Elevated homocysteine levels are known to contribute to the increase in cardiovascular disease due to proinflammatory effects, endothelial dysfunction, and increased oxidation of low-density cholesterol. Therefore, functional medicine doctors in primary care should pay attention to the management of homocysteine to prevent patients from developing cardiovascular disease in the future. In general, coenzymes involved in homocysteine metabolism include vitamin B12, folic acid, and vitamin B6. In case of hyperhomocysteinemia, a blood test is performed to check for deficiency of these coenzymes. However, among these coenzymes, because of vitamin B12 is also produced by intestinal bacteria, the blood test for vitamin B12 test may not reflect the actual vitamin B12 available amount of vitamin B12 in the body. Based on this, these cases report shows the relationship between gut dysbiosis, increased serum vitamin B12 level, and hyperhomocysteinemia, followed by a sustained blood vitamin B12 elevation level and normalization of hyperhomocysteinemia after gut dysbiosis treatment and vitamin B complex support.
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