But if Johns Hopkins researchers did and I know I have mild small vessel disease and heart disease and a high RA factor with rheumatoid arthritis I might as well do the work to lower my level!
You have extra motivation for working on your homocysteine, shacherry. Good for you!
Julie, the wiki suggests methylfolate and methyl-B12, TMG (and choline) and B6 third. If you'd like me to move the B6 in front of the TMG, can do. I had my reasons, but if you want to reflect Bredesen's preferences I can.
I think our information needs to be consistent in both the short recommendations (Primer) and deep dive (Wiki.) Of course, Dr. Bredesen defers to David Smith (Oxford) and Helga Refsum (university of Oslo) as the thought leaders on homocysteine as it relates to cognitive decline and they do consistently point to B12, folate & B6 as primary steps. You can see a recent paper here.
I'm currently researching more about when folate and B12 don't help or cause other problems. Ben Lynch and Chris Masterjohn are both recommending choline and creatine to ease the burden on folate for methyl groups. In fact Lynch claims that creatine can make a difference for people intolerant of folates. I'll probably be in there one of these days to edit anyway after I dig a bit more.
Really interesting. This is so complex and so many factors play into getting this right. You'll appreciate that Smith & Refsum are quick to point out the U shaped curve with vitamins B supplementation. It's very helpful for those who are deficient and may be harmful for those with higher levels. Additionally, it only shows efficacy in addressing cognitive decline in folks with levels >10µmol/L and in the presence of adequate Omega-3s. That said, Bredesen's team has found increased abeta at levels >6µmol/L so I understand their wanting to be more aggressive, but this appears to be an area where a deep understanding and context matter... a lot. I trust you to make the Primer (our concise guide) and Wiki reflect these nuances. One last factoid from Smith & Refsum that illustrates one of the many variables: in those taking a daily aspirin, B vitamins are ineffective and unnecessary .