is considerable variation in this balance depending on cellular need.

Your results could just reflect things like a high protein diet and an increased need for antioxidants.
 

renski

Senior Member
Messages
338
Location
Honolulu
@alicec:

Thanks for explaining it, really helps. I've got CBS A360A +/+ but not the main CBS snp.. I wasn't worried about the snps just whether CBS was upregulated. Fairly sure I'm in oxidative stress.. so that explains it. I'm just trying to figure out why I can't tolerate B6 or P5P :/ I also have trouble with magnesium, if I take this in the evening, the following morning I wake up feeling hyped/over energized. I wonder if it's pushing a pathway but something else is deficient.. I know I'm low in a lot of things so it's possible.

My SAMe is low and methionine little high on the methylation panel, but methionine isn't high on a plasma amino acids I had done in Australia, although I think some of their testing is suspect (Nutripath). I'm going to check plasma amino acids in my next Nutraeval though.
 

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renski

Senior Member
Messages
338
Location
Honolulu
I think what is happening with me is - high homocysteine due to B6 depletion, due to oxidative stress/inflammation. Anything that takes homocysteine away from flowing down CBS makes me feel 10x worse, ie Betaine/B12/folate

It seems to stem from gut issues and toxicity. :/

MTHFR and Homocysteine - Part II
 
Messages
3
Hi Renski,

Just looking at this old thread. Did you resolve this?

Am having similar problems with tolerating supplements even in tiny doses especially B12, B6, folate and especially methylated forms.

I have high oxidative stress/chronic inflammation due to RA and assume there some sort of methylation block somewhere. My methylation profile much the same to yours with mid range methionine, low SAM but homocysteine is 19 with raised cysteine but very low glutathione!

Issues with ammonia and sulfur intolerance if supplement with any of above supplements

Only supplement seem to get on well with is B2 but Nutreval did not show a need for it (green)

RBC Magnesium low.

Had a myriad of tests and trials of supplements particularly over the past 2-3 years but not tolerated any of the recommended supplements!!

Perhaps not possible to supplement way out of it until deal with inflammation
 

helen1

Senior Member
Messages
1,033
Location
Canada
I’m in the same situation. My nutreval results show low B6, B2, B7, B12 & folate. I’m unable to tolerate more than specks of B6 & folate even though I’ve been trying to increase these very slowly in the last two months.

I’m surprised because a few years ago I had a very good 8 months following @Freddd’s methylation plan. I built up carefully back then but nothing like I’m having to do now.

I don’t notice anything bad or good when taking B12, B2 and B7 (biotin). The B12 maybe because it’s not getting absorbed (being well-known for that).

Can anyone explain why B6 and folate might be so difficult to tolerate? Is it really about inflammation and if so, how does that work?
@Learner1
@alicec
@Freddd

Forgot to mention what happens when supplementing tiny bits of folate or B6: I become immobilized, can barely move, talk, think or function.
 
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Messages
95
I’m in the same situation. My nutreval results show low B6, B2, B7, B12 & folate. I’m unable to tolerate more than specks of B6 & folate even though I’ve been trying to increase these very slowly in the last two months.

I’m surprised because a few years ago I had a very good 8 months following @Freddd’s methylation plan. I built up carefully back then but nothing like I’m having to do now.

I don’t notice anything bad or good when taking B12, B2 and B7 (biotin). The B12 maybe because it’s not getting absorbed (being well-known for that).

Can anyone explain why B6 and folate might be so difficult to tolerate? Is it really about inflammation and if so, how does that work?
@Learner1
@alicec
@Freddd

Forgot to mention what happens when supplementing tiny bits of folate or B6: I become immobilized, can barely move, talk, think or function.
This is exactly my problem! Any ideas will help me. Thanks so much!
 
Messages
10
Did anyone ever find out any information about the above situations? I am having a similar problem and very sick at the moment. Any information you have could possibly really help me. Thanks!
 

Learner1

Senior Member
Messages
6,305
Location
Pacific Northwest
Sorry you are so sick. The best thing I can recommend is getting tested to see what you need. Like a Genova Diagnostics NutrEval.

If that's not possible, there are several possibilities. I'd like to hear what @helen1 came up with.

Some guesses:
  • Toxicity of some sort - you're mobilizing something and can't get it fully processed and excreted so its getting reabsorbed - heavy metals, mycotoxins from mold...
  • You're great at phase I detox (CYP450 enzymes) and lousy at Phase II, leacing you with an intermediate metabolite that's more tocic tgsn before it went through a Phase I.
  • Missing cofactors - B2? magnesium? potassium? Not enough of something? Wrong kind of B12? Missing aminos to make glutathione - NAC, glycine, glutamine...
  • Not working backwards from excretion, through transsulfuration, through the methionine cyslcle, and adding folate last, not first. You might need more B1 or molybdenum
  • You're allergic to some ingredient in those products